Establishing critical care nursing research priorities for three Australian regional public hospitals: A mixed method priority setting study.

OBJECTIVE: To determine key priorities for critical care nursing research in three Australian regional public hospitals, representing the shared priorities of healthcare professionals and patient representatives. METHODS: A three phase priority setting study, including consensus methods (nominal group), survey, qualitative interviews and focus groups were conducted between May 2021 and March 2022. Healthcare professionals and patient representatives from critical care units in regional public hospitals in Australia participated. A patient representative contributed to research design and co-authored this paper. RESULTS: In phase one, 29 research topics were generated. In phase two, during a nominal group ranking process, the top 5 priority areas for each site were identified. In the final phase, three themes from focus groups and interviews included patient flow through intensive care, patient care through intensive care journey and intensive care patient recovery. CONCLUSION: Identifying context specific research priorities through a priority setting exercise provides insight into the topics that are important to healthcare professionals and to patients in critical care. The top research priorities for nursing research in critical care in regional Australian hospitals include patient flow, patient recovery, and evidence based patient care through the intensive care journey, such as delirium management, pain and sedation, and mobilisation. These shared priorities will be used to guide future nursing research in critical care over the next 3-5 years. IMPLICATIONS FOR CLINICAL PRACTICE: The method we used in identifying the research priorities can be used by other researchers and clinicians; close collaboration among researchers and clinicians will be beneficial for practice improvement; and how we can be reassured that our practice is evidence based is worthy of attention.

Adolescents Who Have Been Sexually Abused: Trauma Symptoms and Self-Blame while Waiting for Treatment.

OBJECTIVE: Adolescents who have been sexually abused commonly experience trauma symptoms, and many are referred for trauma-based treatment. However, they sometimes spend considerable time on waitlists before beginning treatment. This study examines the course of trauma symptoms among adolescents who have been sexually abused and are waiting for treatment, and the extent to which self-blame for the abuse predicts trauma symptoms at the beginning of treatment. METHOD: Participants were 127 adolescents (89.0% female, Mage = 13.61 years; 53.2% identified as Hispanic) at a Children's Advocacy Center in the southern United States. All had reported being sexually abused. Participants reported on their trauma symptoms and self-blame appraisals at a screening assessment (T1), and trauma symptoms were re-assessed at the beginning of treatment (T2). RESULTS: The mean level of trauma symptoms declined over time for the total sample. Regression analyses indicated that greater self-blame for the abuse at T1 was associated with higher levels of trauma symptoms at T2, even when controlling for T1 trauma symptoms and other correlates of T2 trauma symptoms. Higher levels of trauma symptoms at T1 and adolescent sex (female) were also associated with higher levels of trauma symptoms at T2. CONCLUSIONS: Findings suggest that assessing for self-blame for sexual abuse may be important in triage and treatment planning for youth with trauma symptoms after experiencing sexual abuse.

Impact of unacceptable behaviour between healthcare workers on clinical performance and patient outcomes: a systematic review.

BACKGROUND: Recent studies suggest that displays of unacceptable behaviour, including bullying, discrimination and harassment, between healthcare workers (HCWs) may impair job performance, and in turn, increase the frequency of medical errors, adverse events and healthcare-related complications. The objective of this systematic review was to summarise the current evidence of the impact of unacceptable behaviour occurring between HCWs on clinical performance and patient outcomes. METHODS: We searched MEDLINE, Embase, PsycINFO and CINAHL from 1 January 1990 to 31 March 2021. The search results were screened by two independent reviewers and studies were included if they were original research that assessed the effects of unacceptable behaviour on clinical performance, quality of care, workplace productivity or patient outcomes. Risk of bias was assessed using tools relevant to the study design and the data were synthesised without meta-analysis. RESULTS: From the 2559 screened studies, 36 studies were included: 22 survey-based studies, 4 qualitative studies, 3 mixed-methods studies, 4 simulation-based randomised controlled trials (RCTs) and 3 other study designs. Most survey-based studies were low quality and demonstrated that HCWs perceived a relationship between unacceptable behaviour and worse clinical performance and patient outcomes. This was supported by a smaller number of higher quality retrospective studies and RCTs. Two of four RCTs produced negative results, possibly reflecting inadequate power or study design limitations. No study demonstrated any beneficial effect of unacceptable behaviour on the study outcomes. CONCLUSIONS: Despite the mixed quality of evidence and some inconsistencies in the strengths of associations reported, the overall weight of evidence shows that unacceptable behaviour negatively affects the clinical performance of HCWs, quality of care, workplace productivity and patient outcomes. Future research should focus on the evaluation and implementation of interventions that reduce the frequency of these behaviours.

A national survey of intensive care follow-up clinics in Australia.

BACKGROUND: Intensive care follow-up clinics (ICFCs) have been implemented internationally with the aim to address the growing number of patients living with sequalae of critical illness and intensive care. However, data on Australian intensive care follow-up practice are rare. OBJECTIVES: The primary objective was to determine the proportion of Australian intensive care units (ICUs) that offer a dedicated ICFC to ICU survivors, with the intention of improving long-term outcomes of critical illness. Secondary objectives were to identify models of ICU follow-up and barriers to the implementation of ICFCs. METHODS: A custom-designed, pilot-tested 12-question online survey was sent to the nurse unit managers and medical directors of all 167 Australian ICUs listed in the database of the Australian and New Zealand Intensive Care Society. Outcome measures included proportion of ICUs offering ICFCs, details on types of follow-up services with staffing, funding source, and reasons for not providing ICU follow-up. RESULTS: One hundred seven of the 167 ICUs contacted responded to the survey. Of these, two (2%) operated a dedicated ICFC. Both ICFCs were nursing-led, with one receiving dedicated funding and the other being unfunded. Three units (3%) conducted routine outpatient follow-up by telephone; one of these services was doctor-led, and two were nurse-led. Four units (4%) were performing outpatient follow-up as part of research studies only. Among the units not operating an ICFC, the main reason given for not doing so were financial constraints (58%), followed by lack of clinical need (19%) and perceived lack of evidence (11%). CONCLUSION: In Australia, only two ICUs operated an ICFC. Only one outpatient follow-up service received dedicated funding, and financial constraints were the main reason given for units not offering outpatient follow-up services.

Pathogen Dynamics in an Invasive Frog Compared to Native Species.

Emerging infectious diseases threaten the survival of wildlife populations and species around the world. In particular, amphibians are experiencing population declines and species extinctions primarily in response to two pathogens, the fungus Batrachochytrium dendrobatidis (Bd) and the iridovirus Ranavirus (Rv). Here, we use field surveys and quantitative (q)PCR to compare infection intensity and prevalence of Bd and Rv across species and seasons on Jekyll Island, a barrier island off the coast of Georgia, USA. We collected oral and skin swabs for 1 year from four anuran species and three families, including two native hylids (Hyla cinerea and Hyla squirella), a native ranid (Rana sphenocephala), and the invasive rain frog Eleutherodactylus planirostris. Bd infection dynamics did not vary significantly over sampling months, but Rv prevalence and intensity were significantly higher in fall 2014 compared to spring 2015. Additionally, Rv prevalence and intensity were significantly higher in E. planirostris than in the other three species. Our study highlights the potential role of invasive amphibians as drivers of disease dynamics and demonstrates the importance of pathogen surveillance across multiple time periods and species to accurately capture the infectious disease landscape.

Self-blame for interparental conflict among female adolescents who have been sexually abused.

This study evaluated whether self-blame appraisals for interparental conflict relate to conduct problems among female adolescents who have been sexually abused. Participants included female adolescents who had experienced sexual abuse and a current, primary nonabusing caregiver. Families presented for services at a children's advocacy center. Female adolescents (N = 263, Age 11-17 years, M = 13.68, SD = 1.74) reported on conduct problems, self-blame appraisals for interparental conflict, self-blame appraisals for their sexual abuse, perceptions of the frequency and severity of interparental conflict, and whether the sexual abuse involved coercion. Caregivers reported on adolescent conduct problems and their contact with a romantic partner. Adolescent relationship to the alleged abuser and the severity and duration of the sexual abuse were coded from forensic interviews and case records. Adolescent self-blame appraisals for interparental conflict were positively associated with adolescent and caregiver reports of adolescent conduct problems. These relations emerged even after controlling for other theoretically important variables, such as self-blame appraisals for sexual abuse. Adolescent appraisals for interparental conflict may be an important target for assessment and intervention for female adolescents who have been sexually abused. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Perceived Loss of Social Contact and Trauma Symptoms among Adolescents Who Have Experienced Sexual Abuse.

Child sexual abuse (CSA) is a robust predictor of trauma symptoms. Past research has identified many correlates of trauma symptoms following disclosure of CSA. Theory suggests that loss of social contact may be another important contributor to adolescents' trauma symptoms following CSA. A clinical sample of 166 adolescents (95% female) between 11 and 19 years (M = 13.80, SD = 1.87) reported on perceived loss of social contact, the extent to which the CSA was coercive, appraisals of self-blame for the abuse, supportiveness of a primary non-abusing caregiver, and trauma symptoms. The adolescent's relationship to the abuser, abuse severity and duration were coded from forensic interviews. Results indicated that greater perceived loss of social contact was associated with higher levels of trauma symptoms, even after controlling for other correlates of trauma symptoms and demographic variables. These findings suggest that perceived loss of social contact may be an important variable to consider in assessing and intervening with adolescents who have been sexually abused.

Dermal injuries caused by purse seine capture result in lasting physiological disturbances in coho salmon.

Fish vitality can be measured by classifying reflex impairments (i.e., a visual impression of the ability to respond to induced stimuli) and visible injuries. These metrics can predict survival probability following release from fisheries, and monitoring physiological disturbances following capture can help understand mechanisms of mortality. To test the hypothesis that severity of injury and reflex impairment influences the time course of physiological recovery, coho salmon (Oncorhynchus kisutch) were held for up to 84-h following capture by purse seine. We classified reflex impairments and visible dermal injuries, and through repeated blood sampling, assessed metrics indicative of stress, exhaustion, and osmoregulatory disturbances. Reflex-impairments and blood lactate levels suggested fish were exhausted upon capture but recovered after 48 h. Conversely, fish with dermal injuries showed disruptions to ion homeostasis that were greater in more severely injured fish and increased over time. While reflex impairments may predict short term post-release mortality, the prolonged physiological disturbances caused by dermal injuries are likely to be responsible for delayed mortality; our results suggest that disruptions to ion homeostasis is a possible mechanism of post-release mortality.

Fishing for Effective Conservation: Context and Biotic Variation are Keys to Understanding the Survival of Pacific Salmon after Catch-and-Release.

Acute stressors are commonly experienced by wild animals but their effects on fitness rarely are studied in the natural environment. Billions of fish are captured and released annually around the globe across all fishing sectors (e.g., recreational, commercial, subsistence). Whatever the motivation, release often occurs under the assumption of post-release survival. Yet, capture by fisheries (hereafter "fisheries-capture") is likely the most severe acute stressor experienced in the animal's lifetime, which makes the problem of physiological recovery and survival of relevance to biology and conservation. Indeed, fisheries managers require accurate estimates of mortality to better account for total mortality from fishing, while fishers desire guidance on strategies for reducing mortality and maintaining the welfare of released fish, to maximize current and future opportunities for fishing. In partnership with stakeholders, our team has extensively studied the effects of catch-and-release on Pacific salmon in both marine and freshwater environments, using biotelemetry and physiological assessments in a combined laboratory-based and field-based approach. The emergent theme is that post-release rates of mortality are consistently context-specific and can be affected by a suite of interacting biotic and abiotic factors. The fishing gear used, location of a fishery, water temperature, and handling techniques employed by fishers each can dramatically affect survival of the salmon they release. Variation among individuals, co-migrating populations, and between sexes all seem to play a role in the response of fish to capture and in their subsequent survival, potentially driven by pre-capture pathogen-load, maturation states, and inter-individual variation in responsiveness to stress. Although some of these findings are fascinating from a biological perspective, they all create unresolved challenges for managers. We summarize our findings by highlighting the patterns that have emerged most consistently, and point to areas of uncertainty that require further research.

The stress response predicts migration failure but not migration rate in a semelparous fish.

Recent findings from iteroparous species suggest that glucocorticoid secretion following acute stress can mediate behavior and survival strategies, ultimately influencing fitness. However, these correlates of the stress response may not exist in semelparous animals given the inability to maximize fitness by delaying reproduction. We measured baseline and stress-induced cortisol concentrations in semelparous sockeye salmon (Oncorhynchus nerka) following exposure to an acute stressor at the mouth of the Fraser River in British Columbia. The homing fish were then radio-tagged and tracked throughout their in-river migration. Findings reveal that the stress response (i.e. change from baseline to stress-induced cortisol) was predictive of mortality; fish failing to leave the release site had a significantly greater stress response (mean±SE=1004.0±75.3ng/mL) compared to fish capable of successfully migrating beyond one of the most difficult areas of passage over 100 river kilometers upstream (mean±SE=780.7±66.7ng/mL). However, there were no associations between swimming behaviors, both immediately following release and to last point of detection, and the stress response. This study also introduced an unique method of tagging migrating salmon that allows for rapid capture and sampling and thus provides the first assessment of true baseline cortisol concentrations at river-entry for migrating Pacific salmon in the wild. Results show the stress response to be linked to survival in a semelparous species and therefore set the stage for further exploration into how the evolutionary theories underlying relationships between stress responsiveness and fitness may differ between semelparous and iteroparous species.

Bycatch mortality of endangered coho salmon: impacts, solutions, and aboriginal perspectives.

We used biotelemetry and human dimensions surveys to explore potential solutions to migration mortality of an endangered population of coho salmon caught as bycatch in an aboriginal beach seine fishery. From 2009 to 2011, 182 wild coho salmon caught as bycatch in the lower Fraser River (Canada) were radio-tagged and tracked as they attempted to complete their migrations to natal spawning areas over 300 km upstream. Failure to survive to reach terminal radio receiving stations averaged 39% over three years. This mortality estimate is low compared to those obtained from telemetry studies on other salmon fisheries in the Fraser River. However, this value is markedly higher than the mortality estimate currently used to manage the fishery's impact. It is also in contrast to the perceptions of the majority of aboriginal fishers, who did not think survival of coho salmon is affected by capture and release from their fishery. Increased probability of survival was associated with lower reflex impairment, which is consistent with previous findings. Reflex impairment was positively correlated with entanglement time, suggesting that greater efforts by the fishers to release bycatch from their nets quickly would minimize post-release mortality. Survey responses by aboriginal fishers also suggested that they are receptive to employing new bycatch handling methods if they are shown to increase post-release survival. However, attempts to facilitate revival of a subset of captured fish using cylindrical in-river recovery bags did not improve migration success. Fisheries managers could use the new information from this study to better quantify impacts and evaluate different harvest options. Since aboriginal fishers were receptive to using alternate handling methods, efforts to improve knowledge on minimizing reflex impairment through reductions in handling time could help increase bycatch survival. Such a direct integration of social science and applied ecology is a novel approach to understanding conservation issues that can better inform meaningful actions to promote species recovery.

A field evaluation of an external and neutrally buoyant acoustic transmitter for juvenile salmon: implications for estimating hydroturbine passage survival.

Turbine-passed fish are exposed to rapid decreases in pressure which can cause barotrauma. The presence of an implanted telemetry tag increases the likelihood of injury or death from exposure to pressure changes, thus potentially biasing studies evaluating survival of turbine-passed fish. Therefore, a neutrally buoyant externally attached tag was developed to eliminate this bias in turbine passage studies. This new tag was designed not to add excess mass in water or take up space in the coelom, having an effective tag burden of zero with the goal of reducing pressure related biases to turbine survival studies. To determine if this new tag affects fish performance or susceptibility to predation, it was evaluated in the field relative to internally implanted acoustic transmitters (JSATS; Juvenile Salmon Acoustic Telemetry System) used widely for survival studies of juvenile salmonids. Survival and travel time through the study reach was compared between fish with either tag type in an area of high predation in the Snake and Columbia rivers, Washington. An additional group of fish affixed with neutrally-buoyant dummy external tags were implanted with passive integrated transponder (PIT) tags and recovered further downstream to assess external tag retention and injury. There were no significant differences in survival to the first detection site, 12 river kilometers (rkm) downstream of release. Travel times were also similar between groups. Conversely, externally-tagged fish had reduced survival (or elevated tag loss) to the second detection site, 65 rkm downstream. In addition, the retention study revealed that tag loss was first observed in fish recaptured approximately 9 days after release. Results suggest that this new tag may be viable for short term (<8 days) single-dam turbine-passage studies and under these situations, may alleviate the turbine passage-related bias encountered when using internal tags, however further research is needed to confirm this.

Receptor-interacting protein 2 gene silencing attenuates allergic airway inflammation.

Persistent activation of NF-κB has been associated with the development of asthma. Receptor-interacting protein 2 (Rip2) is a transcriptional product of NF-κB activation. It is an adaptor protein with serine/threonine kinase activity and has been shown to positively regulate NF-κB activity. We investigated potential protective effects of Rip2 gene silencing using small interfering RNA (siRNA) in an OVA-induced mouse asthma model. Rip2 protein level was found to be upregulated in allergic airway inflammation. A potent and selective Rip2 siRNA given intratracheally knocked down Rip2 expression in OVA-challenged lungs and reduced OVA-induced increases in total and eosinophil counts, and IL-4, IL-5, IL-13, IL-1ß, IL-33, and eotaxin levels in bronchoalveolar lavage fluid. Rip2 silencing blocked OVA-induced inflammatory cell infiltration and mucus hypersecretion as observed in lung sections, and mRNA expression of ICAM-1, VCAM-1, E-selectin, RANTES, IL-17, IL-33, thymic stromal lymphopoietin, inducible NO synthase, and MUC5ac in lung tissues. In addition, elevation of serum OVA-specific IgE level in mouse asthma model was markedly suppressed by Rip2 siRNA, together with reduced IL-4, IL-5, and IL-13 production in lymph node cultures. Furthermore, Rip2 siRNA-treated mice produced significantly less airway hyperresponsiveness induced by methacholine. Mechanistically, Rip2 siRNA was found to enhance cytosolic level of IκBα and block p65 nuclear translocation and DNA-binding activity in lung tissues from OVA-challenged mice. Taken together, our findings clearly show that knockdown of Rip2 by gene silencing ameliorates experimental allergic airway inflammation, probably via interruption of NF-κB activity, confirming Rip2 a novel therapeutic target for the treatment of allergic asthma.

Vulnerability of larval and juvenile white sturgeon to barotrauma: can they handle the pressure?

Techniques were developed to determine which life stages of fish are vulnerable to barotrauma from expansion of internal gases during decompression. Eggs, larvae, and juvenile hatchery-reared white sturgeon (Acipenser transmontanus; up to 91 days post hatch; d.p.h.) were decompressed to assess vulnerability to barotrauma and identify initial swim bladder inflation. Barotrauma-related injury and mortality were first observed 9 d.p.h., on the same day as initial exogenous feeding. However, barotrauma-related injury did not occur again until swim bladder inflation 75 d.p.h. (visible at necropsy and on radiographs). Swim bladder inflation was not consistent among individuals, with only 44% being inflated 91 d.p.h. Additionally, swim bladder inflation did not appear to be size dependent among fish ranging in total length from 61 to 153 mm at 91 d.p.h. The use of a combination of decompression tests and radiography was validated as a method to determine initial swim bladder inflation and vulnerability to barotrauma. Extending these techniques to other species and life-history stages would help to determine the susceptibility of fish to hydro turbine passage and aid in fish conservation.

Consequences of acute stress and cortisol manipulation on the physiology, behavior, and reproductive outcome of female Pacific salmon on spawning grounds.

Life-history theory predicts that stress responses should be muted to maximize reproductive fitness. Yet, the relationship between stress and reproduction for semelparous salmon is unusual because successfully spawning individuals have elevated plasma cortisol levels. To tease apart the effects of high baseline cortisol levels and stress-induced elevation of cortisol titers, we determined how varying degrees of cortisol elevation (i.e., acute and chronic) affected behavior, reproductive physiology, and reproductive success of adult female pink salmon (Oncorhynchus gorbuscha) relative to different states of ovulation (i.e., ripe and unripe). Exhaustive exercise and air exposure were applied as acute stressors to manipulate plasma cortisol in salmon either confined to a behavioral arena or free-swimming in a spawning channel. Cortisol (eliciting a cortisol elevation to levels similar to those in post-spawn female salmon) and metyrapone (a corticosteroid synthesis inhibitor) implants were also used to chemically manipulate plasma cortisol. Cortisol implants elevated plasma cortisol, and impaired reproductive success; cortisol-treated fish released fewer eggs and died sooner than fish in other treatment groups. In contrast, acute stressors elevated plasma cortisol and the metyrapone implant suppressed plasma cortisol, but neither treatment significantly altered reproductive success, behavior, or physiology. Our results suggest that acute stressors do not influence behavior or reproductive outcome when experienced upon arrival at spawning grounds. Thus, certain critical aspects of salmonid reproduction can become refractory to various stressful conditions on spawning grounds. However, there is a limit to the ability of these fish to tolerate elevated cortisol levels as revealed by experimental elevation of cortisol.

The effect of chewing gum on self-reported nicotine withdrawal: is it the flavor, the act of chewing, or both?

A healthy alternative that has been shown to lessen the severity of nicotine withdrawal symptoms during brief periods of nicotine abstinence (e.g., 3-4 h) is confectionary chewing gum (Cohen and colleagues, 1997, 1999, & 2001). The current study sought to build upon this line of research by examining the impact of chewing gum on nicotine withdrawal severity over an extended period of nicotine abstinence (e.g., 24 h) while also identifying the specific attributes of chewing gum that may be responsible for the reported decreases in withdrawal. Specifically, the acts of chewing, flavor, as well as the combination of the two, were independently examined. Twenty-four dependent cigarette smokers participated in three experimental conditions (e.g., a flavorless gum base, flavor strips, and flavored chewing gum) as well as a no product control across four weeks while abstaining from smoking for 24 h each week. Using repeated measures ANOVAs, a significant difference in withdrawal severity was reported by participants across conditions, F(3, 69)=2.89, p < .05. Follow-up analyses revealed that the flavored gum condition yielded significantly lower withdrawal scores than the flavorless gum base and no product control conditions. These findings indicate that chewing gum appears useful in lessening the severity of nicotine withdrawal symptoms over a 24-hour period of nicotine abstinence and that it is a combination of flavor and chewing that appears to lead to this effect.