A comparison of the morphokinetic profiles of embryos developed from vitrified versus fresh oocytes.

RESEARCH QUESTION: Do morphokinetic profiles and treatment outcomes differ between embryos developed from vitrified or fresh oocytes? DESIGN: Retrospective multicentre analysis using data from eight CARE Fertility clinics across the UK between 2012 and 2019. Patients receiving treatment using embryos developed from vitrified oocytes (n = 118 women, n = 748 oocytes), providing 557 zygotes during this time period, were recruited and matched with patients undergoing treatment with embryos developed from fresh oocytes (n = 123 women, n = 1110 oocytes), providing 539 zygotes in the same time frame. Time-lapse microscopy was used to assess morphokinetic profiles, including early cleavage divisions (2- through to 8-cell), post-cleavage stages including time to start of compaction, time to morula, time to start of blastulation and time to full blastocyst. Duration of key stages such as the compaction stage were also calculated. Treatment outcomes were compared between the two groups (live birth rate, clinical pregnancy rate and implantation rate). RESULTS: A significant delay of 2-3 h across all early cleavage divisions (2- through to 8-cell) and time to start of compaction occurred in the vitrified group versus fresh controls (all P ≤ 0.01). The compaction stage was significantly shorter in vitrified oocytes (19.02 ± 0.5 h) compared with fresh controls (22.45 ± 0.6 h, P < 0.001). There was no difference in the time that fresh and vitrified embryos reached the blastocyst stage (108.03 ± 0.7 versus 107.78 ± 0.6 h). There was no significant difference in treatment outcomes between the two groups. CONCLUSION: Vitrification is a useful technique for extending female fertility with no effects on IVF treatment outcome.

Academic-Practice Partnership in Rural Maryland: Opportunities for Advanced Practice Registered Nurse Training and Employment.

This case study describes how an innovative, triple-win, academic-practice partnership model can be used to deepen the clinical expertise of advanced practice registered nurse (APRN) students and improve rural Americans' access to quality patient care. It features the experience and strategies used by a school of nursing and a local rural hospital system collaborating to provide clinical experiences for APRN students pursuing doctor of nursing practice degrees.

Building Maryland's health care leadership capacity: The Nurse Leadership Institute at the University of Maryland School of Nursing.

Nurse leadership was identified as essential to the advancement of health care in the State of Maryland. The State's Health Services Cost Review Commission's (HSCRC) committed to building the next generation of nurse leaders as part of its vision for advancing healthcare in Maryland. In 2015, HSCRC approved a $2.5 million, multiyear grant that supported development of the Nurse Leadership Institute (NLI) at the University of Maryland School of Nursing. The NLI designed a leadership development program that prepared nurse faculty and clinicians with critical competencies needed for assuming leadership positions unique to complex adaptive systems, facilitating collaborative partnerships between academia and practice, and ultimately improving health outcomes for Maryland's residents. This article is the first in a series reporting on outcomes of this initiative, which describes the design and implementation of the Nurse Leadership Institute, its Leadership Development Program, and preliminary findings for the first 4 years.

Three-Year Pre-Post Analysis of EBP Integration in a Magnet-Designated Community Hospital.

BACKGROUND: Adoption of evidence-based practices (EBP) by registered nurses (RNs) and nurse leaders continues to be a challenge. Although multiple strategies and substantial resources are being invested to advance nursing practice based on evidence, little is known about the long-term impact of these interventions. AIMS: This study was undertaken to assess nurse leaders' and clinical RNs' beliefs to use EBP, perceptions about organizational readiness for EBP, and frequency of implementing EBP following implementation of multifaceted interventions to achieve and maintain Magnet designation. METHODS: This retrospective descriptive study compared data from two previously administered online surveys (2008 and 2012) at a mid-Atlantic Magnet-designated community hospital. RESULTS: Clinical RNs' self-reported attitudes toward EBP were more positive (2008: M = 53.85, standard error of the mean [SEM] = 0.65; 2012: M = 57.07,SEM = 0.58), as well as their perceptions of organizational readiness (2008: M = 50.72, SEM = 1.20; 2012: M = 81.09, SEM = 0.98), between the two survey years. Contrarily, although nurse leader scores were significantly higher for beliefs (2008: M = 61.15, SEM = 1.23; 2012: M = 60.60., SEM = 0.96), readiness (2008: M = 61.28, SEM = 2.16; 2012: M = 85.18, SEM = 1.64), and implementation (2008: M = 21.35, SEM = 1.72; 2012: M = 19.08, SEM = 1.43) little change was observed in the nurse leader scores between the two survey years compared with clinical RNs. DISCUSSION: Results from this study suggest that the multifaceted interventions have had a positive impact on clinical RNs' beliefs and readiness for EBP, but not for nurse leaders. Albeit low, self-reported implementation of EBP by RNs and nurse leaders has been sustained, but has not improved. LINKING EVIDENCE TO ACTION: Leaders must see their role as not only facilitators of EBP but also as active participants practicing EBP. Actively engaging leaders in EBP by serving on interprofessional EBP teams and role modeling these behaviors to staff is critical to EBP implementation. Realistic expectations of RNs for EBP implementation and clear and accessible resources may enhance RNs' willingness to implement. Going forward, it may be necessary to differentiate the expectations of RNs in EBP implementation by clarifying expectations in the process of identification and analysis of evidence from use of EBP in clinical practice.

Leadership redefined: educating the Doctorate of Nursing Practice nurse leader through innovation.

In today's society, health care systems are characterized by change, unpredictability, increasing speed of information and knowledge exchanges, redefined organizational boundaries and hierarchy, emphasis on value, teamwork, interdisciplinary collaboration, diversity, and interconnectedness. This new reality has forced nurse educators to redefine nursing leadership and prepare the Doctorate of Nursing Practice (DNP) leader through innovative courses offering experiential learning based on complex adaptive systems and quantum leadership theory. This article describes the experiential learning approach and integrated learning experience for DNP students.

Dissemination of a dissonance-based body image promotion program in church settings: A preliminary controlled pilot study with adult women.

Adult women report significant body dissatisfaction yet are often overlooked in body image promotion programs. Although few venues afford opportune settings for intervening with adult women, the church serves as a regular meeting place for many in the South of the United States. This study tested a dissonance-based body image program, Reclaiming Beauty (RB), adapted for adult women in church settings. Six groups (n = 30) were led by two trained church leaders (peer-led) and three groups (n = 21) were led by a trained peer leader and a researcher (researcher-co-led). RB participants, aged 30-77 years (M = 53.1 ± 12.7), completed assessments pre-intervention, immediately post-intervention, and 6 months post-intervention. Waitlist-controls (n = 31) completed assessments at time intervals consistent with intervention participants. RB participants reported significantly decreased thin-ideal internalization, body surveillance, and eating psychopathology at post-intervention and at 6 months post-intervention relative to controls. RB participants also reported significantly increased body satisfaction immediately post-intervention relative to controls, but this was not significant at 6 months post-intervention. Peer-led groups outperformed researcher-co-led groups on body surveillance at 6 months, but RB conditions did not otherwise differ. Our findings provide preliminary support for the dissemination of a culturally-modified dissonance-based body image program to adult women in church settings.

Is it time to pull the plug on 12-hour shifts?: Part 2. Barriers to change and executive leadership strategies.

This article is part 2 of the series "Pulling the Plug on 12-Hour Shifts." In part 1 (March 2010), the authors provided an update on recent evidence that challenges the current scheduling paradigm that supports the lack of safety of long work hours. Part 2 describes the barriers to change and challenges for the nurse executive in moving away from the practice of 12-hour shifts. This is an executive-level analysis of barriers and recommends strategies for change. Translation of evidence into administrative practice requires examination of external environmental factors, internal system consequences, organizational culture, and measures of executive performance.

Thinking about thinking: implications for patient safety.

Clinical medicine, a learned, rational, science-using practice, is labelled a science even though physicians have the good sense not to practise it that way. Rather than thinking like scientists - or how we think scientists think - physicians are engaged in analogical, interpretive reasoning that resembles Aristotle's phronesis, or practical reasoning, more closely than episteme, or scientific reasoning. In medicine, phronesis is clinical judgment; and while it depends on both a fund of information and extensive experience, somehow it is not quite teachable. This practical, clinical rationality relies on case narrative for teaching and learning about illness and disease, for recording and communicating about patient care and, inevitably, for thinking about and remembering the details, as well as the overarching rules of practice. At the same time, "anecdotal" remains the most pejorative word in medicine, and the tension between the justifiable caution this disdain expresses and the pervasive narrative structure of medical knowledge is characteristic of clinical knowing generally: a tug-of-war between apparent irreconcilables that can be settled only by an appeal to the circumstances of the clinical situation. Practical rationality in the clinical encounter is characterized by a productive circulation between the particular details of the patient's presentation and general information about disease stored as a taxonomy of cases. Evidence-based medicine can improve this negotiation between general knowledge and the patient's particulars, but it cannot replace it. In a scientific era, clinical judgment remains the quintessential intellectual strength of the clinician. Why, then, do we not teach the epistemology of medicine? Understanding the mis-description of physicians' thinking - and the accompanying claim that medicine is, in itself, a science - could mitigate the misplaced perfectionism that makes mistakes in medicine personal and unthinkable.

Comprehensive identification of delusions and olfactory, tactile, gustatory, and minor hallucinations in Parkinson's disease psychosis.

INTRODUCTION: Psychotic symptoms are underdiagnosed in Parkinson's disease (PD), and there is a need for a comprehensive PD psychosis rating scale. METHODS: Cross-sectional analysis of 199 consecutive PD outpatients. After a routine clinical visit that included the Unified Parkinson's Disease Rating Scale (UPDRS) and Non-Motor Symptoms Questionnaire (NMS-Quest), subjects completed the enhanced Scale for the Assessment of Positive Symptoms in PD (eSAPS-PD), a structured clinical interview that included the standard SAPS-PD with additional prompts for delusions and olfactory, gustatory, and minor hallucinations. Based on the combined results of these assessments, subjects were categorized as having major psychotic symptoms (hallucinations or delusions; PDP-major), isolated minor psychotic symptoms (passage hallucinations, presence hallucinations, or illusions; PDP-minor), or no psychotic symptoms (PD-controls). RESULTS: We identified 58 subjects (29%) with psychotic symptoms, including 28 (14%) with major psychotic symptoms and 30 (15%) with isolated minor psychotic symptoms. Hallucinations were present in 56 subjects (28%); most commonly visual (24%, of which 21% were minor only), followed by olfactory (6%), tactile (4%), auditory (2%), and gustatory (1%). The eSAPS-PD detected psychotic symptoms in more subjects (n = 55, 28%) than all other assessments combined (clinical visit, UPDRS part 1, and NMS-Quest) (n = 22, 11%). Compared with PD-controls, PDP-minor subjects had a higher burden of other non-motor symptoms on the Non-Motor Symptoms Scale (37 [27-51] vs. 18 [9-36], p < 0.001) and lower quality of life scores on the PD Quality of Life Questionnaire (138 [125-151] vs. 149 [137-165], p = 0.01). CONCLUSION: The eSAPS-PD can markedly improve detection of psychotic symptoms in PD.

Children's Privacy in the Big Data Era: Research Opportunities.

This article focuses on the privacy implications of advertising on social media, mobile apps, and games directed at children. Academic research on children's privacy has primarily focused on the safety risks involved in sharing personal information on the Internet, leaving market forces (such as commercial data collection) as a less discussed aspect of children's privacy. Yet, children's privacy in the digital era cannot be fully understood without examining marketing practices, especially in the context of "big data." As children increasingly consume content on an ever-expanding variety of digital devices, media and advertising industries are creating new ways to track their behaviors and target them with personalized content and marketing messages based on individual profiles. The advent of the so-called Internet of Things, with its ubiquitous sensors, is expanding these data collection and profiling practices. These trends raise serious concerns about digital dossiers that could follow young people into adulthood, affecting their access to education, employment, health care, and financial services. Although US privacy law provides some safeguards for children younger than 13 years old online, adolescents are afforded no such protections. Moreover, scholarship on children and privacy continues to lag behind the changes taking place in global media, advertising, and technology. This article proposes collaboration among researchers from a range of fields that will enable cross-disciplinary studies addressing not only the developmental issues related to different age groups but also the design of digital media platforms and the strategies used to influence young people.

Humanities Education at Northwestern University's Feinberg School of Medicine.

The Medical Humanities and Bioethics Program at Northwestern University's Feinberg School of Medicine is responsible for humanities education in all four years of medical school: five units of the required four-year Patient, Physician, and Society course, 37 to 40 medical humanities seminars in years one and two, more than 125 ethics case conferences in third-year clerkships, and electives for fourth-year students. The program faculty also participate in ethics and humanities education in residencies, and the program offers an annual one-year fellowship. The program introduced the small-group teaching that now characterizes much of the school's curriculum, and its course units and seminars have been a resource for faculty development and curricular innovation. Drawing on literature, religion, ethics, philosophy of medicine, film, history, social and cultural anthropology, and jurisprudence, humanities education is designed to foster habits of discourse on social and moral issues in medicine. Small-group teaching and interactive learning are its central pedagogical methods. Essential to their successful use in a school that enrolls approximately 170 students each year is a large cadre of volunteer clinicians who serve as tutors and the college system, a four-part division of each class instituted by the 1993 curriculum reform. Students are evaluated on preparation, class participation, and regular writing assignments. All course units and seminars are pass/fail (as are all first- and second-year courses); tutors supply narrative comments. The courses themselves are thoroughly evaluated by students and reviewed both by the relevant faculty-student committee and at an annual curriculum retreat.

Workforce development in Maryland to promote clinical-community connections that advance payment and delivery reform.

Promoting clinical-community linkages is at the heart of Maryland's efforts systematically to transform health care delivery, with community health workers (CHW) playing a central role. This article describes how Maryland is using the evidence-base on CHW effectiveness and training to develop a workforce capable of most effectively connecting communities with care.

The new threat of digital marketing.

Because of their avid use of new media and their increased spending power, children and teens have become primary targets of a new "media and marketing ecosystem." The digital marketplace is undergoing rapid innovation as new technologies and software applications continue to reshape the media landscape and user behaviors. The advertising industry, in many instances led by food and beverage marketers, is purposefully exploiting the special relationship that youth have with new media, as online marketing campaigns create unprecedented intimacies between adolescents and the brands and products that now literally surround them.

Toward a liberal education in medicine.

The central thesis of Abraham Flexner's analyses of North American and European medical education was that the university is essential to the provision of a medical education. The authors invoke the spirit of Flexner to envision further contributions of the university at large to undergraduate medical education. Medical curricula now include elements of a variety of other disciplines that are better represented in other parts of the university. Most schools, however, even those closely affiliated with a comprehensive university, do not take full advantage of these resources, nor do they offer sufficient opportunities for students to pursue individualized interests and learning goals. Medical school now plays a different role in the education of physicians than it did a century ago-it remains the definitive, but is no longer the ultimate, stage in a continuum involving college, professional, postgraduate, and continuing education. The authors explore the medical school years as an opportunity for a liberal education in medicine. Beyond the assurance of competence in core knowledge, skills, and perspectives, this model places more emphasis on nurturing students' intellectual curiosity about phenomena of illness and disease, their understanding of the human condition, and their exploration of the many other disciplines related to medicine and the life sciences. A richer, broader education can be achieved through more flexible and individualized paths to the MD and facilitated by realizing medical schools' full academic citizenship in the university.

Interactive food and beverage marketing: targeting adolescents in the digital age.

Because of their avid use of new media and their increased spending power, adolescents have become primary targets of a new "Media and Marketing Ecosystem." Digital media resonate particularly well with many of the fundamental developmental tasks of adolescence by enabling instantaneous and constant contact with peers, providing opportunities for self-expression, identity exploration, and social interaction, and facilitating mobility and independence. Six key features of interactive media--ubiquitous connectivity, personalization, peer-to-peer networking, engagement, immersion, and content creation--are emblematic of the ways in which young people are both shaping and being shaped by this new digital culture. The advertising industry, in many instances led by food and beverage marketers, is purposefully exploiting the special relationship that teenagers have with new media, with online marketing campaigns that create unprecedented intimacies between adolescents and the brands and products that now literally surround them. Major food and beverage companies, including Coca-Cola, McDonald's, Burger King, and Kentucky Fried Chicken (KFC), have incorporated these elements into their interactive marketing strategies, posing particular risks to adolescents, who are not being addressed in the current U.S. policy and self-regulatory regimens. However, recent and emerging neuroscience and psychological research on adolescents suggests a need to revisit the traditional approach to regulation of advertising. Despite the growth of interactive marketing, academic research on the impact of digital advertising on children and youth remains underdeveloped. Additional research and policy initiatives are needed to address the growing health threat facing youth in the digital marketplace.