Law, Regulation or Just Damned Politics: The Under-utilisation and Undervaluing of the World's Largest Health Workforce.

This article analyses the outcomes of a three-year campaign to raise the status and profile of nursing - The Nursing Now Campaign. The Campaign aim was to take forward the recommendations of the Triple Impact Report of the United Kingdom All-Party Parliamentary Group (APPG) on Global Health. The Triple Impact Report documented the undervaluing and under-utilisation of nursing which is the largest health workforce globally and which the APPG believed had the greatest potential to have a positive impact upon the United Nations move to universal health coverage. The framework for analysis is that of Shiffman et al which was developed to explain the emergence and effectiveness of global networks, and is used here to examine the effectiveness of the Nursing Now Campaign against its stated aims.

Nursing leadership and health policy: everybody's business.

We all know great leadership when we see it. Outstanding nurse leaders, guided by a moral compass, simultaneously see the big picture and the consequences at micro level. While policy and politics determine health and nursing practice, most nurses just want to get on with their day job. They carry out decisions made by others but have little say in them, and weak influence or status, although they are increasingly knowledgeable and skilled. In settings where policy decisions are made - parliaments, governments, and boardrooms - nurse leaders are often neither heard nor heeded. This is starting to change. The global Nursing Now campaign is working with the International Council of Nurses, and the World Health Organization, to create and strengthen strategic nursing leadership, as modelled by the International Council of Nurses' Global Nursing Leadership Institute. A new window of opportunity is opening, with the bicentennial of Florence Nightingale's birth in 2020. Now is the moment!

Structural positioning of nurse leaders and empowerment.

AIMS AND OBJECTIVES: To analyse the reporting structures of nursing leaders of publicly funded hospitals and seek both the views of nurse leaders and Chief Executive Officers/Chief Operating Officers on the structural positioning of nurse leaders in the organisation. BACKGROUND: Concern that the continuing restructuring within hospital structures and focus on economic outputs in health services is diminishing the value of nursing leadership. DESIGN: Qualitative surveys with Nursing leaders and Chief Executive Officers of public hospitals. METHODS: Seventeen Directors of Nursing and 10 Chief Executive Officer/Chief Operating Officers' responses were received using two semi-structured questionnaires. Themes were developed from data coded and analysed by hand. RESULTS: Four broad themes emerged from analysis of the data: (1) variable positional reporting between Director of Nursing and Chief Executive Officers occurred; (2) variable levels of inclusion and influence at the executive decision-making level; (3) ambiguous financial responsibilities and accountabilities held by Director of Nursing; and (4) blurred lines existed between operational and professional reporting lines. Findings unique to the research indicate that the varying levels of visibility and inclusion impact on the structural positioning of nurse leaders which influences authority and empowerment. CONCLUSION: Responses from the data analysis indicate that the structural power of nurse leaders defined by the factors of opportunity, power and proportion were hindered by dual accountability reporting lines and a lack of financial control. RELEVANCE TO CLINICAL PRACTICE: The structural positioning of nurse leaders is vital to ensure that they are empowered and able to meet the adaptations required in a changing environment that supports the delivery of effective, quality healthcare.

Antibodies against insulin measured by electrochemiluminescence predicts insulitis severity and disease onset in non-obese diabetic mice and can distinguish human type 1 diabetes status.

BACKGROUND: The detection of insulin autoantibodies (IAA) aids in the prediction of autoimmune diabetes development. However, the long-standing, gold standard 125I-insulin radiobinding assay (RBA) has low reproducibility between laboratories, long sample processing times and requires the use of newly synthesized radiolabeled insulin for each set of assays. Therefore, a rapid, non-radioactive, and reproducible assay is highly desirable. METHODS: We have developed electrochemiluminescence (ECL)-based assays that fulfill these criteria in the measurement of IAA and anti-insulin antibodies (IA) in non-obese diabetic (NOD) mice and in type 1 diabetic individuals, respectively. Using the murine IAA ECL assay, we examined the correlation between IAA, histopathological insulitis, and blood glucose in a cohort of female NOD mice from 4 up to 36 weeks of age. We developed a human IA ECL assay that we compared to conventional RBA and validated using samples from 34 diabetic and 59 non-diabetic individuals in three independent laboratories. RESULTS: Our ECL assays were rapid and sensitive with a broad dynamic range and low background. In the NOD mouse model, IAA levels measured by ECL were positively correlated with insulitis severity, and the values measured at 8-10 weeks of age were predictive of diabetes onset. Using human serum and plasma samples, our IA ECL assay yielded reproducible and accurate results with an average sensitivity of 84% at 95% specificity with no statistically significant difference between laboratories. CONCLUSIONS: These novel, non-radioactive ECL-based assays should facilitate reliable and fast detection of antibodies to insulin and its precursors sera and plasma in a standardized manner between laboratories in both research and clinical settings. Our next step is to evaluate the human IA assay in the detection of IAA in prediabetic subjects or those at risk of type 1 diabetes and to develop similar assays for other autoantibodies that together are predictive for the diagnosis of this common disorder, in order to improve prediction and facilitate future therapeutic trials.

Building capacity in Australian interprofessional health education: perspectives from key health and higher education stakeholders.

OBJECTIVE: A substantial literature engaging with the directions and experiences of stakeholders involved in interprofessional health education exists at the international level, yet almost nothing has been published that documents and analyses the Australian experience. Accordingly, this study aimed to scope the experiences of key stakeholders in health and higher education in relation to the development of interprofessional practice capabilities in health graduates in Australia. METHODS: Twenty-seven semi-structured interviews and two focus groups of key stakeholders involved in the development and delivery of interprofessional health education in Australian higher education were undertaken. Interview data were coded to identify categories that were organised into key themes, according to principles of thematic analysis. RESULTS: Three themes were identified: the need for common ground between health and higher education, constraints and enablers in current practice, and the need for research to establish an evidence base. Five directions for national development were also identified. CONCLUSIONS: The study identified a range of interconnected changes that will be required to successfully mainstream interprofessional education within Australia, in particular, the importance of addressing issues of culture change and the need for a nationally coordinated and research informed approach. These findings reiterate those found in the international literature.

Our future is global: nursing leadership and global health.

Global health matters to every nurse everywhere. In this article we outline why. We highlight some important health issues confronting the world today; explore how these issues are being tackled; and consider the implications for nursing. We describe how nurses are making a difference in the challenging contexts, range and complexity of nursing work round the globe, and we conclude with a call to action. Nurses can influence, and become, policy-makers and politicians, and explain to them why the Sustainable Development Goals cannot be reached without strengthening nursing. In this International Year of the Nurse and Midwife, the window of opportunity is open, but it will not stay open for long. Nurses and midwives globally and locally must be ready to jump through it. We ask you to join hands, and join us.

Department of Veterans Affairs Consensus: Preradiation dental treatment guidelines for patients with head and neck cancer.

Few protocols have been published for the dental management of patients with head and neck cancer to prevent complications from head and neck radiation therapy. Radiation therapy not only affects the tumor cells targeted, but also the dentition, bone, salivary gland, and oral soft tissue structures. A comprehensive dental evaluation prior to head and neck radiation therapy can help prevent many complications. The following clinical guidelines were established by a workgroup of oral health providers within the Department of Veterans Affairs. This workgroup focused on developing a set of recommendations regarding dental care prior to the initiation of head and neck radiation therapy based on the best clinical evidence and expert consensus. A systematic algorithm was developed for the evaluation including pre-exam data gathering, examination, education, and treatment, followed by maintenance and postradiation dental follow-up. This document is evidence-based, patient-centered, consistent with accepted practices of care and safety, and in accordance with applicable statutes and regulations.

Being seen within 48 hours--what do patients think?

A questionnaire survey of 1000 patients was carried out to determine the proportion of patients attending a large genitourinary medicine department in Newcastle upon Tyne who wish to be seen within 48 hours. The Department of Health target for patients offered an appointment within 48 hours is 100%. Its target for the proportion of patients seen within 48 hours is 95%. Patients were surveyed to ascertain their preference about waiting times for appointments within the clinic. In total, only 33% stated that they wished always to be seen within the government's target of 48 hours.

The Magic Pudding Comment on "Four Challenges That Global Health Networks Face".

This commentary reflects on the contribution of this editorial and its "Three Challenges That Global Health Networks Face" to the totality of the framework developed over the past decade by Shiffman and his collaborators. It reviews the earlier works to demonstrate that the whole is greater than the sum of the parts in providing a package of tools for analysis of network effectiveness.Additionally the assertion is made that the framework can be utilised in reverse to form a map for action planning for network activity around a potential health policy issue.

Yeast lifespan variation correlates with cell growth and SIR2 expression.

Isogenic wild type yeast cells raised in controlled environments display a significant range of lifespan variation. Recent microfluidic studies suggest that differential growth or gene expression patterns may explain some of the heterogeneity of aging assays. Herein, we sought to complement this work by similarly examining a large set of replicative lifespan data from traditional plate assays. In so doing, we reproduced the finding that short-lived cells tend to arrest at senescence with a budded morphology. Further, we found that wild type cells born unusually small did not have an extended lifespan. However, large birth size and/or high inter-generational growth rates significantly correlated with a reduced lifespan. Finally, we found that SIR2 expression levels correlated with lifespan and intergenerational growth. SIR2 expression was significantly reduced in large cells and increased in small wild type cells. A moderate increase in SIR2 expression correlated with reduced growth, decreased proliferation and increased lifespan in plate aging assays. We conclude that cellular growth rates and SIR2 expression levels may contribute to lifespan variation in individual cells.

Allelic alterations in pancreatic endocrine tumors identified by genome-wide single nucleotide polymorphism analysis.

Pancreatic endocrine tumors (PETs) are uncommon and the genetic alterations in these indolent tumors are not well characterized. Chromosomal imbalances are frequent in tumors but PETs have not been studied by high-density single nucleotide polymorphism (SNP) array. We used genome-wide high-density SNP array analysis to detect copy number alterations using matched tumor and non-neoplastic tissue samples from 15 patients with PETs. In our study, whole or partial loss of chromosomes 1, 3, 11, 22 was present in 40, 47, 53, 40% of tumors respectively, and gain of chromosomes 5, 7, 12, 14, 17, and 20 was present in 47, 60, 47, 53, 53, and 47% of tumors respectively. One tumor had loss of heterozygosity of chromosome 3 and another of chromosome 22 without copy number alterations, suggesting uniparental disomy due to non-disjunction and deletion or to chromosomal recombination. Chromosomal aberrations of the autosomal chromosomes were correlated with chromosomal loss or gain of other chromosomes (r>0.5, P<0.5). About 60% of PETs had high allelic imbalances (AI) defined by more than four chromosomal aberrations, and 40% of tumors had low AI. The PETs with high AI were larger: the mean tumor size with high AI was 5.4 +/- 3.1 cm compared with 2.3 +/- 1.3 cm for low AI (P = 0.03). Our study shows that genome-wide allelotyping is a powerful new tool for the analysis of AI in PETs.

An electrochemiluminescence-based competitive displacement immunoassay for the type-2 brevetoxins in oyster extracts.

A new competitive electrochemiluminescence-based immunoassay for the type-2 brevetoxins in oyster extracts was developed. The assay was verified by spiking known amounts of PbTx-3 into 80% methanol extracts of Gulf Coast oysters. We also provide preliminary data demonstrating that 100% acetone extracts, aqueous homogenates, and the clinical matrixes urine and serum can also be analyzed without significant matrix interferences. The assay offers the advantages of speed ( 2 h analysis time); simplicity (only 2 additions, one incubation period, and no wash steps before analysis); low limit of quantitation (conservatively, 50 pg/mL = 1 ng/g tissue equivalents); and a stable, nonradioactive label. Due to the variety of brevetoxin metabolites present and the lack of certified reference standards for liquid chromatography-mass spectrometry confirmation, a true validation of brevetoxins in shellfish extracts is not possible at this time. However, our assay correlated well with another brevetoxin immunoassay currently in use in the United States. We believe this assay could be useful as a regulatory screening tool and could support pharmacokinetic studies in animals and clinical evaluation of neurotoxic shellfish poisoning victims.

Preferences for teaching methods in a baccalaureate nursing program: how second-degree and traditional students differ.

Accelerated baccalaureate nursing programs are in great demand in the United States. Currently there are 197 such programs, but little research has been conducted on student characteristics and program outcomes. This quantitative study explores preferences of second-degree students and traditional generic students with regard to teaching methods and relationships with faculty. The results indicate that statistically significant differences exist between the two groups of students. Three areas of significance are ability for self-directed learning, expectations of faculty and classroom structure, and obtaining a grade that really matters.

Generational (age) differences in nursing students' preferences for teaching methods.

A generational age transformation is occurring in nursing classrooms across the United States. Nurse educators need to prepare for the different values and expectations of students from Generation X and the newly emerging Generation Y in the educational environment. This quantitative, descriptive research begins to examine the preferences and expectations of these generations regarding teaching methods.

National comparative curriculum evaluation of baccalaureate nursing degrees: a framework for the practice based professions.

The primary aim of the study was to determine whether Australian undergraduate nursing curricula incorporate the necessary skills and knowledge to prepare graduates for the current health care environment in Australia. The eligibility criteria for inclusion in this evaluation included Australian university undergraduate pre-registration nursing programs. All of the 29 universities offering such programs in Australia were contacted by letter to the Deans of Nursing and their current curriculum document requested. Twenty six of 29 (90%) eligible Australian curricula were included in the curriculum evaluation. A comprehensive and flexible curriculum evaluation framework was developed for the analysis of the 26 curricula. The evaluation revealed the ways in which nursing curricula balance various aspects of courses, respond to changes in society, education and health care industries. Overall it was found that graduates are well prepared for practice. However questions of quality and coordination of clinical learning were highlighted for future focus and major challenges lie in addressing excessive workload and assessment. Also work needs to be done in improving the inclusion of issues around the health of Aboriginal and Torres Strait Islander (ATSI) peoples, people living in remote or rural Australia and older people.

Our future is global: nursing leadership and global health / Nosso futuro é global: liderança em enfermagem e saúde global / Nuestro futuro es global: el liderazgo en Enfermería y la salud global

Global health matters to every nurse everywhere. In this article we outline why. We highlight some important health issues confronting the world today; explore how these issues are being tackled; and consider the implications for nursing. We describe how nurses are making a difference in the challenging contexts, range and complexity of nursing work round the globe, and we conclude with a call to action. Nurses can influence, and become, policy-makers and politicians, and explain to them why the Sustainable Development Goals cannot be reached without strengthening nursing. In this International Year of the Nurse and Midwife, the window of opportunity is open, but it will not stay open for long. Nurses and midwives globally and locally must be ready to jump through it. We ask you to join hands, and join us.

A saúde global importa para os enfermeiros do mundo todo. Neste artigo, descrevemos o motivo. Destacamos algumas questões de saúde importantes que o mundo está enfrentando atualmente; exploramos como essas questões estão sendo abordadas; e consideramos as implicações para a Enfermagem. Descrevemos como os enfermeiros estão fazendo a diferença nos contextos desafiadores, destacamos a extensão e a complexidade dos trabalhos dos enfermeiros ao redor do mundo, e concluímos com um apelo à ação. Os enfermeiros podem influenciar, e se tornarem, elaboradores de política e políticos, e explicar para eles o motivo pelo qual os Objetivos de Desenvolvimento Sustentável não podem ser alcançados sem fortalecer a Enfermagem. Neste Ano Internacional da Enfermagem e da Obstetrícia, a janela de oportunidade está aberta, mas não ficará aberta por muito tempo. Os enfermeiros e as parteiras devem estar prontos para atravessar essa janela, tanto em nível global quanto local. Pedimos que vocês deem as mãos e juntem-se a nós.

La salud global es importante para cualquier enfermera en cualquier lugar del mundo. En este artículo detallamos por qué. Destacamos algunos problemas de salud importantes que enfrenta el mundo actualmente, estudiamos de qué manera se están abordando estos problemas y consideramos las repercusiones para la Enfermería. Describimos de qué manera las enfermeras están marcando la diferencia en los contextos problemáticos, la amplitud y complejidad del trabajo de Enfermería en todo el planeta y concluimos con una convocatoria para la acción. Las enfermeras pueden influenciar a los encargados de elaborar normas y a los políticos (además de pasar a desempeñar esos roles) y explicarles por qué las Metas de desarrollo sustentable no pueden alcanzarse sin fortalecer la Enfermería. En este Año Internacional de las Enfermeras y Parteras la ventana de las oportunidades está abierta, pero no será así por mucho tiempo. Tanto a nivel global como local, las enfermeras deben estar preparadas para aprovecharla. Les pedimos que se tomen de las manos y que se sumen a nosotros.

The effects of sustained delivery of estrogen on bone strength and cardiovascular panels in osteoporotic female rats.

Osteoporosis and cardiovascular disease (CVD) are common age-related conditions, which are major public health problems leading to an increase in mortality, morbidity, and disability. There have been several connections found between CVD and osteoporosis such as common genetic factors, risk factors, and pathological mechanisms. There is a direct effect of estrogen on CVD and osteoporosis that is demonstrated by the manifestation of estrogen receptors on osteoblasts, osteoclasts, and vascular endothelial and smooth muscle cells. Loss of estrogen has been found to be involved in the pathogenesis of atherosclerosis and bone loss through modulation of other factors including cytokines and oxidized lipids. The goal of this proposed research was to determine if sustained delivery of estrogen is capable of regulating bone cell function while improving cardiovascular panels. Ovariectomized Sprague Dawley rats were administered estradiol at a rate of 5ng/day over an eight-week period. Body weights, estradiol levels, cholesterol levels, and bone strength were determined at 2, 4, and 8 weeks following sustained delivery of estradiol and compared with intact control and ovariectomized control animals. Estrogen replacement resulted in improved cholesterol panels without significant changes in bone flexural strength or improvements in bone porosity. Additional long term studies are needed to determine if the benefits of estrogen replacement outweigh the inherent risks associated with hormone replacement therapies.