Creation of an asynchronous faculty development curriculum on well-written narrative assessments that avoid bias.

BACKGROUND: The COVID-19 pandemic in parallel with concerns about bias in grading resulted in many medical schools adopting pass/fail clinical grading and relying solely on narrative assessments. However, narratives often contain bias and lack specificity. The purpose of this project was to develop asynchronous faculty development to rapidly educate/re-educate > 2000 clinical faculty spread across geographic sites and clinical disciplines on components of a well-written narrative and methods to minimize bias in the assessment of students. METHODS: We describe creation, implementation, and pilot data outcomes for an asynchronous faculty development curriculum created by a committee of volunteer learners and faculty. After reviewing the literature on the presence and impact of bias in clinical rotations and ways to mitigate bias in written narrative assessments, the committee developed a web-based curriculum using multimedia learning theory and principles of adult learning. Just-in-time supplemental materials accompanied the curriculum. The Dean added completion of the module by 90% of clinical faculty to the department chairperson's annual education metric. Module completion was tracked in a learning management system, including time spent in the module and the answer to a single text entry question about intended changes in behavior. Thematic analysis of the text entry question with grounded theory and inductive processing was used to define themes of how faculty anticipate future teaching and assessment as a result of this curricula. OUTCOMES: Between January 1, 2021, and December 1, 2021, 2166 individuals completed the online module; 1820 spent between 5 and 90 min on the module, with a median time of 17 min and an average time of 20.2 min. 15/16 clinical departments achieved completion by 90% or more faculty. Major themes included: changing the wording of future narratives, changing content in future narratives, and focusing on efforts to change how faculty teach and lead teams, including efforts to minimize bias. CONCLUSIONS: We developed a faculty development curriculum on mitigating bias in written narratives with high rates of faculty participation. Inclusion of this module as part of the chair's education performance metric likely impacted participation. Nevertheless, time spent in the module suggests that faculty engaged with the material. Other institutions could easily adapt this curriculum with provided materials.

The Implementation of a Structured Nursing Leadership Development Program for Succession Planning in a Health System.

Preparing future nursing leaders to be successful is important because many current leaders will retire in large numbers in the future. A structured nursing leadership development program utilizing the Essentials of Nurse Manager Orientation online program provided future nursing leaders with content aligned with nursing leadership competencies. Paired with assigned mentors and monthly leadership sessions, the participants increased their perception of leadership competence.

Stepping to stability and fall prevention in adult psychiatric patients.

Fall prevention is a major area of concern in inpatient settings. This article reports on the feasibility of implementing a daily exercise program that features line dancing to promote stability, balance, and flexibility in adult psychiatric patients and describes the impact of that program. Six hundred sixty-five patient charts drawn from before and after the practice change were reviewed. The fall rate after the introduction of line dancing was 2.8% compared with 3.2% before implementation. In a setting that treats both men and women of many ages and with varying levels of mobility, line dancing offers a viable approach to exercise in a secure setting.

The Power of Two:: One Academic-Practice Partnership's Response to Coronavirus Disease 2019 (COVID-19).

Academic-practice partnerships are necessary for strengthening nursing practice, robust and relevant academic programs, and advancing health care. The purpose of this paper is to describe how a strong academic-practice partnership shaped our response to the coronavirus disease 2019 (COVID-19) pandemic. During this unprecedented time, existing relationships between the health system and school of nursing were quickly leveraged to provide mutually beneficial relief, opportunities, and support. Initiatives described in this paper demonstrate how powerful a concentrated academic-practice partnership can be in transforming the nursing profession. Moving forward, it will be crucial for schools to build partnerships with appropriate organizations that have a vested interest in preparing nurses for the future.

Collaboration Between Infection Prevention and Clinical Education in Response to COVID-19.

With the rapid escalation of COVID-19 educational needs within hospitals, it was imperative for content experts of the infection prevention departments to lean on the expertise of nursing professional development specialists. This article provides a brief overview of how a clinical education and professional development department was deployed to assist and support the COVID-19 response efforts.

Using photographic image analysis to assess ground cover: a case study of forest road cutbanks.

Road prisms, including cutbanks, road surfaces, and fillslopes, can be important contributors of sediment to streams in forested watersheds. Following road construction, cutbanks and fillslopes are often seeded, mulched, and sometimes fertilized to limit erosion and sedimentation. Assessing the success of vegetation establishment on cutbanks and fillslopes is a common task of forested land managers. This study developed and applied a photographic image analysis method to assess percent ground cover along an entire cutbank of a cut-and-fill haul road in the Monongahela National Forest in Tucker County, West Virginia. Variable-sized sections were employed to quantify the vegetative cover. Measurements obtained by this technique were similar to more commonly applied fixed-area plots, and it proved to be a useful tool for land managers who require a more repeatable quantification of ground cover than is possible through visual assessments. Cutbank slope and aspect also were analyzed to determine their potential impact on cutbank vegetation establishment. Slope was not a significant variable in explaining differences in vegetation cover; however, aspect did affect vegetation establishment. South-facing aspects had significantly lower percent vegetation cover than northeast, east, northwest, and north northwest aspects after the first year following seeding and throughout the entire study. Mean percent cover on the south-facing cutbanks was 32% over all time periods, compared to 60% to 73% for the other represented aspects. This result was expected since south-facing slopes generally are drier in the growing season and are subject to more freeze-thaw cycles in the winter. Timber felled onto the cutbank also decreased vegetative cover in the short term on north and north northwest aspects, but vegetation quickly became reestablished on these aspects with their favorable growing conditions.

Podcasting: making waves in millennial education.

Podcasting is a useful addition to the repertoire of distance learning technologies that provides a fresh and mobile learning option particularly for millennial learners. Nurse educators should capitalize on this new educational approach, which has much to offer in the line of audio recordings.

Elevating the Voice of Nursing Leadership: AONL's Virtual Advocacy Day.

As we began planning for AONL Advocacy Day during the International Year of the Nurse and Midwife, we expected record attendance at AONL's annual event in Washington, DC. What a great opportunity to raise the profile of nursing and increase legislators' understanding of nursing's impact in advancing health! Registration substantially outpaced all prior years. Then on January 21, 2020, the Centers for Disease Control and Prevention confirmed the first United States case of the novel coronavirus that had already taken 6 lives in China,1 changing life in this country as we know it. As this pandemic changed the way we deliver care, it has also changed the way legislators interact with their constituents.

Assessing streamflow sensitivity of forested headwater catchments to disturbance and climate change in the central Appalachian Mountains region, USA.

Forest headwater catchments are critical sources of water, but climate change and disturbance may threaten their ability to produce reliable and abundant water supplies. Quantifying how climate change and forest disturbances individually and interactively alter streamflow provides important insights into the stability and availability of water derived from headwater catchments that are particularly sensitive to change. We used long-term water balance data, forest inventory measurements, and a multiple-methods approach using Budyko decomposition and paired catchment models to assess how climate change and forest disturbances interact to alter streamflow in five headwater catchments located along a disturbance gradient in the Appalachian Mountains, USA. We found that disturbance was the dominant driver of streamflow changes; disturbed catchments were more sensitive to climate change than the undisturbed catchment; and disturbance was an important factor for a catchment's sensitivity to climate change, principally through changes in species composition and xylem anatomy. Streamflow sensitivity to climate change increased with increasing proportion of diffuse porous species, suggesting that not all disturbances are equal when it comes to streamflow sensitivity to climate change. Climate change effects were masked by disturbance in catchments with high magnitude/low frequency disturbances and amplified in a catchment with low magnitude/high frequency disturbance. Furthermore, critical assumptions of Budyko decomposition were assessed to evaluate the efficacy of applying decomposition to the headwater scale. Our study demonstrates the efficacy and usefulness of applying decomposition to scales potentially useful to resource managers and decision makers. Our study contributes to a more thorough understanding about the impacts of climate change on disturbed headwater catchments that will help managers to better prepare for and adapt to future changes.

Effect of Peer-to-Peer Nurse-Physician Collaboration on Attitudes Toward the Nurse-Physician Relationship.

The goal of this study was to pilot a novel peer-to-peer nurse-physician collaboration program and assess for changes in attitudes toward collaboration among a group of newly licensed nurses and resident physicians (n = 39). The program included large group meetings, with discussion of key concepts related to interprofessional collaboration. In unit-based teams, the registered nurses and physicians developed a quality improvement project to meet a need on their unit. Creating learning activities like this program enable nursing professional development specialists to promote interprofessional collaboration and learning.

Test-Retest Reliability of the Genetics and Genomics in Nursing Practice Survey Instrument.

BACKGROUND AND PURPOSE: Assessment of nursing genomic competency is critical given increasing genomic applications to health care. The study aims were to determine the test-retest reliability of the Genetics and Genomics in Nursing Practice Survey (GGNPS), which measures this competency, and to revise the survey accordingly. METHODS: Registered nurses (n = 232) working at 2 Magnet-designated hospitals participating in a multiinstitutional genomic competency study completed the GGNPS. Cohen's kappa and weighted kappa were used to measure the agreement of item responses between Time 1 and Time 2. Survey items were revised based on the results. RESULTS: Mean agreement for the instrument was 0.407 (range = 0.150-1.000). Moderate agreement or higher was achieved in 39% of the items. CONCLUSIONS: GGNPS test-retest reliability was not optimal, and the instrument was refined based on the study findings. Further testing of the revised instrument is planned to assess the instrument performance.

Clonogenic analysis reveals reserve stem cells in postnatal mammals. II. Pluripotent epiblastic-like stem cells.

Undifferentiated cells have been identified in the prenatal blastocyst, inner cell mass, and gonadal ridges of rodents and primates, including humans. After isolation these cells express molecular and immunological markers for embryonic cells, capabilities for extended self-renewal, and telomerase activity. When allowed to differentiate, embryonic stem cells express phenotypic markers for tissues of ectodermal, mesodermal, and endodermal origin. When implanted in vivo, undifferentiated noninduced embryonic stem cells formed teratomas. In this report we describe a cell clone isolated from postnatal rat skeletal muscle and derived by repetitive single-cell clonogenic analysis. In the undifferentiated state it consists of very small cells having a high ratio of nucleus to cytoplasm. The clone expresses molecular and immunological markers for embryonic stem cells. It exhibits telomerase activity, which is consistent with its extended capability for self-renewal. When induced to differentiate, it expressed phenotypic markers for tissues of ectodermal, mesodermal, and endodermal origin. The clone was designated as a postnatal pluripotent epiblastic-like stem cell (PPELSC). The undifferentiated clone was transfected with a genomic marker and assayed for alterations in stem cell characteristics. No alterations were noted. The labeled clone, when implanted into heart after injury, incorporated into myocardial tissues undergoing repair. The labeled clone was subjected to directed lineage induction in vitro, resulting in the formation of islet-like structures (ILSs) that secreted insulin in response to a glucose challenge. This study suggests that embryonic-like stem cells are retained within postnatal mammals and have the potential for use in gene therapy and tissue engineering.

Stagnant perceptions of nursing among high school students: results of a shadowing intervention study.

To gain insight into high school students' perceptions of the role of the nurse and to explore students' impressions of nursing following a nurse-shadowing intervention. Often nurses abandon staffing positions in the first 1-2 years, reporting a "poor fit" with nursing. Few studies have examined expectations and perceptions of nursing among high school students; a population of potential nurses in whom a more accurate view of nursing opportunities and professionalism may be fostered. High school students from two North Carolina counties participated in a nurse-shadowing intervention. Constant comparison and thematic coding were used for analysis of post-intervention in-depth interviews. Sixteen of 24 students completed the study. Misperception of nursing was the dominant theme. Five sub-themes were professional role responsibility, teamwork, caring relationships, tools and technology, and medication management. Experiential knowledge of nursing was a core need for students interested in nursing careers. These data suggest that a nurse shadowing program may positively influence perceptions of nursing, and may result in improved recruitment and retention in the workplace.

Ozone exposures and implications for vegetation in rural areas of the central Appalachian Mountains, U.S.A.

The United States is making the transition from the 1979 1 hr maximum ozone standard to the newly adopted 8 hr ozone standard (3 yr average of the 4th highest maximum 8 hr ozone concentration). Consequently, we analyzed and compared ozone concentrations under both standards from a variety of monitoring sites throughout the central Appalachian region of Kentucky (KY), West Virginia (WV), and Virginia (VA). Data from 1988-1999 were used to determine how ozone exposure between the two metrics compared for remote sites. Most sites exceeded the 1 hr standard in 1988-1990 due to the 3 yr averaging and multiple high ozone concentrations that occurred over the region in 1988. All sites were in compliance with the 1 hr standard every year after 1991. It was much more common for the ozone exposure to exceed the 8 hr standard, particularly from 1997-1999. Many sites showed exceedences beginning in 1995; Big Meadows (VA) exceeded the 8 hr standard all years except 1994 and 1996. Response of vegetation to ozone in these areas was determined using the combination of W126 values (sigmoidally weighted exposure index), the number of hours that average concentrations > or = 0.10 ppm (N100), and the presence of moderate or more extreme droughts. In general, W126 and N100 values suggested that negative vegetation growth responses over most of the 12 yr would have been minimal for most sites, even for those exceeding ozone standards. Drought-induced stomatal closures would have overridden more extreme negative growth responses at all but the Big Meadows site in 1988.

Sampling considerations for establishment of baseline loadings from forested watersheds for TMDL application.

Five methods for estimating maximum daily and annual nitrate (NO3) and suspended sediment loads using periodic sampling of varying intensities were compared to actual loads calculated from intensive stormflow and baseflow sampling from small, forested watersheds in north central West Virginia to determine if the less intensive sampling methods were accurate and could be utilized in TMDL development. There were no significant differences between the annual NO3 load estimates using non-intensive sampling methods and the actual NO3 loads. However, maximum daily NO3 loads were estimated less accurately than annual loads. The ability to estimate baseline NO3 loads fairly accurately with non-intensive concentration data is attributed to the small fluctuation in NO3 concentrations over flow and time, particularly during storms. By contrast, suspended sediment exports determined by any of the non-intensive methods varied significantly and widely from and compared poorly to the actual exports for both daily and annual methods. Weekly sampling better approximated actual annual exports, but there were no significant statistical differences among weekly, monthly, and quarterly estimates. Suspended sediment concentrations varied widely within and among storm events, so that accurate estimates of total annual or maximum daily loads could not be obtained from infrequent sampling.

A survey of ovary-, testis-, and soma-biased gene expression in Drosophila melanogaster adults.

BACKGROUND: Sexual dimorphism results in the formation of two types of individuals with specialized reproductive roles and is most evident in the germ cells and gonads. RESULTS: We have undertaken a global analysis of transcription between the sexes using a 31,464 element FlyGEM microarray to determine what fraction of the genome shows sex-biased expression, what tissues express these genes, the predicted functions of these genes, and where these genes map onto the genome. Females and males (both with and without gonads), dissected testis and ovary, females and males with genetically ablated germlines, and sex-transformed flies were sampled. CONCLUSIONS: Using any of a number of criteria, we find extensive sex-biased expression in adults. The majority of cases of sex differential gene expression are attributable to the germ cells. There is also a large class of genes with soma-biased expression. There is little germline-biased expression indicating that nearly all genes with germline expression also show sex-bias. Monte Carlo simulations show that some genes with sex-biased expression are non-randomly distributed in the genome.

FlyGEM, a full transcriptome array platform for the Drosophila community.

We have constructed a DNA microarray to monitor expression of predicted genes in Drosophila. By using homotypic hybridizations, we show that the array performs reproducibly, that dye effects are minimal, and that array results agree with systematic northern blotting. The array gene list has been extensively annotated and linked-out to other databases. Incyte and the NIH have made the platform available to the community via academic microarray facilities selected by an NIH committee.