Objective structured clinical exam: how clinical nurse educators can support internationally educated nurses.

Internationally educated nurses (IENs) require robust teaching programmes to support them through the objective structured clinical exam (OSCE) process to gain registration with the Nursing and Midwifery Council. There should be measures in place to support these nurses from a clinical and pastoral perspective. It is also important to learn from IENs, because moving to a different country is an emotional and life-changing experience that affects nurses and their families. Preparation is central to completing the programme successfully, alongside having the resources required in terms of time and a dedicated facility for practise. This article describes the development and implementation of an OSCE preparation teaching programme to support IENs, discusses the challenges for teachers and participants, and shows how having a dedicated facility and programme lead has led to excellent results.

MRI Evidence of Neuropathic Changes in Former College Football Players.

OBJECTIVE: To examine effects of participating in collegiate football on neural health several years after retirement. We hypothesized that relative cortical thinning and loss of white matter integrity would be observed in former players. DESIGN: Former NCAA Division I football players were compared with demographically similar track-and-field athletes with regard to cortical thickness and white matter integrity. SETTING: Participants participated in MRI scans at the Center for Imaging Research at the University of Cincinnati. PARTICIPANTS: Eleven former football players and 10 demographically similar track-and-field athletes. MAIN OUTCOME MEASURES: Normalized cortical thickness was compared between groups using 2-tailed Student t test. As a secondary analysis, Spearman correlation coefficient was calculated between cortical thickness and number of concussions. Fractional anisotropy for regions-of-interest placed in frontal white matter tracts and internal capsule were compared between groups using 2-tailed Student t test. RESULTS: Football players showed significantly lower cortical thickness within portions of both the frontal and temporal cortex. Affected frontal regions included left frontal pole and right superior frontal gyrus. Affected temporal regions included portions of the superior temporal gyrus, left inferior temporal gyrus, and right middle and superior temporal gyri. Cortical thickness inversely correlated with number of reported concussions over most of these regions. In addition, fractional anisotropy was lower in the right internal capsule of former football players, relative to controls. CONCLUSIONS: These findings suggest that at least some consequences of high-level collegiate football play persist even after the cessation of regular head blows. Longer-term studies are warranted to examine potential cognitive and functional implications of sustained cortical atrophy.

Mercury speciation and effects on soil microbial activities.

To study Hg toxicity on soil microbes and their activities, it is necessary to understand its various forms in soils. The objectives of this study were to investigate Hg speciation in four soil types spiked with Hg (300 mg kg(-1) soil) and its effects on soil microbial respiration and enzymes (amidohydrolases and phosphatase) activities. An assessment of the chemical forms, amounts, reactions, and mobility of Hg in soils and sediments is of significant importance to improve and maintain soil and environmental health and sustainability. Mercury speciation analysis was investigated under acidic and alkaline conditions using a modified sequential procedure, which differentiates Hg into the four distinct fractions. Soil microbial respiration and enzymes activities were determined under laboratory settings, by incubating the soils at 25°C for 30 days, and then determining the amount of CO(2) evolved. Speciation results revealed that the water soluble form was the least, with < 1% of the total Hg in the soil types investigated irrespective of the pH condition, while the residual fraction was the most abundant (> 80%) in Canisteo, Houston, and Ketona soils under acidic conditions and < 35% in Decatur soil. Under alkaline conditions, the residual fraction was ≤ 70% in Canisteo, Houston, and ketona and ≤ 29% in Decatur soil. The exchangeable fraction was the second most abundant fraction in the soils used ranging from 3.7-50.0% under acid conditions and 16.9-52.1% under alkaline conditions indicating that Hg desorption was found to be more favorable under alkaline than acidic conditions. Soil respiration was suppressed by Hg especially at the 100 mg kg(-1) concentration level. Amidohydrolases and phosphatases' response in the presence of Hg was variable. Amidohydrolases were more sensitive to Hg (18-90%) than phosphatase (0-35%) in all soils. This study demonstrated that the forms in which Hg exist in soils may determine its bioavailability and toxicity. Also microbial respiration and enzyme activities are potential bioindicators of heavy metal contamination of the environment.

Reduction of catheter-associated urinary tract infections among patients in a neurological intensive care unit: a single institution's success.

OBJECT: To date, there has been a shortage of evidence-based quality improvement initiatives that have shown positive outcomes in the neurosurgical patient population. A single-institution prospective intervention trial with continuous feedback was conducted to investigate the implementation of a urinary tract infection (UTI) prevention bundle to decrease the catheter-associated UTI rate. METHODS: All patients admitted to the adult neurological intensive care unit (neuro ICU) during a 30-month period were included. The study consisted of two 1-month preintervention observation periods (approximately 1200 catheter days) followed by a 30-month intervention phase (20,394 catheter days). A comprehensive evidence-based UTI bundle encompassing avoidance of catheter insertion, maintenance of sterility, product standardization, and early catheter removal was enacted. RESULTS: The urinary catheter utilization rate dropped from 100% to 73.3% during the intervention phase (p < 0.0001) without any increase in the rate of sacral decubitus ulcers or other skin breakdown. The rate of catheter-associated UTI was also significantly reduced from 13.3 to 4.0 infections per 1000 catheter days (p < 0.001). There was a linear relationship between the decreased quarterly catheter utilization rate and the decreased catheter-associated UTI rate (r(2) = 0.79, p < 0.0001). CONCLUSIONS: This single-center prospective study demonstrated that a comprehensive UTI prevention bundle along with a continuous quality improvement program can significantly reduce the duration of urinary catheterization and rate of catheter-associated UTI in a neuro ICU.

Evaluating spectroscopic and chromatographic techniques to resolve dissolved organic matter via end member mixing analysis.

Real-time or near real-time in-situ monitoring of dissolved organic matter (DOM) composition in natural waters and engineered treatment systems provides critical information to water quality scientists and engineers, particularly when the monitoring techniques can provide some information about the chemical nature of DOM. The efficacy of various indices derived from rapid, low-cost spectroscopic and chromatographic techniques to discriminate DOM composition was tested for samples prepared from well-defined mixtures of purified Aldrich humic acid (PAHA) and Suwannee River fulvic acid (SRFA). Sensitivities of the discrimination indices were examined by comparing (1) the differences between measured values and those predicted based from mass balance and the end member characteristics, and (2) the linear correlations between index values and mass ratios of the DOM mixtures. Size exclusion chromatography (SEC) results revealed that the weight-average molecular weight (MW(w)) may be a useful approach for tracking DOM mixing processes, although the number-average molecular weight (MW(n)) may be better for distinguishing different DOM compositions. Specific ultraviolet absorbance measured at 254 nm (SUVA(254)) performed better as a discrimination index than did two previously recommended absorbance ratios, both in terms of making better predictions of intermediate compositions and in exhibiting a more linear correlation with PAHA mass ratio. Several well-defined peaks in the derivative absorption spectra (301 and 314 nm for the first derivative, 217 nm for the third derivative, and 211 and 224 nm for the fourth derivative) also were found to be promising potential DOM discrimination indices. Finally, a fluorescence ratio based on humic- versus fulvic-like fluorescence proved to be a superior DOM discrimination index for the two DOM end members studied here. In general, this study illustrates the evaluation process that should be followed to develop rapid, low-cost discrimination indices to monitor DOM compositions based on end member mixing analyses.