Nursing and midwifery research priorities for Kenya: Results from a national Delphi survey.

BACKGROUND: The International Council of Nurses and the World Health Organization have prioritized evidence-based nursing and midwifery practice derived from nurse-led research. However, in a low-resource country like Kenya, there is a need to identify research priorities to optimize utilization of limited existing research infrastructure and funding. Kenya lacks a nursing and midwifery research strategy to guide research prioritization. INTRODUCTION: The goal of this study was to identify and describe nursing and midwifery research priorities for Kenya. METHODS: A cross-sectional Delphi survey using two iterative rounds of electronic data collection was used to reach a consensus about priorities for nursing and midwifery research in Kenya. NVivo-12 was used to analyze the qualitative data to identify categories, sub-themes, and themes; descriptive statistics were used to analyze quantitative data. RESULTS: Participants included 159 nurse managers, administrators, and educators representing regional, county, and national referral, private, and faith-based hospitals, nurse training schools, research institutions, and nursing organizations in Kenya. Staffing challenges, motivation, remuneration, and funding for higher education were ranked as the top critically important issues using a cutoff point of ≥ 70% agreement. CONCLUSION: There is a need for the development of a National Framework for Nursing and Midwifery Research Priorities in Kenya to guide research that builds excellence in meeting nursing and midwifery human resource concerns and ultimately improves patient care practices and outcomes. IMPLICATIONS FOR NURSING AND NURSING POLICY: The objective of Kenya's health goals delineated within three key national health documents cannot be attained without adequate numbers of nursing and midwifery professionals and policies that address nursing and midwifery staffing challenges, remuneration for employment, and improved funding for higher education.

Prepartum Magnesium Butyrate Supplementation of Dairy Cows Improves Colostrum Yield, Calving Ease, Fertility, Early Lactation Performance and Neonatal Vitality.

Butyrate promotes rumen epithelium growth and function; however, the effect of prepartum butyrate supplementation on dairy cow productivity, health and their offspring has not been extensively studied. Furthermore, no studies have investigated the effect of magnesium butyrate (MgB), which is also a source of magnesium. A trial was performed to test the hypothesis that prepartum MgB supplementation (105 g/cow/day) would increase colostrum quality and improve calving, newborn calf vitality and cow health. Multiparous Holstein cows were randomly assigned to MgB supplemented (n = 107) and Control groups (n = 112). Colostrum yield and the total yield of IgG, protein and lactose were higher (p ≤ 0.05) in the supplemented group. The calving assistance rate was lower (p ≤ 0.012), and the neonatal vitality score was higher (p ≤ 0.001) in the MgB group. Improved parameters related to cow health and fertility were observed in the supplemented group. The MgB group also had higher milk yield during the first week of lactation (p ≤ 0.001), and a higher (p ≤ 0.05) body condition score from 3 to 9 weeks after calving. In conclusion, prepartum MgB supplementation provides a wide range of benefits for dairy cows, as well as their newborn calves.

Effect of Prepartum Magnesium Butyrate Supplementation on Rumination Time, Milk Yield and Composition, and Blood Parameters in Dairy Cows.

BACKGROUND: Magnesium butyrate (MgB) supplementation of dairy cows during the three-week close-up period was tested for its effects on blood energy analytes, rumination time, inflammation, and lactation performance. METHODS: Daily milk yield was recorded and weekly milk samples collected for the first 70 days of lactation from MgB supplemented (MgB, n = 34), and unsupplemented (Control, n = 31) multiparous Holstein-Friesian cows. During a period from week 3 to week 10 postpartum, blood samples were taken and analyzed for various parameters, and ruminant activity was measured. RESULTS: The MgB group yielded 25.2% more milk than the Control during week 1, and had increased milk fat and protein concentrations over a longer duration. Somatic cell counts (SCC) were decreased in the MgB group independent of days in milk. No differences were observed between groups in terms of plasma non-esterified fatty acids, ß-hydroxybutyrate, glucose, or blood iCa levels. The MgB group had lower haptoglobin (Hp) levels during lactation relative to the Control group. Time spent ruminating increased after calving with MgB due to a shorter post calving rumination delay relative to the Control group. CONCLUSIONS: Prepartum MgB supplementation improved lactation performance without affecting blood energy analytes. The basis by which MgB also improved rumination activity remains to be determined, as DMI could not be assessed. As MgB lowered SCC and Hp concentrations, it is speculated that MgB may help minimize postpartum inflammatory processes.

Dietary Protected Butyrate Supplementation of Broilers Modulates Intestinal Tight Junction Proteins and Stimulates Endogenous Production of Short Chain Fatty Acids in the Caecum.

Short chain fatty acid (SCFA) butyrate has various beneficial effects on the gut microbiota as well as on the overall health status and metabolism of the host organism. The modulatory role of butyrate on gut barrier integrity reflected by tight junction protein expression has been already described in mammalian species. However, there is limited information available regarding chickens. Therefore, the main aim of this study was to monitor the effects of protected butyrate on claudin barrier protein and monocarboxylate transporter 1 abundance in different gastrointestinal segments of chickens as well as the growth performance of broiler chickens. The effect of protected butyrate on the caecal microbiota was monitored by quantifying the concentrations of total eubacteria and key enzymes of butyrate production. Furthermore, intestinal SCFA concentrations were also measured. Based on the data obtained, protected butyrate increased the overall performance as well as the barrier integrity of various gut segments. Protected butyrate also positively affected the SCFA concentration and composition. These findings provide valuable insight into the complex effects of protected butyrate on broiler gut health, highlighting the beneficial effects in improving intestinal barrier integrity and performance parameters.

Motherhood and decision-making among women living with HIV in developed countries: a systematic review with qualitative research synthesis.

BACKGROUND: Women living with HIV (WLH) lack evidence-based information about reproductive options while managing pressures from family, clinicians, and communities to give up the idea of having children. As the reproduction intentions of WLH are not well understood, stigmatizing behaviors force them to hide their disease to avoid rejection by their family, partner, and social networks. Compliance with social norms, fear of stigma, and discrimination influence their experience. Current research is individual qualitative studies lacking the synthesis perspective necessary to guide intervention development. The purpose of this study was to synthesize the evidence to explain the reproductive decision-making process for WLH in developed countries. METHODS: A systematic review with qualitative research synthesis was conducted through searches in 10 electronic databases (CINAHL, EMBASE, MEDLINE, Scopus, Social Science Citation Index, Web of Science, Google Scholar, Cuidatge, Cuiden Enfispo, and SciELO). Studies published in journals from 1995 to 2019 with qualitative data about reproductive decision-making among WLH in developed countries were eligible for inclusion. Developed country was operationalized by membership in the OECD for comparative conditions of social wellbeing and economic stability. The CASP and JBI checklists for qualitative research were used to assess study quality and methodological integrity. Thematic analysis and qualitative meta-summary techniques were used for the synthesis. RESULTS: Twenty studies from 12 developed countries were included in the synthesis. Findings were organized into 3 meta-themes from 15 themes and 45 subthemes, including: (1) Shattered identity, (2) Barriers, inequities, and misinformation, (3) Coping, resiliency, and support. Reproductive decision-making was perceived as a complex process influenced by facilitators and barriers. The facilitators helped WLH cope with their new situation to become more resilient, while the barriers made their situation more difficult to manage. CONCLUSION: WLH encounter reproductive decision-making with knowledge deficits and limited social support. An integrated approach to holistic care with comprehensive multidisciplinary counseling is needed to support WLH. Clinicians could benefit from professional development to learn how to be authentically present for WLH, including engaging in conversations, demonstrating compassion, and understanding situations. Evidence-based clinical practice guidelines need to be tailored for the family planning and sexual health needs of WLH.

RESUMEN: ANTECEDENTES: Las mujeres que viven con el VIH (MVV) carecen de información basada en evidencias sobre las opciones reproductivas mientras son presionadas por la familia, los profesionales de la salud y los miembros de la comunidad para renunciar a la idea de tener hijos. Como las intenciones reproductivas de las MVV no son comprendidas, las conductas estigmatizantes las obligan a ocultar su enfermedad para evitar el rechazo de su familia, pareja y grupos sociales. El cumplimiento de las normas sociales, el miedo al estigma y la discriminación influyen en su experiencia. La presente investigación está compuesta por estudios cualitativos que de forma individual carecen de la perspectiva de síntesis necesaria para guiar el desarrollo de las intervenciones. El propósito de este estudio fue sintetizar la evidencia para explicar el proceso de toma de decisiones reproductivas para las MVV en los países desarrollados. MéTODOS: Se realizó una revisión sistemática con síntesis de investigación cualitativa mediante búsquedas en 10 bases de datos electrónicas (CINAHL, EMBASE, MEDLINE, Scopus, Social Science Citation Index, Web of Science, Google Scholar, Cuidatge, Cuiden Enfispo y SciELO). Los estudios publicados en revistas de entre 1995 y 2019 que contuvieran datos cualitativos sobre la toma de decisiones reproductivas entre las MVV en países desarrollados fueron elegibles para su inclusión. Se consideraron países desarrollados aquellos que pertenecieran a la OCDE con el objetivo de comparar condiciones de bienestar social y estabilidad económica. Las listas de verificación CASP y JBI para la investigación cualitativa se utilizaron para evaluar la calidad del estudio y la integridad metodológica. Para la síntesis se utilizaron técnicas de análisis temático y metanálisis cualitativo. RESULTADOS: En la síntesis se incluyeron veinte estudios de 12 países desarrollados. Los hallazgos se organizaron en 3 metatemas de 15 temas y 45 subtemas, incluyendo: (1) Identidad fragmentada, (2) Barreras, inequidades y desinformación, (3) Afrontamiento, resiliencia y apoyo. La toma de decisiones reproductivas se percibió como un proceso complejo influenciado por factores facilitadores y barrera. Los facilitadores ayudaron a las MVV a afrontar su nueva realidad para volverse más resilientes, mientras que las barreras hicieron que su situación fuera más difícil de manejar. CONCLUSIóN: Las MVV enfrentan la toma de decisiones reproductivas con déficits de conocimiento y apoyo social limitado. Es necesario adoptar un enfoque holístico de atención integral con asesoramiento multidisciplinario para acompañar a las MVV. Los clínicos podrían beneficiarse del desarrollo profesional para aprender a estar verdaderamente presentes para las MVV, participando en reflexiones, demostrando compasión y comprendiendo sus situaciones. Las guías de práctica clínica basadas en la evidencia deben adaptarse a las necesidades de planificación familiar y salud sexual y reproductiva de las MVV. Plain Language Summary Women living with HIV can become pregnant and deliver a healthy baby due to advances in medicine. Being a mother is an important role that gives meaning to life for most women. For women living with HIV thinking about having a baby is difficult because HIV complicates many areas of daily living. When women living with HIV try to speak with physicians and nurses about having a baby, they often do not feel supported and report feeling stigmatized. This review of the scientific literature summarizes the experiences of women living with HIV in developed countries as they considered having a baby. Ten electronic databases were searched for studies published between 1995 and 2019 reporting interviews with women living with HIV about becoming pregnant and having a baby. From the 4519 articles identified, 20 were included for review with 1395 participants from 12 developed countries. After abstracting and analyzing the interviews, three themes were developed to summarize the process described by women living with HIV as they considered pregnancy and the possibility of having a baby, including: (1) Shattered identity, (2) Barriers, inequities, and misinformation, and (3) Coping, resiliency, and support. When women living with HIV consider having a baby, they need to feel comfortable and safe speaking with physicians and nurses about family planning. They also need more support from their partner, as well as family and friends. Strategies need to be implemented to improve the family planning process for women living with HIV, including education health care providers about speaking to women about pregnancy and having a healthy baby.

Rising atmospheric CO2 is reducing the protein concentration of a floral pollen source essential for North American bees.

At present, there is substantive evidence that the nutritional content of agriculturally important food crops will decrease in response to rising levels of atmospheric carbon dioxide, Ca However, whether Ca-induced declines in nutritional quality are also occurring for pollinator food sources is unknown. Flowering late in the season, goldenrod (Solidago spp.) pollen is a widely available autumnal food source commonly acknowledged by apiarists to be essential to native bee (e.g. Bombus spp.) and honeybee (Apis mellifera) health and winter survival. Using floral collections obtained from the Smithsonian Natural History Museum, we quantified Ca-induced temporal changes in pollen protein concentration of Canada goldenrod (Solidago canadensis), the most wide spread Solidago taxon, from hundreds of samples collected throughout the USA and southern Canada over the period 1842-2014 (i.e. a Ca from approx. 280 to 398 ppm). In addition, we conducted a 2 year in situtrial of S. Canadensis populations grown along a continuous Ca gradient from approximately 280 to 500 ppm. The historical data indicated a strong significant correlation between recent increases in Ca and reductions in pollen protein concentration (r(2)= 0.81). Experimental data confirmed this decrease in pollen protein concentration, and indicated that it would be ongoing as Ca continues to rise in the near term, i.e. to 500 ppm (r(2)= 0.88). While additional data are needed to quantify the subsequent effects of reduced protein concentration for Canada goldenrod on bee health and population stability, these results are the first to indicate that increasing Ca can reduce protein content of a floral pollen source widely used by North American bees.

Botany: a record-breaking pollen catapult.

The release of stored elastic energy often drives rapid movements in animal systems, and plant components employing this mechanism should be able to move with similar speed. Here we describe how the flower stamens of the bunchberry dogwood (Cornus canadensis) rely on this principle to catapult pollen into the air as the flower opens explosively. Our high-speed video observations show that the flower opens in less than 0.5 ms--to our knowledge, the fastest movement so far recorded in a plant.