A quality improvement approach to improving recognition of Maori tamariki (children) and assessing barriers to culturally responsive care in a paediatric ward setting.

BACKGROUND: Health inequity persists in Aotearoa (New Zealand) and internationally amongst most indigenous peoples. To address these health inequities, countries need to contend with the ramifications of entrenched historical, cultural and systemic failures. Within Aotearoa part of the solution to rectifying persistent health inequities lies in shifting everyday healthcare practices towards a more culturally responsive, patient-centred approach that utilises Maori knowledge and principles. Although the need for culturally responsive services in healthcare settings is clearly evident, most practitioners struggle with the challenge of creating a culturally safe environment. Further to these challenges, there are issues related to accurate recognition of ethnicity within the time constraints of an overwrought hospital environment. Within this environment, the correct identification of ethnicity is a fundamental step in the process of moving towards culturally responsive and more inclusive care. METHOD: The research was concerned with indigenous Maori patients being consistently and correctly identified so that they might receive culturally appropriate interaction and treatment. The research specifically focused on the impact of introducing a customised sticker prompt on the front cover of clinical notes of Maori tamariki (children) to assist with correct ethnicity identification. Surveys were conducted on the paediatric ward over a 3-week period, prior to and during the intervention to evaluate the effect of the customised stickers. This study sought to (1) assess the efficacy of a sticker to improve recognition of Maori tamariki (children), (2) examine key barriers to identifying ethnicity and (3) identify wider impacts of a sticker prompt on clinical practice. RESULTS: Results showed wide ranging positive impacts on clinical practice and culturally responsive care. Sixty-four per cent of participants indicated that the stickers were a useful tool to improve identification of Maori tamariki. Respondents reported increased accuracy of identifying patients by ethnicity, as well as improved awareness of existing ethnicity documentation, and increased engagement regarding cultural needs and ethnicity. CONCLUSIONS: This study identified that sticker prompts are a useful tool for healthcare workers to improve recognition and awareness of ethnicity and to increase dialogue around cultural needs. The stickers led to increased consideration of the wider elements of holistic wellbeing and therefore improved culturally responsive care for Maori tamariki.

Meals of differing caloric content do not alter physical activity behavior during a subsequent simulated recess period in children.

OBJECTIVE: Research on adults and animals has demonstrated that chronic and acute overfeeding can alter physical activity behavior. However, there are no assessments of the acute effects of high-calorie (HC) meals on physical activity behavior in children. This is of importance as a typical school lunch is HC. If this type of meal negatively impacts subsequent physical activity behavior, the ability of post-lunch recess periods as a means to increase energy expenditure may be lessened. PURPOSE: To assess the effect of two meals of differing caloric content, HC and low calorie (LC), on children's subsequent physical activity behavior. METHODS: Nineteen healthy children (aged 6-10) completed two laboratory sessions where they were fed lunch with HC or LC content, but equivalent macronutrient distribution. Children had 15 min to consume as much of the meal as possible per session. Children consumed 659.5 ± 101.3 kcal in the HC condition and 291.8 ± 12.1 kcal in the LC condition. After the meal, children went to a gymnasium for 40 min. In the gymnasium children had free-choice access to obstacle courses, various sports equipment, and a table with sedentary activities. Children could play with any of the activities in any amount they wished for the entire activity session. Children's physical activity was monitored with accelerometers and that data was converted into caloric expenditure. Each child ate all meals and participated in the free-choice activity sessions with no other children present. RESULTS: Caloric expenditure during the free-choice activity sessions was not significantly different (p = 0.4) between the HC (89.2 ± 27.3 kcals) and LC (83.4 ± 34.9 kcals) conditions. However, caloric balance (kcals eaten-kcals expended) was 2.74-fold greater (p < 0.001) in the HC condition (Δ 570.3 ± 92.2 kcals) than the LC condition (Δ 208.4 ± 32.0 kcals). CONCLUSION: Children did not alter their physical activity behavior during a free-choice activity session after consuming a HC meal versus a LC meal. Because activity was not different across the two conditions, children had a much greater caloric surplus during the HC condition than the LC condition.

Community navigation to reduce institutional recidivism and promote recovery: initial evaluation of opening doors to recovery in Southeast Georgia.

New approaches for preventing repeated inpatient psychiatric stays, detention in jails and prisons, and homelessness among individuals with serious mental illnesses with established histories of such recidivism, while promoting recovery, are direly needed. We present findings from an initial program evaluation of a new community-based, recovery-oriented "community navigation" program in southeast Georgia, called Opening Doors to Recovery. Twenty-three in-depth interviews were conducted with key stakeholders, program participants, community navigation specialist team members, and referring mental health professionals to identify hopes and strengths, challenges and weaknesses, and recommendations pertaining to the new program. Cited strengths included teamwork and pooling of resources from various partners, as well as the novel recovery-based, community navigation team approach. An initial lack of fidelity processes across teams and an ongoing scarcity of safe and affordable housing were identified as weaknesses, with the latter seen as a liability of the overall mental health and social service systems rather than the program itself. Findings from this evaluation highlight strengths and opportunities of this new community navigation approach, including those related to the involvement of certified peer specialists and multiple community partners.

Using NANDA, NIC, and NOC in an undergraduate nursing practicum.

Although use of diagnoses originally developed by NANDA (now known as NANDA-I), NIC, and NOC in education and practice is increasing, many faculty members have not been educated in their use and may be reluctant to teach these languages. This article provides guidance on the use of NANDA-I, NIC, and NOC in clinical education. This guidance will facilitate both faculty and student learning.

Comparison of larval thermal maxima between Fundulus heteroclitus and F. grandis.

Fundulus heteroclitus and F. grandis are resident salt marsh fishes that overlap in distribution over a narrow range in northeastern Florida. The objective of the present study was to examine whether the limits of the species' ranges could be explained by differences in thermal tolerance. Two populations of each species were collected and then spawned in the laboratory, and 9-day-old larvae were used for critical thermal maxima trials. Mean LOE temperatures of larvae ranged from 43.04 to 43.65 degrees C and showed little difference between species. Therefore, differences in high temperatures experienced cannot account for the differences of the distributions of the two species. Condition-specific competition may play a greater role in determining the observed range of the two species.

Short- and long-term effects of inhaled iloprost therapy in children with pulmonary arterial hypertension.

OBJECTIVES: This study investigated the short- and long-term outcome of children with pulmonary arterial hypertension (PAH) treated with inhaled iloprost. BACKGROUND: Inhaled iloprost has been approved for the treatment of adults with PAH, but little is known about the effects in children with PAH. METHODS: We evaluated the acute effects of inhaled iloprost on hemodynamic status and lung function and the response to long-term therapy in 22 children (range 4.5 to 17.7 years) with PAH (idiopathic, n = 12; congenital heart disease, n = 10). Cardiac catheterization, standard lung function testing before and after iloprost inhalation, 6-min walk test, World Health Organization functional class, and hemodynamic parameters were monitored. RESULTS: Acute administration of inhaled iloprost lowered mean pulmonary artery pressure equivalent to the response to inhaled nitric oxide with oxygen. Acute iloprost inhalation reduced forced expiratory volume in 1 s and mid-volume forced expiratory flow by 5% and 10%, respectively, consistent with acute bronchoconstriction. At 6 months, functional class improved in 35%, decreased in 15%, and remained unchanged in 50% of children. Sixty-four percent of patients continued receiving long-term iloprost therapy, 36% stopped iloprost, due to lower airway reactivity, clinical deterioration, or death. In 9 patients on chronic intravenous prostanoids, 8 transitioned from intravenous prostanoids to inhaled iloprost, which continued during follow-up. CONCLUSIONS: Inhaled iloprost caused sustained functional improvement in some children with PAH, although inhaled iloprost occasionally induced bronchoconstriction. Most patients tolerated the transition from intravenous to inhaled prostanoid therapy. Clinical deterioration, side effects, and poor compliance, owing to the frequency of treatments, could limit chronic treatment in children.

Intravenous injection of pharmaceutical tablets presenting as multiple pulmonary nodules and declining pulmonary function in an adolescent with cystic fibrosis.

Here we present the unusual case of an adolescent with cystic fibrosis presenting with declining pulmonary function and diffuse micronodular pulmonary disease. This case illustrates the radiographic and pathologic findings associated with the intravenous injection and pulmonary arterial embolization of insoluble pharmaceutical-tablet constituents. The number of first-time users reporting nonmedical use of prescription pain relievers is increasing dramatically, especially in adolescents. Recognition of both the diagnostic imaging features and histologic features on lung biopsy are critical steps for early diagnosis, intervention, and potential prevention of sudden death in these at-risk patients.

What is "marked" in visual marking? Evidence for effects of configuration in preview search.

Visual search for a conjunction target is facilitated when distractor sets are segmented over time: the preview benefit Watson and Humphreys (1997) suggested that this benefit involved inhibition of old items (visual marking, VM). We investigated whether the preview benefit is sensitive to the configuration of the old distractors. Old distractors changed their location prior to the occurrence of the new items, while also either changing or maintaining their configuration. Configuration changes disrupted search. The results are consistent with object-based VM, which is sensitive to the configuration of old stimuli.

Visual change with moving displays: more evidence for color feature map inhibition during preview search.

Preview search with moving stimuli was investigated. The stimuli moved in multiple directions, and preview items could change either their color or their shape before onset of the new (search) displays. In Experiments 1 and 2, the authors found that (a) a preview benefit occurred even when more than 5 moving items had to be ignored, and (b) color change, but not shape change, disrupted preview search in moving stimuli. In contrast, shape change, but not color change, disrupted preview search in static stimuli (Experiments 3 and 4). Results suggest that preview search with moving displays is influenced by inhibition of a color map, whereas preview search with static displays is influenced by inhibition of locations of old distractors.

When a reappearance is old news: visual marking survives occlusion.

Performance in a visual search task becomes more efficient if half of the distractors are presented before the rest of the stimuli. This "preview benefit" may partly be due to inhibition of the old (previewed) items. The preview effect is abolished, however, if the old items offset briefly before reappearing (D. G. Watson & G. W. Humphreys, 1997). The authors examined whether this offset effect still occurred if the old items undergo occlusion. Results show that a preview benefit was found when the old items were occluded but not otherwise, consistent with the idea of top-down attentional inhibition being applied to the old items. The preview benefit is attenuated, however, by movement of the irrelevant stimuli in the displays.

History matters: the preview benefit in search is not onset capture.

Visual search for a conjunction target is made easier when distractor items are temporally segregated over time to produce two separate old and new groups (the new group containing the target item). The benefit of presenting half the distractors first is known as the preview effect. Recently some researchers have argued that the preview effect occurs because new stimuli capture attention. This account was tested in the present study by using a novel "top-up" condition that exploits the fact that when previews appear only briefly before the search display, there is minimal preview benefit. We show that effects of a brief preview can be "topped up" by an earlier exposure of the same items, even when the preview disappears between its first and second presentations. This top-up effect demonstrates that the history of the old stimuli is important for the preview benefit, contrary to the account favoring onset capture. We discuss alternative accounts of how the preview benefit arises.

How do we pass NP autonomy legislation?

NP practice autonomy means prescribing medication and treatment based on graduate nursing education and credentials, without physician supervision. NP advancement and optimal professional practice depends on autonomy. NP researchers conducted a study to describe legislative initiatives in states where NPs practice and prescribe autonomously. This article outlines the strategies NPs used to pass autonomy legislation in South Carolina. NPs in other states can use these strategies to pursue autonomy legislation.