Nurse practitioner job preference: A discrete choice experiment.

BACKGROUND: Nurse practitioners play a critical role in improving the access to care and in meeting the needs for health care. However, prior to the COVID-19 pandemic, the average turnover rate of nurse practitioners was 10 % with associated total direct cost that ranged from $85,832 to $114,919 for each episode of turnover in the United States. Little is known about the job preference of nurse practitioners and the cost savings to an organization that provides jobs with characteristics attractive to nurse practitioners. OBJECTIVE: The aim of this study was to identify the preferred job characteristics that are associated with nurse practitioners' job choices; and to determine the extent to which nurse practitioners would need to be compensated for practicing without these characteristics. DESIGN: A two-stage design using a mixed method approach. SETTING(S): The state of Georgia in the United States. PARTICIPANTS: 2757 nurse practitioners who were actively licensed were invited to participate. Of the 412 participants, 372 actively employed in Georgia were included in the analysis. METHODS: A 2-stage discrete choice experiment was designed. Stage-1 was a qualitative design using a focus group to identify nurse practitioners' preferred job characteristics. Stage-2 was a quantitative design using survey distribution and analysis. A mixed logit model was used for ranking nurse practitioners' preferred job characteristics and the extent to which they would need to be compensated. RESULTS: On average nurse practitioners were 47.4 years of age; the majority were female (90 %), white (75.3 %), and educated at the master's level (88.7 %). Participants did not value teams that were not very cohesive (ß = -1.50); administration that was not very responsive and supportive (ß = -1.04); being supervised by a physician (ß = -0.58); not having their own panel of patients (ß = -0.42); and not billing under their own National Provider Identifier (ß = -0.18). Participants would need an increase in annual income of USD$21,780 for practicing in a not very cohesive team; USD$15,280 for practicing with a not very responsive administration; and USD$21,450 for being supervised by a physician. CONCLUSIONS: A cohesive, responsive, and supportive working environment and being able to practice independently are important characteristics for nurse practitioners when choosing a job. Healthcare managers should provide a workplace culture that reflects these preferred job characteristics to attract and retain nurse practitioners. Policymakers should consider reforming the scope of practice legislation to promote the independent practice of nurse practitioners.

Patient familiarity with, understanding of, and preferences for clinical trial endpoints and terminology.

BACKGROUND: Although there is increased attention to designing and explaining clinical trials in ways that are clinically meaningful for patients, there is limited information on patient preferences, understanding, and perceptions of this content. METHODS: Maximum difference scaling (MaxDiff) methodology was used to develop a survey for assessing patients' understanding of 19 clinical terms and perceived importance of 9 endpoint surrogate phrases used in clinical trials and consent forms. The survey was administered electronically to individuals with metastatic breast cancer affiliated with the Metastatic Breast Cancer Alliance. Analyses were performed using Bayesian P values with statistical software. RESULTS: Among 503 respondents, 77% had a college degree, 70% were diagnosed with metastatic disease ≥2 years before survey completion, and 77% had received ≥2 lines of systemic therapy. Less than 35% of respondents reported understanding "fairly well" the terms symptomatic progression, duration of disease control, time to treatment cessation, and endpoints. Income level and time since onset of metastatic disease correlated with comprehension. Patients who had received ≥6 lines of therapy perceived that time until serious side effects (P < .001) and time on therapy (P < .001) were more important compared with those who had received only 1 line of therapy. Positively phrased parameters were associated with increased perceived importance. CONCLUSIONS: Even among educated, heavily pretreated patients, many commonly used clinical research terms are poorly understood. Comprehension and the perceived importance of trial endpoints vary over the course of disease. These observations may inform the design, discussion, and reporting of clinical trials.

Kilogram-scale prexasertib monolactate monohydrate synthesis under continuous-flow CGMP conditions.

Advances in drug potency and tailored therapeutics are promoting pharmaceutical manufacturing to transition from a traditional batch paradigm to more flexible continuous processing. Here we report the development of a multistep continuous-flow CGMP (current good manufacturing practices) process that produced 24 kilograms of prexasertib monolactate monohydrate suitable for use in human clinical trials. Eight continuous unit operations were conducted to produce the target at roughly 3 kilograms per day using small continuous reactors, extractors, evaporators, crystallizers, and filters in laboratory fume hoods. Success was enabled by advances in chemistry, engineering, analytical science, process modeling, and equipment design. Substantial technical and business drivers were identified, which merited the continuous process. The continuous process afforded improved performance and safety relative to batch processes and also improved containment of a highly potent compound.

A microsphere coupler for a nanowire waveguide plasmonic probe for molecular imaging.

Highly forward scattering of light by a silica microsphere is predicted by Mie theory. Finite-difference time-domain simulations are used to examine the use of a silica microsphere for coupling light into a ZnO nanowire terminated with a gold nanoparticle (NP) tip, intended for near-field imaging of single molecules immobilized on a gold substrate or gold nanoparticle-labeled cell membranes. The results show that plasmonic coupling at the Au tip is dependent on the incident angle of the excitation. Pre-conditioning the signal with the microsphere amplifies the coupling while reducing background energy levels, significantly boosting the signal-to-noise ratio.

Surface plasmon-based nanopatterning assisted by gold nanospheres.

A pulsed laser is used to produce surface plasmon excitation in a monolayer of gold (Au) spheres to nanopattern a silicon substrate. An electrodynamic model accompanies the experimental data, based on the numerical solution to the complete Maxwell's equations including near- and far-field effects and reflection from the substrate. The Drude-employing finite-difference time-domain method describes the deformation and enhancement of the laser pulse around the boundary of a Au sphere and the resulting distribution of intensity incident upon the substrate. The effect of the incident laser angle on the plasmon generation and lithographic potential is studied.