Unpacking the Paradox: Understanding the Gap Between Perceived and Actual Competence in LGBTQ+ Health Care.

BACKGROUND: Awareness about existing health disparities affecting sexual minorities remains insufficient, and nursing professionals often lack self-awareness about their biases and assumptions concerning lesbian, gay, bisexual, transgender, or queer/questioning (LGBTQ) individuals. PURPOSE: To explore how exposure to the LGBTQ community, during both classroom and clinical experiences, relates to nursing students' confidence in providing culturally congruent care to this group. METHODS: This nonexperimental correlational study occurred at a Midwest 4-year public university, involving final-semester baccalaureate nursing students who completed demographic and educational preparation surveys regarding their confidence in providing health care to the LGBTQ population. RESULTS: Results indicate that participants with no direct care experience were more confident in their communication skills and culturally congruent patient care for sexual minorities compared to those exposed to sexual minorities in clinical settings. CONCLUSIONS: Nursing students' perceptions and experiences in delivering culturally congruent health care to sexual minorities provide an interesting perspective for examining the Dunning-Kruger effect.

Understanding poverty through virtual simulation: implications for student clinical practice.

BACKGROUND: Competency-based education among baccalaureate nursing students is emerging based on American Association of Colleges of Nursing Essentials. With the impact of COVID-19 on nursing education and AACN recommendations, changes were required to provide alternative modes of delivery and means of assessment. PURPOSE: Virtual poverty simulation data is limited. The use of virtual poverty simulation will ensure students' mastery of core competencies while offering versatility in an online environment. METHODS: Students virtually completed online pre-work, SPENT, a virtual poverty simulation, online debriefing, post-simulation assessment using the Simulation Effectiveness Tool, and post-simulation journaling. RESULTS: 94 % of students demonstrated improved clinical decision making, increased confidence in prioritizing care, communication and reporting, and fostering patient safety. Four themes were identified from journals. CONCLUSIONS: The use of virtual poverty simulation with baccalaureate nursing students was identified as useful pedagogy for increasing student understanding of health implications related to poverty in a virtual learning environment.

Consideration of Gender in Cardiovascular Disease Prevention and Management.

According to the World Health Organization, heart disease is the leading cause of death worldwide, accounting for approximately 17.9 million deaths annually. Although both men and women experience heart disease, there are notable differences in pathophysiology, evaluation, and pharmacologic management related to biological sex and gender. Men are more likely to develop heart disease at younger ages with more severe presentations. Women usually develop heart disease later in life and have more subtle symptoms, including microvascular involvement. It is essential that providers are aware of gender disparities, social determinants, and modifiable risk factors in prevention of heart disease.

Consideration of Gender on Hormone Therapy Management.

Hormone therapy is a common treatment method for adult males, females, and transgender and gender-diverse individuals. Both men, women, and transgender and gender-diverse people may use hormone therapy at some point in their lives. There are notable differences and similarities in risk factors related to hormone therapy use based on genetics, sex, gender, personal history, and the type of hormone therapy used. Provider awareness in gender-inclusive hormone therapy management with the consideration of nonmodifiable and modifiable risk factors, prevention of complications, and monitoring parameters is essential in clinical practice.

Decreased 14-3-3 expression correlates with age-related regional reductions in CNS dopamine and motor function in the pond snail, Lymnaea.

Ageing is associated in many organisms with a reduction in motor movements. We have previously shown that the rate of feeding movements of the pond snail, Lymnaea, decreased with age but the underlying cause is not fully understood. Here, we show that dopamine in the cerebro-buccal complex is an important signalling molecule regulating feeding frequency in Lymnaea and that ageing is associated with a decrease in CNS dopamine. A proteomic screen of young and old CNSs highlighted a group of proteins that regulate stress responses. One of the proteins identified was 14-3-3, which can enhance the synthesis of dopamine. We show that the Lymnaea 14-3-3 family exists as three distinct isoforms. The expression of the 29 kDa isoform (14-3-3Lym3) in the cerebro-buccal complex decreased with age and correlated with feeding rate. Using a 14-3-3 antagonist (R18) we were able to reduce the synthesis of L-DOPA and dopamine in ex vivo cerebro-buccal complexes. Together these data suggest that an age-related reduction in 14-3-3 can decrease CNS dopamine leading to a consequential reduction in feeding rate.

Physical Performance and Fall Risk in Persons With Traumatic Brain Injury.

Injuries sustained from traumatic brain injury (TBI) culminate in both cognitive and neuromuscular deficits. Patients often progress to higher functioning on the Rancho continuum even while mobility deficits persist. Although prior studies have examined physical performance among persons with chronic symptoms of TBI, less is known about the relatively acute phase of TBI as patients prepare for rehabilitation discharge. The aims of this cross-sectional study were to (a) compare balance and gait performance in 20 ambulant persons with moderate to severe TBI who were nearing rehabilitation discharge with their age-matched controls and (b) describe performance with thresholds for fall risk and community navigation. During a designed task circuit, 40 participants (20 persons with TBI and 20 controls) performed the Timed Up and Go (TUG), gait velocity, and Walking and Remembering tests. Balance testing included the Fullerton Advanced Balance Scale (FABS) and instrumented Modified Clinical Test for Sensory Interaction in Balance (MCTSIB). Statistical analyses included analysis of covariance for group comparisons and a multivariate analysis of covariance for MCTSIB sway velocities with anthropometric controls. The TBI group (mean [ M] age = 42, standard deviation [ SD] =19.5 years; 70% males) performed significantly more poorly on all mobility tests ( p < .05) and their scores reflected a potential fall risk. Gait velocity was significantly slower for the TBI versus control group ( M = .96, SD = 2.6 vs. M = 1.5, SD = 2.2 m/s; p < .001), including TUG times ( M = 13.5, SD = 4.9 vs. M = 7.7, SD = 1.4; p < .001). TBI participants also demonstrated significantly greater sway velocity on all MCTSIB conditions ( p < .01) and lower performance on the FABS ( p < .001). Performance indices indicate potential fall risk and community navigation compromise for individuals with moderate to severe TBI. Physical performance scores support the need for continued interventions to optimize functional mobility upon discharge.

Results-Based Financing in Mozambique's Central Medical Store: A Review After 1 Year.

BACKGROUND: Public health commodity supply chains are typically weak in low-income countries, partly because they have many disparate yet interdependent functions and components. Approaches to strengthening supply chains in such settings have often fallen short-they address technical weaknesses, but not the incentives that motivate staff to perform better. METHODS: We reviewed the first year of a results-based financing (RBF) program in Mozambique, which began in January 2013. The program aimed to improve the performance of the central medical store-Central de Medicamentos e Artigos Medicos (CMAM)-by realigning incentives. We completed in-depth interviews and focus group discussions with 33 key informants, including representatives from CMAM and donor agencies, and collected quantitative data on performance measures and use of funds. IMPLEMENTATION: The RBF agreement linked CMAM performance payments to quarterly results on 5 performance indicators related to supply planning, distribution planning, and warehouse management. RBF is predicated on the theory that a combination of carrot and stick-i.e., shared financial incentives, plus increased accountability for results-will spur changes in behavior. Important design elements: (1) indicators were measured against quarterly targets, and payments were made only for indicators that met those targets; (2) targets were set based on documented performance, at levels that could be reasonably attained, yet pushed for improvement; (3) payment was shared with and dependent on all staff, encouraging teamwork and collaboration; (4) results were validated by verifiable data sources; and (5) CMAM had discretion over how to use the funds. FINDINGS: We found that CMAM's performance continually improved over baseline and that CMAM achieved many of its performance targets, for example, timely submission of quarterly supply and distribution planning reports. Warehouse indicators, such as inventory management and order fulfillment, proved more challenging but were nonetheless positive. By linking payments to periodic verified results, and giving CMAM discretion over how to spend the funds, the RBF agreement motivated the workforce; focused attention on results; strengthened data collection; encouraged teamwork and innovation; and ultimately strengthened the central supply chain. CONCLUSION: Policy makers and program managers can use performance incentives to catalyze and leverage existing investments. To further strengthen the approach, such incentive programs can shift attention from quantity to quality indicators, improve verification processes, and aim to institutionalize the approach.

Financial incentives and maternal health: where do we go from here?

Health financing strategies that incorporate financial incentives are being applied in many low- and middle-income countries, and improving maternal and neonatal health is often a central goal. As yet, there have been few reviews of such programmes and their impact on maternal health. The US Government Evidence Summit on Enhancing Provision and use of Maternal Health Services through Financial Incentives was convened on 24-25 April 2012 to address this gap. This article, the final in a series assessing the effects of financial incentives--performance-based incentives (PBIs), insurance, user fee exemption programmes, conditional cash transfers, and vouchers--summarizes the evidence and discusses issues of context, programme design and implementation, cost-effectiveness, and sustainability. We suggest key areas to consider when designing and implementing financial incentive programmes for enhancing maternal health and highlight gaps in evidence that could benefit from additional research. Although the methodological rigor of studies varies, the evidence, overall, suggests that financial incentives can enhance demand for and improve the supply of maternal health services. Definitive evidence demonstrating a link between incentives and improved health outcomes is lacking; however, the evidence suggests that financial incentives can increase the quantity and quality of maternal health services and address health systems and financial barriers that prevent women from accessing and providers from delivering quality, lifesaving maternal healthcare.

Performance-based incentives to improve health status of mothers and newborns: what does the evidence show?

Performance-based incentives (PBIs) aim to counteract weak providers' performance in health systems of many developing countries by providing rewards that are directly linked to better health outcomes for mothers and their newborns. Translating funding into better health requires many actions by a large number of people. The actions span from community to the national level. While different forms of PBIs are being implemented in a number of countries to improve health outcomes, there has not been a systematic review of the evidence of their impact on the health of mothers and newborns. This paper analyzes and synthesizes the available evidence from published studies on the impact of supply-side PBIs on the quantity and quality of health services for mothers and newborns. This paper reviews evidence from published and grey literature that spans PBI for public-sector facilities, PBI in social insurance reforms, and PBI in NGO contracting. Some initiatives focus on safe deliveries, and others reward a broader package of results that include deliveries. The Evidence Review Team that focused on supply-side incentives for the US Government Evidence Summit on Enhancing Provision and Use of Maternal Health Services through Financial Incentives, reviewed published research reports and papers and added studies from additional grey literature that were deemed relevant. After collecting and reviewing 17 documents, nine studies were included in this review, three of which used before-after designs; four included comparison or control groups; one applied econometric methods to a five-year time series; and one reported results from a large-scale impact evaluation with randomly-assigned intervention and control facilities. The available evidence suggests that incentives that reward providers for institutional deliveries result in an increase in the number of institutional deliveries. There is some evidence that the content of antenatal care can improve with PBI. We found no direct evidence on the impact of PBI on neonatal health services or on mortality of mothers and newborns, although intention of the study was not to document impact on mortality. A number of studies describe approaches to rewarding quality as well as increases in the quantities of services provided, although how quality is defined and monitored is not always clear. Because incentives exist in all health systems, considering how to align the incentives of the many health workers and their supervisors so that they focus efforts on achieving health goals for mothers and newborns is critical if the health system is to perform more effectively and efficiently. A wide range of PBI models is being developed and tested, and there is still much to learn about what works best. Future studies should include a larger focus on rewarding quality and measuring its impact. Finally, more qualitative research to better understand PBI implementation and how various incentive models function in different settings is needed to help practitioners refine and improve their programmes.

Chromatographic assay to study the activity of multiple enzymes involved in the synthesis and metabolism of dopamine and serotonin.

Serotonin and dopamine are crucial regulators of signalling in the peripheral and central nervous systems. We present an ex-vivo, isocratic chromatographic method that allows for the measurement of tyrosine, L-3,4-dihydroxyphenylalanine (L-DOPA), dopamine, 3,4-dihydroxyphenylacetic acid (DOPAC), tryptophan, 5-hydroxytryptophan (5-HTP), serotonin and 5-hydroxy-3-indoleacetic acid (5-HIAA) in a model central nervous (CNS) system, to study the role of key enzymes involved in the synthesis and metabolism of serotonin and dopamine. By utilising a sample splitting technique, we could test a single CNS sample at multiple time points under various pharmacological treatments. In, addition, we were able to conduct this assay by utilising the endogenous biochemical components of the CNS to study the synthesis and metabolism of serotonin and dopamine, negating the requirement of additional enzyme activators or stabilisers in the biological matrix. Finally we utilised NSD-1015, an aromatic amino acid decarboxylase enzyme inhibitor used to study the synthesis of dopamine and serotonin to monitor alterations in levels of key neurochemicals. 3-hydroxybenzylhydrazine dihydrochloride (NSD-1015) was able to reduce levels of serotonin and dopamine, whilst elevating precursors L-DOPA and 5-HTP.

Neural responses to visual scenes reveals inconsistencies between fMRI adaptation and multivoxel pattern analysis.

Human observers can recognize real-world visual scenes with great efficiency. Cortical regions such as the parahippocampal place area (PPA) and retrosplenial complex (RSC) have been implicated in scene recognition, but the specific representations supported by these regions are largely unknown. We used functional magnetic resonance imaging adaptation (fMRIa) and multi-voxel pattern analysis (MVPA) to explore this issue, focusing on whether the PPA and RSC represent scenes in terms of general categories, or as specific scenic exemplars. Subjects were scanned while viewing images drawn from 10 outdoor scene categories in two scan runs and images of 10 familiar landmarks from their home college campus in two scan runs. Analyses of multi-voxel patterns revealed that the PPA and RSC encoded both category and landmark information, with a slight advantage for landmark coding in RSC. fMRIa, on the other hand, revealed a very different picture: both PPA and RSC adapted when landmark information was repeated, but category adaptation was only observed in a small subregion of the left PPA. These inconsistencies between the MVPA and fMRIa data suggests that these two techniques interrogate different aspects of the neuronal code. We propose three hypotheses about the mechanisms that might underlie adaptation and multi-voxel signals.

Improving communication and cost-effectiveness in the intensive care unit through palliative care: a review of literature.

Approximately 20% of deaths in the United States each year occur in the intensive care unit. This article reviews the literature on this important topic to critical-care nurses.

Distances between real-world locations are represented in the human hippocampus.

Spatial navigation is believed to be guided in part by reference to an internal map of the environment. We used functional magnetic resonance imaging (fMRI) to test for a key aspect of a cognitive map: preservation of real-world distance relationships. University students were scanned while viewing photographs of familiar campus landmarks. fMRI response levels in the left hippocampus corresponded to real-world distances between landmarks shown on successive trials, indicating that this region considered closer landmarks to be more representationally similar and more distant landmarks to be more representationally distinct. In contrast, posterior visually responsive regions such as retrosplenial complex and the parahippocampal place area were sensitive to landmark repetition and encoded landmark identity in their multivoxel activity patterns but did not show a distance-related response. These data suggest the existence of a map-like representation in the human medial temporal lobe that encodes the coordinates of familiar locations in large-scale, real-world environments.

Raising stroke awareness among rural dwellers with a Facts for Action to Stroke Treatment-based educational program.

Stroke is the third leading cause of death in the United States with 780,000 new and/or recurrent strokes each year. Interventions aimed at the onset of stroke symptoms have been successful in decreasing long-term neurological deficits; however, providing the prompt medical interventions in rural areas involves unique challenges. To decrease time-to-treatment in rural areas, education about symptoms of stroke and the need for immediate medical attention are critical. The objective of this study was to measure the effectiveness of the Facts for Action to Stroke Treatment (FAST)-based educational intervention program focused on the improving knowledge about stroke of 402 rural-dwelling adults. Using a paired means t test, the participants had a significant increase in knowledge from pretest to posttest (p = .000). Of those, 215 subjects participated in 2-month follow-up testing with the paired t test showing that the increased score from pretest to 2-month follow-up remained significant (p = .000). The authors concluded that the FAST-based program was an effective tool to use when teaching recognition of stroke symptoms and the need for immediate medical intervention to rural adults.

Early milk feeding influences taste acceptance and liking during infancy.

BACKGROUND: We identified a model system that exploits the inherent taste variation in early feedings to investigate food preference development. OBJECTIVE: The objective was to determine whether exposure to differing concentrations of taste compounds in milk and formulas modifies acceptance of exemplars of the 5 basic taste qualities in a familiar food matrix. Specifically, we examined the effects of consuming hydrolyzed casein formulas (HCFs), which have pronounced bitter, sour, and savory tastes compared with breast milk (BM) and bovine milk-based formulas (MFs), in which these taste qualities are weaker. DESIGN: Subgroups of BM-, MF- and HCF-fed infants, some of whom were fed table foods, were studied on 6 occasions to measure acceptance of sweet, salty, bitter, savory, sour, and plain cereals. RESULTS: In infants not yet eating table foods, the HCF group ate significantly more savory-, bitter-, and sour-tasting and plain cereals than did the BM or MF groups. HCF infants displayed fewer facial expressions of distaste while eating the bitter and savory cereals, and they and BM infants were more likely to smile while they were eating the savory cereal. In formula-fed infants eating table foods, preferences for the basic tastes reflected the types of foods they were being fed. In general, those infants who ate more food displayed fewer faces of distaste. CONCLUSIONS: The type of formula fed to infants has an effect on their response to taste compounds in cereal before solid food introduction. This model system of research investigation sheds light on sources of individual differences in taste and perhaps cultural food preferences.

Breastfeeding and smoking: short-term effects on infant feeding and sleep.

OBJECTIVE: The present experimental study was designed to determine how breastfeeding from a mother who smokes affects infants in the short-term. METHODS: Fifteen mother-infant dyads were tested on 2 days separated by 1 week. Mothers smoked (not in the presence of their infants) on one test day and refrained from smoking on the other. For the next 3.5 hours, infants breastfed on demand. Sleep and activity patterns were monitored by placing an actigraph on the infants' leg, and milk intake was determined by weighing the infants before and after each feeding. The nicotine content of the milk was measured to determine the dose of nicotine delivered to the infants. RESULTS: Although there was no significant difference in breast milk intake, despite the taste changes in the milk, infants spent significantly less time sleeping during the hours immediately after their mothers smoked (53.4 minutes), compared with the session when their mothers abstained from smoking (84.5 minutes). This reduction was attributable to shortening of the longest sleep bout and reductions in the amounts of time spent in both active sleep and quiet sleep. With greater doses of nicotine delivered to the infant, less time was spent in active sleep. CONCLUSIONS: An acute episode of smoking by lactating mothers altered infants' sleep/wake patterning. Perhaps concerns that their milk would taste like cigarettes and their infants' sleep patterning would be disrupted would motivate lactating mothers to abstain from smoking and to breastfeed longer.

A call for replication.

PURPOSE: To promote the use of replication as a means for strengthening knowledge for nursing practice. METHODS: Examination of two clinical examples of how replication could strengthen nursing practice. FINDINGS: The first example had no research evidence to support the practice and the other was based on the findings of a single medical study. Both led to nursing practices that were not effective or efficient, although not harmful. Replication can be used to overcome design limitations, increase validity of findings, and bring about correction of error. In addition, potential barriers and solutions to increase replication were identified. CONCLUSIONS: Replication is a critical step in validating research to build evidence and to promote use of findings in practice.