Building a Foundation of Evidence to Support Nurses Returning to School: The Role of Empowerment.

AIM: The aim of the study was to investigate the role of Kanter's theory of workplace empowerment in nurses' attitude toward returning to school. BACKGROUND: Increasing the percentage of BSNs has a positive effect on outcomes, but few hospitals offer formal support systems beyond tuition reimbursement. Workplace empowerment theory may explain attitudes toward returning to school. METHOD: A mixed-methods design was used with a cross-sectional survey and focus group. RESULTS: Significant predictors of attitude toward returning to school (n = 162) were formal power (p = .003), access to support (p = .007), and access to resources (p = .050). Focus group themes (n = 3) were resources important to returning to school/manager support, timing, becoming aware of opportunities after enrolling, and intrinsic desire to return to school. CONCLUSION: Exploring relationships between workplace empowerment and attitudes toward returning to school will guide hospital executives in building support systems for nurses returning to school.

Building a collaborative Psychological Science: Lessons learned from ManyBabies 1.

The field of infancy research faces a difficult challenge: some questions require samples that are simply too large for any one lab to recruit and test. ManyBabies aims to address this problem by forming large-scale collaborations on key theoretical questions in developmental science, while promoting the uptake of Open Science practices. Here, we look back on the first project completed under the ManyBabies umbrella - ManyBabies 1 - which tested the development of infant-directed speech preference. Our goal is to share the lessons learned over the course of the project and to articulate our vision for the role of large-scale collaborations in the field. First, we consider the decisions made in scaling up experimental research for a collaboration involving 100+ researchers and 70+ labs. Next, we discuss successes and challenges over the course of the project, including: protocol design and implementation, data analysis, organizational structures and collaborative workflows, securing funding, and encouraging broad participation in the project. Finally, we discuss the benefits we see both in ongoing ManyBabies projects and in future large-scale collaborations in general, with a particular eye towards developing best practices and increasing growth and diversity in infancy research and psychological science in general. Throughout the paper, we include first-hand narrative experiences, in order to illustrate the perspectives of researchers playing different roles within the project. While this project focused on the unique challenges of infant research, many of the insights we gained can be applied to large-scale collaborations across the broader field of psychology.

Nurse and Patient Satisfaction.

The American Nurses Credentialing Center's Magnet Recognition Program 2019 Magnet Application Manual "continue(s) to raise the bar as the gold standard for nursing" (p. IX). In this column, the authors, who are Magnet commissioners, provide background and guidance on the standards for nurse satisfaction and patient satisfaction.

Survey of HIV care providers on management of HIV serodiscordant couples - assessment of attitudes, knowledge, and practices.

Human immunodeficiency virus (HIV) serodiscordant couples are at risk of sexual transmission of HIV between the infected and uninfected partner. We assessed New York area care providers for people living with HIV regarding attitudes, knowledge, and practice patterns toward fertility and conception in serodiscordant couples. Data were collected via a survey distributed in October 2013. Seventeen percent of respondents reported prescribing antiretroviral preexposure prophylaxis (PrEP) for a woman in a serodiscordant couple, and 38% percent of respondents reported having counseled serodiscordant couples on timed, unprotected intercourse without PrEP. Respondents who reported being "very" familiar with the data on HIV transmission in serodiscordant couples were more likely to report counseling their patients in timed, unprotected intercourse compared with those who reported less familiarity with the data (41% vs. 8%, p = 0.001). Although only 20% reported being "very" or "somewhat" familiar with the data on the safety of sperm washing with intrauterine insemination, those who did were more likely to have reported referring a patient for assisted reproductive technology (61% vs. 32%, p = 0.006). Effective patient counseling and referral for appropriate reproductive options were associated with knowledge of the literature pertaining to these options. This emphasizes the need for further provider education on reproductive options and appropriate counseling for serodiscordant couples.

Syntactic generalization with novel intransitive verbs.

To understand how children develop adult argument structure, we must understand the nature of syntactic and semantic representations during development. The present studies compare the performance of children aged 2;6 on the two intransitive alternations in English: patient (Daddy is cooking the food/The food is cooking) and agent (Daddy is cooking). Children displayed abstract knowledge of both alternations, producing appropriate syntactic generalizations with novel verbs. These generalizations were adult-like in both flexibility and constraint. Rather than limiting their generalizations to lexicalized frames, children produced sentences with a variety of nouns and pronouns. They also avoided semantic overgeneralizations, producing intransitive sentences that respected the event restrictions and animacy cues. Some generated semantically appropriate agent intransitives when discourse pressure favored patient intransitives, indicating a stronger command of the first alternation. This was in line with frequency distributions in child-directed speech. These findings suggest that children have early access to representations that permit flexible argument structure generalization.

Interplay between single resistance-associated mutations in the HIV-1 protease and viral infectivity, protease activity, and inhibitor sensitivity.

Resistance-associated mutations in the HIV-1 protease modify viral fitness through changes in the catalytic activity and altered binding affinity for substrates and inhibitors. In this report, we examine the effects of 31 mutations at 26 amino acid positions in protease to determine their impact on infectivity and protease inhibitor sensitivity. We found that primary resistance mutations individually decrease fitness and generally increase sensitivity to protease inhibitors, indicating that reduced virion-associated protease activity reduces virion infectivity and the reduced level of per virion protease activity is then more easily titrated by a protease inhibitor. Conversely, mutations at more variable positions (compensatory mutations) confer low-level decreases in sensitivity to all protease inhibitors with little effect on infectivity. We found significant differences in the observed effect on infectivity with a pseudotype virus assay that requires the protease to cleave the cytoplasmic tail of the amphotropic murine leukemia virus (MuLV) Env protein. Additionally, we were able to mimic the fitness loss associated with resistance mutations by directly reducing the level of virion-associated protease activity. Virions containing 50% of a D25A mutant protease were 3- to 5-fold more sensitive to protease inhibitors. This level of reduction in protease activity also resulted in a 2-fold increase in sensitivity to nonnucleoside inhibitors of reverse transcriptase and a similar increase in sensitivity to zidovudine (AZT), indicating a pleiotropic effect associated with reduced protease activity. These results highlight the interplay between enzyme activity, viral fitness, and inhibitor mechanism and sensitivity in the closed system of the viral replication complex.

Analysis of participatory photojournalism in a widely disseminated skin cancer prevention program.

This article describes the content of pictures submitted to a photo contest as part of a nationally disseminated skin cancer prevention program called Pool Cool. The aims of this analysis are to describe sun-safety behaviors and environmental supports depicted in the photos and to gain insight into pool staff perceptions of the program. A directed approach was used to assess the content of 1,886 photos submitted in 2005 and 2006. Staying in the shade and applying sunscreen were the most common sun-safety behaviors shown among children. Among adults and lifeguards, wearing sunglasses and a shirt with sleeves were most common. Most photos contained at least one sun-safety support, and half showed use of Pool Cool program materials. Most photos promoted the use of Pool Cool materials, sun-safety behaviors, or sun-safe pool environments. Participatory photojournalism is a low-cost and effective way to generate widespread interest and support for community health promotion programs.

Shadowing to Improve Teamwork and Communication:: A Potential Strategy for Surge Staffing.

Teamwork and communication are paramount to patient safety. Poor communication during handoff is implicated in near misses and adverse events. Exposing nurses to other units' workflow early in their orientation may also aid in surge staffing. This study showed improvements in teamwork and communication, and a deeper understanding of another units' workflow.

Identifying and Managing Malnourished Hospitalized Patients Utilizing the Malnutrition Quality Improvement Initiative: The UPMC Experience.

Registered dietitian nutritionists at University of Pittsburgh Medical Center, a group of 40 academic, community, and specialty hospitals in Pittsburgh, PA, recognized the need to improve the identification and management of malnourished adult patients at their institutions. It was decided to pilot the Malnutrition Quality Improvement Initiative (MQii) at two institutions within their health care system. The MQii is based on the dual-pronged approach of malnutrition-focused electronic clinical quality measures and a quality improvement toolkit (MQii Toolkit), to help identify and manage malnourished adult patients. The quality improvement implementation focused on hospital-wide adoption of the Nutrition Focused Physical Examination (NFPE). The MQii team was guided by the malnutrition electronic clinical quality measures focused on completing a nutrition assessment (the NFPE) within 24 hours of identification of malnutrition risk and ensuring documentation of a malnutrition diagnosis when it was identified. Performance on both measures improved significantly (P<0.01). Performance on appropriate timing of nutrition risk screening improved slightly, and there was almost perfect compliance for completion of nutrition care plans in the presence of malnutrition. Overall, the performance data demonstrated the effectiveness of using the MQii to improve the nutrition processes and the ability to implement NFPE into the process of malnutrition identification. FUNDING/SUPPORT: Publication of this supplement was supported by Abbott. The Academy of Nutrition and Dietetics does not receive funding for the MQii. Avalere Health's work to support the MQii was funded by Abbott.

The Psychological Science Accelerator: Advancing Psychology through a Distributed Collaborative Network.

Concerns have been growing about the veracity of psychological research. Many findings in psychological science are based on studies with insufficient statistical power and nonrepresentative samples, or may otherwise be limited to specific, ungeneralizable settings or populations. Crowdsourced research, a type of large-scale collaboration in which one or more research projects are conducted across multiple lab sites, offers a pragmatic solution to these and other current methodological challenges. The Psychological Science Accelerator (PSA) is a distributed network of laboratories designed to enable and support crowdsourced research projects. These projects can focus on novel research questions, or attempt to replicate prior research, in large, diverse samples. The PSA's mission is to accelerate the accumulation of reliable and generalizable evidence in psychological science. Here, we describe the background, structure, principles, procedures, benefits, and challenges of the PSA. In contrast to other crowdsourced research networks, the PSA is ongoing (as opposed to time-limited), efficient (in terms of re-using structures and principles for different projects), decentralized, diverse (in terms of participants and researchers), and inclusive (of proposals, contributions, and other relevant input from anyone inside or outside of the network). The PSA and other approaches to crowdsourced psychological science will advance our understanding of mental processes and behaviors by enabling rigorous research and systematically examining its generalizability.

Utility of Ovarian Reserve Screening with Anti-Müllerian Hormone for Reproductive Age Women Deferring Pregnancy.

BACKGROUND: Ovarian reserve (OR) testing with serum anti-Müllerian hormone (AMH) can provide information about a woman's fertility potential. The aim of this study was to assess interest and knowledge about OR testing and investigate the utility of measuring AMH in women of reproductive age deferring pregnancy. METHODS: Women ages 27-37 years currently delaying childbearing were invited to take a survey regarding attitudes and knowledge about OR testing before and after an AMH measurement with explanation of their results. RESULTS: Of 121 women who took the pre-test survey, 96% believed OR testing was beneficial. The median AMH of the 97 women who underwent testing was 3.3 ng/mL (IQR 1.9-5.4 ng/mL). Nineteen percent of women had AMH <10th percentile for age and 3% had an undetectable AMH. Although 83% of these women were using hormonal contraception, none had known risk factors for diminished ovarian reserve. Seventy-eight percent of women with low AMH levels for age planned to seek fertility preservation or pregnancy, while those with AMH levels within established age normograms were reassured. On the post-test survey, 100% reported benefit in knowing their AMH level. Follow-up testing, 6-8 months after the initial measurement, showed stable AMH levels for most participants. CONCLUSIONS: Women are interested in OR testing. Most women will be reassured by knowing their AMH level, whereas those with a lower AMH can be counseled on fertility preservation options or may attempt pregnancy earlier.

A Collaborative Approach to Infant Research: Promoting Reproducibility, Best Practices, and Theory-Building.

The ideal of scientific progress is that we accumulate measurements and integrate these into theory, but recent discussion of replicability issues has cast doubt on whether psychological research conforms to this model. Developmental research-especially with infant participants-also has discipline-specific replicability challenges, including small samples and limited measurement methods. Inspired by collaborative replication efforts in cognitive and social psychology, we describe a proposal for assessing and promoting replicability in infancy research: large-scale, multi-laboratory replication efforts aiming for a more precise understanding of key developmental phenomena. The ManyBabies project, our instantiation of this proposal, will not only help us estimate how robust and replicable these phenomena are, but also gain new theoretical insights into how they vary across ages, linguistic communities, and measurement methods. This project has the potential for a variety of positive outcomes, including less-biased estimates of theoretically important effects, estimates of variability that can be used for later study planning, and a series of best-practices blueprints for future infancy research.