Dose, Content, and Context of Usual Care in Stroke Upper Limb Motor Interventions: A Systematic Review.

OBJECTIVE: The objectives of this systematic review were to describe the current dose and content of usual care upper limb motor intervention for inpatients following stroke and examine if context factors alter dose and content. DATA SOURCES: A systematic search (EMBASE, MEDLINE) was completed from January 2015 to February 2023 (PROSPERO CRD42021281986). METHODS: Studies were eligible if they reported non-protocolised usual care upper limb motor intervention dose data for stroke inpatients. Studies were rated using the Johanna Briggs Institute critical appraisal tool. Data were descriptively reported for dose dimensions of time (on task or, in therapy) and intensity (repetitions, repetition/minute), content (intervention type/mode), and context (e.g., severity strata). RESULTS: Eight studies were included from four countries, largely reflecting inpatient rehabilitation. Time in therapy ranged from 23 to 121 min/day. Time on task ranged from 8 to 44 min/day. Repetitions ranged from 36 to 57/session, and 15 to 282/day. Time on task was lowest in the stratum of people with severe upper limb impairment (8 min/day), the upper limit for this stratum was 41.5 min/day. There was minimal reporting of usual care content across all studies. CONCLUSION: Upper limb motor intervention dose appears to be increasing in usual care compared to prior reports (e.g., average 21 min/day and 23 to 32 repetitions/session). Context variability suggests that doses are lowest in the stratum of patients with a severely impaired upper limb. Consistent reporting of the multiple dimensions of dose and content is necessary to better understand usual care offered during inpatient rehabilitation.

Considerations for conducting a young person's health assessment in the general practice setting: Insights from key informants in Victoria.

BACKGROUND AND OBJECTIVES: There have been calls for a Medicare Benefits Schedule rebate to support a young person's health assessment in general practice. The aim of this study was to understand Victorian providers' needs and perspectives about implementing young people's health assessments in general practice. METHOD: Focus groups and interviews were conducted over Zoom with current general practitioners (GPs), practice nurses (PNs) and practice managers (PMs). A qualitative descriptive approach and conventional content analysis were used. RESULTS: Two focus groups and five interviews were conducted between September and November 2021. Participants (11 GPs, nine PNs and three PMs) represented metropolitan (n = 11), regional (n = 10) and rural (n = 2) Victoria. Key facilitators to implementing a young person's health assessment included established clinic systems and staff roles as well as the potential to empower young people. Key barriers included scheduling logistics and billing structures. DISCUSSION: Key informants generated substantive stakeholder perspectives to aid planning and implementing young people's health assessments in general practice.

Hot-Tail Runaway Seed Landscape during the Thermal Quench in Tokamaks.

Runaway electron populations seeded from the hot tail generated by the rapid cooling in plasma-terminating disruptions are a serious concern for next-step tokamak devices such as ITER. Here, we present a comprehensive treatment of the thermal quench, including the superthermal electron dynamics, heat and particle transport, atomic physics, and radial losses due to magnetic perturbations: processes that are strongly linked and essential for the evaluation of the runaway seed in disruptions mitigated by material injection. We identify limits on the injected impurity density and magnetic perturbation level for which the runaway seed current is acceptable without excessive thermal energy being lost to the wall via particle impact. The consistent modeling of generation and losses shows that runaway beams tend to form near the edge of the plasma, where they could be deconfined via external perturbations.

Prognostic Value of Elevated Cardiac Troponin I in Hospitalized Covid-19 Patients.

This study aimed to determine if cardiac troponin I (cTnI) is an independent predictor of clinical outcomes and whether higher values are associated with worse clinical outcomes in Covid-19 patients. This case-series study was conducted at Phoebe Putney Health System. Participants were confirmed Covid-19 patients admitted to our health system between March 2, 2020 and June 7, 2020. Data were collected from electronic medical records. Patients were divided into 2 groups: with and without elevated cTnI. The cTnI were further divided in 4 tertiles. Multivariable logistic regression analysis was performed to adjust for demographics, baseline comorbidities, and laboratory parameters including D-dimer, ferritin, lactate dehydrogenase, procalcitonin and C-reactive protein. Out of 309 patients, 116 (37.5%) had elevated cTnI. Those with elevated cTnI were older (59.9 vs. 68.2 years, p <0.001), and more likely to be males (53.5% vs. 36.3%, p = 0.003). Elevated cTnI group had higher baseline comorbidities. After multivariable adjustment, overall mortality was significantly higher in elevated cTnI group (37.9% vs. 11.4%, odds ratio:4.45; confidence interval:1.78 to 11.14, p <0.001). Need for intubation, dialysis, and intensive care unit (ICU) transfer was higher in elevated cTnI group. Among those with elevated cTnI, mortality was 23.2% for 50th percentile, 48.4% for 75th percentile, and 55.2% for 100th percentile. Similarly, further increase in cTnI was associated with a higher need for intubation, dialysis, and ICU transfer. In conclusion, myocardial injury occurs in significant proportion of hospitalized Covid-19 patients and is an independent predictor of clinical outcomes, with higher values associated with worse outcomes.

Muslim transplant recipients' family experiences following organ transplantation.

BACKGROUND: Despite the importance of family and its relationship to positive transplant outcomes, little is known about family experiences following organ transplantation from the perspective of the transplant recipients. The literature is also devoid of information that describes the family experiences of Muslim transplant recipients. AIMS: The purpose of this study was to describe Muslim transplant recipients' family experiences following organ transplantation. METHODS: A hermeneutical phenomenological approach was employed to determine the emergent themes present in the data. The sample was composed of 12 Muslim organ transplant recipients (heart, kidney and liver) living in Iran. Semi-structured interviews were conducted with each participant. RESULTS: The primary constitutive pattern that emerged from the interview data was 'Altered Family Relationships' and three themes: fear in relationships, abnormal relationships, and the family at the centre of organ transplant issues. CONCLUSIONS: There are several important findings in this study, notably that Muslim transplant recipients describe their family experiences following organ transplantation as 'altered' and not as they were pre-transplant. More research is needed that focuses on the family experience post-transplant, and how Muslim transplant recipient families are impacted by the transplant experience.

The Effects of Religious and Cultural Beliefs on Muslim Transplant Candidates During the Pretransplant Waiting Period.

BACKGROUND: Awaiting organ transplantation can be stressful, and pretransplant candidates' religious and cultural beliefs can influence how they adapt to the stress. While little is known about the effect religious and cultural beliefs have on the pretransplant waiting period, virtually nothing is known regarding whether and how Shia Muslim patients' religious and cultural beliefs facilitate more positive patient outcomes while they await transplantation. Therefore, it is important for nurses and other health care providers to understand transplant candidates' experiences dealing with the stressors that present themselves during the pretransplant waiting period, especially how their religious and cultural beliefs affect their adaptation to the stressors. AIM: The purpose of this study was to explore the lived experience of Shia Muslim organ transplant candidates regarding how their religious and cultural beliefs affect their adaptation to the pretransplant waiting period. SAMPLE: A purposeful sample of 11 Shia Muslim organ transplant candidates who were on an organ transplant waiting list in Iran (kidney, n = 4; heart, n = 4; liver, n = 3) was recruited. METHOD: A qualitative research design using the hermeneutical phenomenological approach was utilized in this study. In-depth unstructured interviews were conducted by one of the authors (ZS) in different locations across Iran. RESULTS: Data analysis led to the development of six themes: "the misty road of organ transplantation," "to accede to organ transplantation despite religious conflict," "one step away from death," "the master key of liberation," "fear of the unknown," and "reliance on God." NURSING IMPLICATIONS: The findings of this study will help nurses understand the religious and cultural meaning associated with stressors experienced by Shia Muslim patients awaiting organ transplant. This information can assist nurses to develop plans of care that include patient-specific interventions that take into consideration the patients' religious and cultural beliefs. CONCLUSION: Shia Muslim patients awaiting organ transplantation experience feelings that are often in conflict with their religious and cultural beliefs. However, the patients' reliance on God during the pretransplant waiting period facilitated healthier attitudes regarding transplantation.

Location dependent coordination chemistry and MRI relaxivity, in de novo designed lanthanide coiled coils.

Herein, we establish for the first time the design principles for lanthanide coordination within coiled coils, and the important consequences of binding site translation. By interrogating design requirements and by systematically translating binding site residues, one can influence coiled coil stability and more importantly, the lanthanide coordination chemistry. A 10 Å binding site translation along a coiled coil, transforms a coordinatively saturated Tb(Asp)3(Asn)3 site into one in which three exogenous water molecules are coordinated, and in which the Asn layer is no longer essential for binding, Tb(Asp)3(H2O)3. This has a profound impact on the relaxivity of the analogous Gd(iii) coiled coil, with more than a four-fold increase in the transverse relaxivity (21 to 89 mM-1 s-1), by bringing into play, in addition to the outer sphere mechanism present for all Gd(iii) coiled coils, an inner sphere mechanism. Not only do these findings warrant further investigation for possible exploitation as MRI contrast agents, but understanding the impact of binding site translation on coordination chemistry has important repercussions for metal binding site design, taking us an important step closer to the predictable and truly de novo design of metal binding sites, for new functional applications.

Using simulation to improve the medication administration skills of undergraduate nursing students.

AIM: This quasi-experimental pilot study examined simulation methods to improve nursing students' medication calculation and administration abilities. BACKGROUND: Approximately 25 percent of junior-level students in the nursing program who took a medication administration exam (MAE) failed in their first attempt. It was theorized that simulation could facilitate their success. METHOD: Students in the control group (n = 79) attended a didactic medication administration review session; students in the intervention group (n = 79) participated in a medication administration simulation review session. All students took the MAE within a week of their review. RESULTS: The intervention group scored significantly higher (M = 95 percent, SD = 6.8) on the MAE than the control group (M = 90 percent, SD = 12.9) at the p = .004 level. CONCLUSION: The simulation facilitated student success by giving students a state-of-the-art contextual reference to apply when taking the MAE.

Constructivist philosophy and nursing student medication calculations.

Prelicensure nursing students often have difficulty performing medication calculations (MCs). Faculty at one baccalaureate nursing program wanted to use nursing theory to guide the development of a teaching-learning approach related to MC's. Finding little theory related to the topic of MCs, a constructivist-based teaching-learning approach was used instead. The purpose of the study was to assess whether nursing students who received an MC review class that used a teaching-learning approach based on constructivist philosophy had better results on an MC examination than students who received their review via traditional teaching-learning methods. The study participants consisted of two cohorts of first-semester junior-level nursing students from one university-based school of nursing in the Midwestern United States. The results indicated that students in the simulation review class had higher mean scores on an MC examination than students who received their review via more traditional means. Teaching-learning strategies related to MCs based on constructivist philosophy have the potential to improve student learning outcomes, but more research is needed before middle-range theory related to this critically important area of nursing education can be developed.

Critical thinking skills of basic baccalaureate and Accelerated second-degree nursing students.

AIM: The purpose of this study was to describe the critical thinking (CT) skills of basic baccalaureate (basic-BSN) and accelerated second-degree (ASD) nursing students at nursing program entry. BACKGROUND: Many authors propose that CT in nursing should be viewed as a developmental process that increases as students' experiences with it change. However, there is a dearth of literature that describes basic-BSN and ASD students' CT skills from an evolutionary perspective. METHOD: The study design was exploratory descriptive. RESULTS: The results indicated thatASD students had higher CT scores on a quantitative critical thinking assessment at program entry than basic-BSN students. CONCLUSION: CT data are needed across the nursing curriculum from basic-BSN and ASD students in order for nurse educators to develop cohort-specific pedagogical approaches that facilitate critical thinking in nursing and produce nurses with good CT skills for the future.

Characterization of organic chemical contaminants in sediments from Jobos Bay, Puerto Rico.

Jobos Bay, located on the southeastern coast of Puerto Rico, contains a variety of habitats including mangroves, seagrass meadows, and coral reefs. The watershed surrounding the bay includes a number of towns, agricultural areas, and the Jobos Bay National Estuarine Research Reserve (NERR). Jobos Bay and the surrounding watershed are part of a Conservation Effects Assessment Project (CEAP), involving the Jobos Bay NERR, the US Department of Agriculture, and the National Oceanic and Atmospheric Administration (NOAA) to assess the benefits of agricultural best management practices (BMPs) on the terrestrial and marine environments. As part of the Jobos Bay CEAP, NOAA collected sediment samples in May 2008 to characterize over 130 organic chemical contaminants. This paper presents the results of the organic contaminant analysis. The organic contaminants detected in the sediments included polycyclic aromatic hydrocarbons (PAHs), polychlorinated biphenyls, and the pesticide DDT. PAHs at one site in the inner bay near a boat yard were significantly elevated; however, all organic contaminant classes measured were below NOAA sediment quality guidelines that would have indicated that impacts were likely. The results of this work provide an important baseline assessment of the marine environment that will assist in understanding the benefits of implementing BMPs on water quality in Jobos Bay.

The effect of context on nursing student math aptitude.

Math proficiency is a prerequisite to the performance of many nursing functions, including medication calculations, but many nursing students have difficulty performing this basic clinical skill. Research has demonstrated that math aptitude alone does not fully explain student outcomes on medication calculation assessments (MCAs), and contextual factors associated with reading and interpreting written medication questions are important for nurse educators to better understand. Reading and English aptitude are proposed as two potential contextual factors that may help explain the nursing student's ability to pass a written MCA. The purpose of this study was to describe the effects of reading and English aptitude on baccalaureate nursing students' ability to pass an MCA taken during the junior year of the nursing curriculum.

Nursing students' reading and English aptitudes and their relationship to discipline-specific formal writing ability: a descriptive correlational study.

Formal writing assignments are commonly used in nursing education to develop students' critical thinking skills, as well as to enhance their communication abilities. However, writing apprehension is a common phenomenon among nursing students. It has been suggested that reading and English aptitudes are related to formal writing ability, yet neither the reading nor the English aptitudes of undergraduate nursing students have been described in the literature, and the relationships that reading and English aptitude have with formal writing ability have not been explored. The purpose of this descriptive correlational study was to describe writing apprehension and to assess the relationships among reading and English aptitude and discipline-specific formal writing ability among undergraduate nursing students. The study sample consisted of 146 sophomores from one baccalaureate nursing program. The results indicated that both reading and English aptitude were related to students' formal writing ability.

Use of aptitude to understand bachelor of science in nursing student attrition and readiness for the National Council Licensure Examination-Registered Nurse.

Attrition is a serious issue among Bachelor of Science in Nursing (BSN) students with attrition rates around 50% nationwide. To help minimize BSN student attrition, many nursing programs use commercially available standardized nursing aptitude tests as adjuncts to scholastic aptitude data, usually operationalized as pre-nursing grade point average, to select students for admission. Little is known regarding the usefulness of scholastic and nursing aptitude data for predicting long-term retention in a BSN program and readiness for the National Council Licensure Examination-Registered Nurse (NCLEX-RN). Therefore, the purpose of this study was to describe the relationships among scholastic aptitude, nursing aptitude, BSN student attrition prior to the final semester of the curriculum, and BSN student readiness for the NCLEX-RN. This study's findings, along with other findings in the literature, suggest the need for a parsimonious explanatory model of BSN student attrition that can be used to guide admission and progression policies, and ensure that students ready for the NCLEX-RN are the ones graduating from BSN programs.

Ethnic minority baccalaureate nursing student academic dismissal: a description of the antecedent academic characteristics.

Dismissal for academic reasons from a baccalaureate nursing (BSN) program is a phenomenon that has rarely been discussed in the literature, and, as a result, little is known about the academic characteristics of the students who are dismissed. Presently, minority students that have been admitted to BSN programs are less likely to graduate from their respective nursing programs than White BSN students are, but whether or not ethnic minority student attrition is due to academic dismissal has not been clearly described. In addition, the antecedent academic characteristics that may identify minority BSN students at high risk for academic dismissal are not fully understood. Thus, the primary purpose of this study was to describe the academic characteristics ofa sample of minority BSN students who experienced academic dismissal. A secondary purpose was to compare ethnic minority BSN students who were dismissed with a sample of ethnic minority BSN students who were academically successful. The results revealed that ethnic minority BSN students who were dismissed for academic reasons tended to have low scholastic and nursing aptitudes, and that nursing aptitudes were higher among ethnic minority BSN students who were academically successful.

Nursing student math aptitude and success on a medication calculation assessment.

The authors describe the relationship between nursing student math aptitude and success on a medication calculation assessment given during the second year of the nursing curriculum. The importance of understanding this relationship to nursing education is highlighted.

Assessment of pain in the transport environment: a review of the literature.

INTRODUCTION: Critically ill or injured patients who are transported experience pain. Pain is associated with multiple adverse affects including tachycardia, hypertension, anxiety, elevated blood glucose levels, and diaphoresis. METHODS: Using multiple search terms, the Cumulative Index of Nursing and Allied Health Literature and MEDLINE databases as well as pertinent Web sites were searched for relevant information. RESULTS: An important component of pain management is pain assessment, yet little empirically based literature is available regarding pain assessment for patients who are transported. DISCUSSION: The purpose of this article is to review the literature regarding the transport nursing environment and barriers to pain assessment during transport.

Faculty role modeling of professional writing: one baccalaureate nursing program's experience.

According to The Essentials of Baccalaureate Education for Professional Nursing Practice (American Association of Colleges of Nursing, 1998), professional writing is an important outcome of baccalaureate nursing education. Most baccalaureate nursing programs in the United States expect formally written student papers to adhere to the style requirements outlined in the Publication Manual of the American Psychological Association (APA, 2001). It is essential for the baccalaureate nursing faculty members who evaluate student papers to be role models for the desired writing behaviors to facilitate student attainment of professional writing outcomes. However, to what extent nursing faculty members' writing behaviors and knowledge of the APA style requirements impact student writing outcomes is not known because the issue has not been addressed in the literature. The purpose of this article is to describe one Midwestern baccalaureate nursing program's faculty development efforts to assess faculty familiarity with the APA style requirements and how such knowledge may impact baccalaureate nursing students' writing outcomes.

The impact of community college transfer on entry-level baccalaureate nursing student retention.

Student attrition is a major issue for entry-level baccalaureate science in nursing (BSN) programs. Where BSN students complete the prerequisite nursing courses may contribute to attrition. Because many BSN students satisfy prerequisite courses at community colleges (CCs), a better understanding regarding how a CC education impacts BSN student retention is needed. The author reviews the literature regarding factors that potentially impact entry-level BSN student retention after CC transfer.