Nurse Certification and Test Anxiety.

OBJECTIVE: To determine the relationship between scores on the Westside Test Anxiety Scale (WTAS) and nurse certification rates. BACKGROUND: Nurse certification is associated with improved outcomes. Understanding intrinsic factors associated with low certification rates including test anxiety could help nurse leaders improve certification rates. METHODS: This descriptive, correlational study used a convenience sample of 577 RNs with at least 2 years of nursing experience. Participants completed a survey of their demographics and the 10-question WTAS. RESULTS: Certified nurses were significantly older and had more years of experience. Noncertified nurses had significantly higher scores on the WTAS. CONCLUSIONS: Facilities working to increase their nurse certification rates may consider adding test anxiety reduction interventions to other levels of support.

Individual and practice differences among physicians who perform ERCP at varying frequency: a national survey.

BACKGROUND: ERCP practice patterns in the United States are largely unknown. OBJECTIVE: To characterize the ERCP practice of U.S. gastroenterologists, stratified by their annual case volume: high volume (HV, >200), moderate volume (MV, 50-200), and low volume (LV, <50). DESIGN: Anonymous electronic survey. SUBJECTS: American Society for Gastrointestinal Endoscopy members who are practicing U.S. gastroenterologists. RESULTS: Among all responders (N = 1006), 63% were derived from community practices. Physicians who performed ERCPs and provided data on annual volume (n = 669) were classified as LV (n = 254), MV (n = 284), and HV (n = 131). During training, 77% of LV physicians did not complete 180 ERCPs compared with 58% of MV and 34% of HV physicians (P < .0001). Only 58% of LV physicians enjoy performing ERCP compared with 88% of MV and 98% of HV physicians (P < .0001); 60% reported being "very comfortable" with ERCP compared with more than 90% of MV and HV physicians (P < .0001). LV physicians are less comfortable with pancreatic duct stenting (PDS) (57% vs 92% [MV] and 98% [HV], P ≤ .02) and using prophylactic PDS. Although HV physicians (42%) were least likely to use short-wire devices (P < .02), use of wire-guided cannulation was similar (74% LV, 72% MV, 66% HV, P = .13). Thirty-seven percent of LV physicians reported comfort with needle-knife sphincterotomy compared with 75% (MV) and 99% (HV) (P < .0001). LIMITATIONS: Survey completion rate of 18.5%. CONCLUSIONS: Self-reported comfort and/or enjoyment with ERCP is lower among LV physicians. Wire-guided cannulation is used by the majority of all ERCP practitioners, but prophylactic PDS is less frequently used by LV physicians. Because many LV physicians perform ERCP for higher-grade indications and use advanced techniques (eg, needle-knife sphincterotomy), further LV physician ERCP outcomes data are needed.

Regional decline of an iconic amphibian associated with elevation, land-use change, and invasive species.

Ecological theory predicts that species with restricted geographic ranges will have the highest probability of extinction, but species with extensive distributions and high population densities can also exhibit widespread population losses. In the western United States populations of northern leopard frogs (Lithobates pipiens)-historically one of the most widespread frogs in North America-have declined dramatically in abundance and geographic distribution. To assess the status of leopard frogs in Colorado and evaluate causes of decline, we coupled statewide surveys of 196 historically occupied sites with intensive sampling of 274 wetlands stratified by land use. We used an information-theoretic approach to evaluate the contributions of factors at multiple spatial extents in explaining the contemporary distribution of leopard frogs. Our results indicate leopard frogs have declined in Colorado, but this decline was regionally variable. The lowest proportion of occupied wetlands occurred in eastern Colorado (2-28%), coincident with urban development and colonization by non-native bullfrogs (Lithobates catesbeianus). Variables at several spatial extents explained observed leopard frog distributional patterns. In low-elevation wetlands introduced fishes, bullfrogs, and urbanization or suburbanization associated negatively with leopard frog occurrence, whereas wetland area was positively associated with occurrence. Leopard frogs were more abundant and widespread west of the Continental Divide, where urban development and bullfrog abundance were low. Although the pathogenic chytrid Batrachochytrium dendrobatidis (Bd) was not selected in our best-supported models, the nearly complete extirpation of leopard frogs from montane wetlands could reflect the individual or interactive effects of Bd and climate patterns. Our results highlight the importance of considering multiple, competing hypotheses to explain species declines, particularly when implicated factors operate at different spatial extents.

Ceruloplasmin induces polymorphonuclear leukocyte priming in localized aggressive periodontitis.

BACKGROUND: Polymorphonuclear leukocytes (PMNs) from subjects with localized aggressive periodontitis (LAgP) present multiple functional abnormalities associated with a phenotypically primed PMN phenotype. Local inflammation is characterized by hypoxia, which leads to increased production of superoxide (O(2)(-)) by PMNs. Ceruloplasmin (CP) is also induced by hypoxia and inflammation. The aim of this study was to investigate the role of CP in O(2)(-) generation in PMNs from healthy subjects and patients with LAgP. METHODS: PMNs were isolated from healthy subjects and those with LAgP (N = 36). Superoxide was measured by cytochrome-C reduction at 550 nm. Intracellular CP expression was analyzed by real-time polymerase chain reaction and Western blotting. Serum levels of CP were measured by enzyme-linked immunosorbent assay. Intracellular iron ion conversion was spectrophotometrically determined by measuring the absorbance of sigma-phenanthroline at 510 nm. RESULTS: O(2)(-) generation was significantly higher in LAgP PMNs before and after stimulation with formyl-methionyl-leucyl-phenylalanine (100 nM). CP expression in PMNs and CP levels in serum were significantly higher in subjects with LAgP compared to the PMNs and serum samples from matched healthy donors (P <0.05). LAgP PMNs also had significantly higher levels of Fe(3+) and lower levels of Fe(2+) compared to healthy PMNs (P <0.05), suggesting increased iron conversion. Exogenous CP treatment of healthy PMNs resulted in significant increases in O(2)(-) generation and iron ion conversion similar to LAgP PMNs. CONCLUSION: LAgP PMNs are primed to express higher levels of CP, leading to hypoxia-mediated O(2)(-) generation in PMNs and increased oxidative stress and neutrophil-mediated tissue injury in LAgP.