Association and Dose-Response Relationship of Self-Reported Physical Activity and Disability Among Adults ≥50 Years: National Health and Nutrition Examination Survey, 2011-2016.

Disability is a tremendous public health challenge. No study has assessed whether meeting U.S. Physical Activity guidelines is associated with disability in mobility tasks, activities of daily living, and social participation among U.S. older adults. Using 2011-2016 National Health and Nutrition Examination Survey data, this study examined this relationship among 8,309 individuals aged ≥50 years. Most participants (n = 4,272) did not achieve guidelines, and 2,912 participants were completely inactive. People who did not meet guidelines had higher odds of disability compared with those who did (adjusted odds ratio [AOR] = 1.80) in addition to difficulty with mobility tasks (AOR = 1.85), activities of daily living (AOR = 1.66), and social participation (AOR = 2.09). There was a dose-response effect for each level of activity (inactive, insufficient, and meeting and exceeding recommendations). Among adults aged ≥50 years, meeting the U.S. guidelines was associated with better social and physical functioning.

Onset of Antarctic Circumpolar Current 30 million years ago as Tasmanian Gateway aligned with westerlies.

Earth's mightiest ocean current, the Antarctic Circumpolar Current (ACC), regulates the exchange of heat and carbon between the ocean and the atmosphere, and influences vertical ocean structure, deep-water production and the global distribution of nutrients and chemical tracers. The eastward-flowing ACC occupies a unique circumglobal pathway in the Southern Ocean that was enabled by the tectonic opening of key oceanic gateways during the break-up of Gondwana (for example, by the opening of the Tasmanian Gateway, which connects the Indian and Pacific oceans). Although the ACC is a key component of Earth's present and past climate system, the timing of the appearance of diagnostic features of the ACC (for example, low zonal gradients in water-mass tracer fields) is poorly known and represents a fundamental gap in our understanding of Earth history. Here we show, using geophysically determined positions of continent-ocean boundaries, that the deep Tasmanian Gateway opened 33.5 ± 1.5 million years ago (the errors indicate uncertainty in the boundary positions). Following this opening, sediments from Indian and Pacific cores recorded Pacific-type neodymium isotope ratios, revealing deep westward flow equivalent to the present-day Antarctic Slope Current. We observe onset of the ACC at around 30 million years ago, when Southern Ocean neodymium isotopes record a permanent shift to modern Indian-Atlantic ratios. Our reconstructions of ocean circulation show that massive reorganization and homogenization of Southern Ocean water masses coincided with migration of the northern margin of the Tasmanian Gateway into the mid-latitude westerly wind band, which we reconstruct at 64° S, near to the northern margin. Onset of the ACC about 30 million years ago coincided with major changes in global ocean circulation and probably contributed to the lower atmospheric carbon dioxide levels that appear after this time.

Impact of a sepsis educational program on nurse competence.

Sepsis is an emerging life-threatening entity and a worldwide epidemic. Nurses are in key positions to identify patients with sepsis, mobilize the medical team, and implement interventions. A study of self-assessed nurse competence was conducted to determine the influence of a specially designed sepsis education program on nurses' perceived ability to identify early, intervene, and care for patients with sepsis. The program was a multimodal design incorporating online interactive didactic presentations, video vignettes, pre- and postknowledge tests, and high-fidelity medical simulation scenarios. A sample of 82 critical care and emergency department nurses in a 1-year critical care nurse training program was used for this study. Pretest and posttest module knowledge scores and self-assessed competence data were collected and analyzed. No improvement in the overall self-assessed competence scores was found; however, self-perceived frequency of use of competence behaviors improved. Participants felt more competent on three sepsis-targeted statements, and posttest knowledge scores showed significant improvement.

Specialized new graduate RN pediatric orientation: a strategy for nursing retention and its financial impact.

New graduate RN retention in the first year of employment is a challenge for hospitals, ranging from a low of 25% to a high of 64%. In 2005, hospitals in New York state spent 11.7% of their nursing budgets on temporary nursing staffing. The objectives of this study were to determine the retention and costs associated with the employment of new graduate RNs before and after the initiation of specialized year-long pediatric critical care, emergency department, and hematology/oncology orientation programs. The major study findings were improved retention of 84% to 94%, significant retention between the two groups at 9 months, and an annual financial savings related to decreased nursing turnover in the specialized orientation group. Specialized orientation programs that support new graduate RNs have documented increased RN retention and decreased RN turnover. In concert with the increased retention and decreased turnover, health care finances were positively impacted by specialized orientation programs.

A Cenozoic record of the equatorial Pacific carbonate compensation depth.

Atmospheric carbon dioxide concentrations and climate are regulated on geological timescales by the balance between carbon input from volcanic and metamorphic outgassing and its removal by weathering feedbacks; these feedbacks involve the erosion of silicate rocks and organic-carbon-bearing rocks. The integrated effect of these processes is reflected in the calcium carbonate compensation depth, which is the oceanic depth at which calcium carbonate is dissolved. Here we present a carbonate accumulation record that covers the past 53 million years from a depth transect in the equatorial Pacific Ocean. The carbonate compensation depth tracks long-term ocean cooling, deepening from 3.0-3.5 kilometres during the early Cenozoic (approximately 55 million years ago) to 4.6 kilometres at present, consistent with an overall Cenozoic increase in weathering. We find large superimposed fluctuations in carbonate compensation depth during the middle and late Eocene. Using Earth system models, we identify changes in weathering and the mode of organic-carbon delivery as two key processes to explain these large-scale Eocene fluctuations of the carbonate compensation depth.

Leadership initiatives to disseminate the institute of medicine's future of nursing report.

This article discusses the critical role professional nurses will play and the tremendous impact nursing education and leadership development will have on the future of health care, as outlined in the recommendations of the Institute of Medicine's report, "The future of nursing: Leading change, and advancing health." Six doctorate of nursing practice students from Case Western Reserve University analyzed the Institute of Medicine (IOM) report and developed projects to disseminate key components to selected organizations. The students developed two primary initiatives. One initiative involved presenting the report to various professional organizations, including a local chapter of an international honor society, a specialty organization, and a health care organization. The second initiative included interviewing several nurse leaders within a large multihospital health system, and a nursing leader in academia to determine (a) the level of awareness about the IOM report and (b) strategies these leaders have implemented or envisioned to address the report recommendations.

A review of current clinical photography guidelines in relation to smartphone publishing of medical images.

The rise in popularity of smartphones has seen a surge in the number of smartphone-specific software applications (apps) available. Among these apps, many are medical and healthcare related, of benefit to both the general public and healthcare staff. With this improved technology comes the ability to display full-colour images and videos, for which medical images could be utilised. We reviewed current clinical photography guidelines in relation to the publishing of medical images in smartphone apps. Of the 5 relevant guidelines, none discussed hand-held electronic media or smartphone app publishing. This creates confusion for clinicians as to how to interpret current guidelines for this purpose. Medical illustrators, clinicians and NHS Trusts need to be aware of the changes in technology and the ethical considerations of allowing medical images to be published within smartphones. We discuss the issues surrounding consent and provide practical tips for obtaining informed consent from patients to publish medical images in smartphone apps.

Permanent El Niño-like conditions during the Pliocene warm period.

During the warm early Pliocene (approximately 4.5 to 3.0 million years ago), the most recent interval with a climate warmer than today, the eastern Pacific thermocline was deep and the average west-to-east sea surface temperature difference across the equatorial Pacific was only 1.5 +/- 0.9 degrees C, much like it is during a modern El Niño event. Thus, the modern strong sea surface temperature gradient across the equatorial Pacific is not a stable and permanent feature. Sustained El Niño-like conditions, including relatively weak zonal atmospheric (Walker) circulation, could be a consequence of, and play an important role in determining, global warmth.

A transient rise in tropical sea surface temperature during the Paleocene-Eocene thermal maximum.

The Paleocene-Eocene Thermal Maximum (PETM) has been attributed to a rapid rise in greenhouse gas levels. If so, warming should have occurred at all latitudes, although amplified toward the poles. Existing records reveal an increase in high-latitude sea surface temperatures (SSTs) (8 degrees to 10 degrees C) and in bottom water temperatures (4 degrees to 5 degrees C). To date, however, the character of the tropical SST response during this event remains unconstrained. Here we address this deficiency by using paired oxygen isotope and minor element (magnesium/calcium) ratios of planktonic foraminifera from a tropical Pacific core to estimate changes in SST. Using mixed-layer foraminifera, we found that the combined proxies imply a 4 degrees to 5 degrees C rise in Pacific SST during the PETM. These results would necessitate a rise in atmospheric pCO2 to levels three to four times as high as those estimated for the late Paleocene.