Nurse and midwife researcher collaboration in eastern sub-Saharan Africa: a social network analysis.

AIM: To investigate the collaborative networks among expert clinical nurse and midwifery researchers in eastern and southern Africa. METHODS: Thirty-eight clinical nurse and midwifery researchers completed an online survey to analyse collaboration between respondents. Data were analysed using social network analysis, generating a network map and associated measurements. RESULTS: Regional collaboration was poor. Those links that did exist centred on geographic proximity and participation in regional and international organizations. CONCLUSION: These results help us to understand better ways to strengthen and support nursing and midwifery clinical research in eastern and southern Africa. IMPLICATIONS FOR NURSING POLICY: Clinical nursing and midwifery research capacity building efforts should focus on supporting collaboration networks among individuals and institutions in the region.

In vivo overexpression of Emi1 promotes chromosome instability and tumorigenesis.

Cell cycle genes are often aberrantly expressed in cancer, but how their misexpression drives tumorigenesis mostly remains unclear. From S phase to early mitosis, EMI1 (also known as FBXO5) inhibits the anaphase-promoting complex/cyclosome, which controls cell cycle progression through the sequential degradation of various substrates. By analyzing 7403 human tumor samples, we find that EMI1 overexpression is widespread in solid tumors but not in blood cancers. In solid cancers, EMI1 overexpression is a strong prognostic marker for poor patient outcome. To investigate causality, we generated a transgenic mouse model in which we overexpressed Emi1. Emi1-overexpressing animals develop a wide variety of solid tumors, in particular adenomas and carcinomas with inflammation and lymphocyte infiltration, but not blood cancers. These tumors are significantly larger and more penetrant, abundant, proliferative and metastatic than control tumors. In addition, they are highly aneuploid with tumor cells frequently being in early mitosis and showing mitotic abnormalities, including lagging and incorrectly segregating chromosomes. We further demonstrate in vitro that even though EMI1 overexpression may cause mitotic arrest and cell death, it also promotes chromosome instability (CIN) following delayed chromosome alignment and anaphase onset. In human solid tumors, EMI1 is co-expressed with many markers for CIN and EMI1 overexpression is a stronger marker for CIN than most well-established ones. The fact that Emi1 overexpression promotes CIN and the formation of solid cancers in vivo indicates that Emi1 overexpression actively drives solid tumorigenesis. These novel mechanistic insights have important clinical implications.

Developing clinical decision support within a commercial electronic health record system to improve antimicrobial prescribing in the neonatal ICU.

OBJECTIVE: To develop and implement a clinical decision support (CDS) tool to improve antibiotic prescribing in neonatal intensive care units (NICUs) and to evaluate user acceptance of the CDS tool. METHODS: Following sociotechnical analysis of NICU prescribing processes, a CDS tool for empiric and targeted antimicrobial therapy for healthcare-associated infections (HAIs) was developed and incorporated into a commercial electronic health record (EHR) in two NICUs. User logs were reviewed and NICU prescribers were surveyed for their perceptions of the CDS tool. RESULTS: The CDS tool aggregated selected laboratory results, including culture results, to make treatment recommendations for common clinical scenarios. From July 2010 to May 2012, 1,303 CDS activations for 452 patients occurred representing 22% of patients prescribed antibiotics during this period. While NICU clinicians viewed two culture results per tool activation, prescribing recommendations were viewed during only 15% of activations. Most (63%) survey respondents were aware of the CDS tool, but fewer (37%) used it during their most recent NICU rotation. Respondents considered the most useful features to be summarized culture results (43%) and antibiotic recommendations (48%). DISCUSSION: During the study period, the CDS tool functionality was hindered by EHR upgrades, implementation of a new laboratory information system, and changes to antimicrobial testing methodologies. Loss of functionality may have reduced viewing antibiotic recommendations. In contrast, viewing culture results was frequently performed, likely because this feature was perceived as useful and functionality was preserved. CONCLUSION: To improve CDS tool visibility and usefulness, we recommend early user and information technology team involvement which would facilitate use and mitigate implementation challenges.

Göteborg quality of life study of men born in 1913 and 1923--age, sex, job satisfaction and cardiovascular diseases.

To see whether well-being and symptoms are affected by age, job satisfaction, and cardiovascular diseases a quality of life assessment of men born in 1913 and 1923 and living in Göteborg was performed. Age influenced both well-being and symptoms in different ways. Many well-being variables declined and many symptoms decreased with age. Symptoms were strongly related to both global health and job satisfaction--more symptoms were found in participants with low global health or low job satisfaction. Participants with cardiovascular disease and diabetes mellitus showed considerable variation in their quality of life. Hypertensive and diabetic patients showed only small deviations in the well-being and symptom profile. Congestive heart failure patients generally had a low quality of life. It was not possible to decide if the lack of well-being was caused by the diseased state, the treatment, or the patients' awareness of having a specific disease.

The role of the clinical nurse specialist in the assessment and development of social-sexual skills of adults who are developmentally disabled.

Clinical nurse specialists (CNSs) functioning in ambulatory settings such as sheltered workshops or other community placements where developmentally disabled persons receive services have an excellent opportunity to use their teaching, counseling and guidance and interaction skills to assist them in gaining competencies that they need to be successful in social/sexual interactions. In this article, preassessment of these skills was performed and an outline of an educational program provided so that CNSs can assume this important teaching and counseling role.

Mammary carcinogenesis in rats in relation to age at time of N-nitroso-N-methylurea administration.

The effects on mammary carcinogenesis when N-nitroso-N-methylurea (NMU) is administered to rats of different ages were studied. Female outbred Sprague-Dawley rats received two iv injections of NMU (5 mg/100 g body wt/injection) 1 week apart beginning at either 35, 50, 80, 140, or 200 days of age. Animals were killed 6 months after the initial NMU injection, and all mammary tumors were histologically classified. The percent incidence of mammary carcinomas for each age group was as follows: 100%, 35 days old; 94%, 80 days old; 59%, 80 days old; 30%, 140 days old; and 22%, 200 days old. Rats receiving NMU at a young age also exhibited a greater number of carcinomas per rat with latent periods that were in general shorter than those of rats treated at later ages. Since NMU does not require metabolic activation, the observed decrease in chemically induced mammary tumors in aging rats appears to be primarily due to changes occurring within the mammary gland.