Individual variation in life-history timing: synchronous presence, asynchronous events and phenological compensation in a wild mammal.

Many animals and plants have species-typical annual cycles, but individuals vary in their timing of life-history events. Individual variation in fur replacement (moult) timing is poorly understood in mammals due to the challenge of repeated observations and longitudinal sampling. We examined factors that influence variation in moult duration and timing among elephant seals (Mirounga angustirostris). We quantified the onset and progression of fur loss in 1178 individuals. We found that an exceptionally rapid visible moult (7 days, the shortest of any mammals or birds), and a wide range of moult start dates (spanning 6-10× the event duration) facilitated high asynchrony across individuals (only 20% of individuals in the population moulting at the same time). Some of the variation was due to reproductive state, as reproductively mature females that skipped a breeding season moulted a week earlier than reproductive females. Moreover, individual variation in timing and duration within age-sex categories far outweighed (76-80%) variation among age-sex categories. Individuals arriving at the end of the moult season spent 50% less time on the beach, which allowed them to catch up in their annual cycles and reduce population-level variance during breeding. These findings underscore the importance of individual variation in annual cycles.

Post-ovulatory aging is associated with altered patterns for small ubiquitin-like modifier (SUMO) proteins and SUMO-specific proteases.

Mammalian oocytes are ovulated arrested at metaphase of the second meiotic division. If they are not fertilized within a short period, the oocyte undergoes several progressive morphological, structural, and molecular changes during a process called oocyte aging. Herein, we focused on those functional events associated with proper cytoskeleton organization and those that correlate with spindle displacement and chromosome misalignment or scatter. Post-translational modifications by Small Ubiquitin-like Modifier (SUMO) proteins are involved in spindle organization and here we demonstrate that the SUMO pathway is involved in spindle morphology changes and chromosome movements during oocyte aging. SUMO-2/3 as well as the SUMO-specific proteases SENP-2 localization are affected by postovulatory aging in vitro. Consistent with these findings, UBC9 decreases during oocyte aging while differential ubiquitination patterns also correlate with in vitro oocyte aging. These results are consistent with postovulatory aging-related alterations in the posttranslational modifications of the spindle apparatus by SUMO and its SENP proteases. These findings are suggestive that such age-related changes in SUMOylation and the deSUMOylation of key target proteins in the spindle apparatus and kinetochore may be involved with spindle and chromosome alignment defects during mammalian oocyte postovulatory aging. Such findings may have implications for ART-related human oocyte aging in vitro regarding the activities of the SUMO pathway and fertilization success.

Implications for new particle formation in air of the use of monoethanolamine in carbon capture and storage.

Alkanolamines are currently being deployed in carbon capture and storage (CCS) technology worldwide, and atmospheric emissions have been found to coincide with locations exhibiting elevated concentrations of methanesulfonic acid (MSA). It is thus critical to understand the fate and potential atmospheric reactions of these chemicals. This study reports the characterization of sub-10 nm nanoparticles produced through the acid-base reaction between gas phase monoethanolamine (MEA) and MSA, a product of organosulfur compound oxidation in air, using a flow reactor under dry and humid (up to ∼60% RH) conditions. Number size distribution measurements show that MEA is even more efficient than methylamine in forming nanoparticles on reaction with MSA. This is attributed to the fact that the MEA structure contains both an -NH2 and an -OH group that facilitate hydrogen bonding within the clusters, in addition to the electrostatic interactions. Due to this already strong H-bond network, water has a relatively small influence on new particle formation (NPF) and growth in this system, in contrast to MSA reactions with alkylamines. Acid/base molar ratios of unity for 4-12 nm particles were measured using thermal desorption chemical ionization mass spectrometry. The data indicate that reaction of MEA with MSA may dominate NPF under some atmospheric conditions. Thus, the unique characteristics of alkanolamines in NPF must be taken into account for accurate predictions of impacts of CCS on visibility, health and climate.

A seasonal hybrid model for the evolution of flowering onset.

In strongly seasonal environments, many plants tend to divide the favorable season into an earlier part, where they allocate resources to vegetative growth, and a later part, where they allocate resources to reproduction. The onset of flowering typically indicates the shift from one to the other. We derive and analyze a model for the evolution of flowering onset on the phenotypic level. Our model tracks a continuous phenotype distribution through the various seasons from year to year. We analyze a special case of a monomorphic population with the tools of adaptive dynamics. We analyze the general case by a moment approximation. We find that (the mean of) flowering onset converges to some intermediate time within the favorable season. In the monomorphic case, we prove that this is an ESS. The moment approach reveals that there are different time scales involved on which the plant density, the mean flowering onset, and its variance converge.

Lucidity in the Context of Advanced Neurodegenerative Disorders: A Concept Analysis.

Individuals with advanced dementias resulting from neurodegenerative disorders (NDs) occasionally surprise caregivers with episodes of clarity and cognitive function that are not usually present. Lucid episodes-aptly named paradoxical lucidity in the literature-seem to involve a return of the "old self" during advanced neurodegenerative changes. Lucid episodes pose a problem for theories of neurological degeneration, which position dementias as progressive, incurable, and irreversible. In addition, lucid episodes raise ethical questions about whether information gleaned during lucid episodes is appropriate to direct future patient-centered care. The concept requires analysis and clarification if it is to guide future theorizing and research. The underlying goals of the current concept analysis are twofold: (a) to clarify the meaning of lucidity in the context of advanced NDs; and (b) to develop a theoretical definition that can guide future practice, research, and policy development. Walker and Avant's method is used to identify uses of the concept, defining attributes, antecedents, consequences, and empirical referents. [Journal of Gerontological Nursing, 46(12), 42-50.].

Temporal and SUMO-specific SUMOylation contribute to the dynamics of Polo-like kinase 1 (PLK1) and spindle integrity during mouse oocyte meiosis.

During mammalian meiosis, Polo-like kinase 1 (PLK1) is essential during cell cycle progression. In oocyte maturation, PLK1 expression is well characterized but timing of posttranslational modifications regulating its activity and subcellular localization are less clear. Small ubiquitin-related modifier (SUMO) posttranslational modifier proteins have been detected in mammalian gametes but their precise function during gametogenesis is largely unknown. In the present paper we report for mouse oocytes that both PLK1 and phosphorylated PLK1 undergo SUMOylation in meiosis II (MII) oocytes using immunocytochemistry, immunoprecipitation and in vitro SUMOylation assays. At MII, PLK1 is phosphorylated at threonine-210 and serine-137. MII oocyte PLK1 and phosphorylated PLK1 undergo SUMOylation by SUMO-1, -2 and -3 as shown by individual in vitro assays. Using these assays, forms of phosphorylated PLK1 normalized to PLK1 increased significantly and correlated with SUMOylated PLK1 levels. During meiotic progression and maturation, SUMO-1-SUMOylation of PLK1 is involved in spindle formation whereas SUMO-2/3-SUMOylation may regulate PLK1 activity at kinetochore-spindle attachment sites. Microtubule integrity is required for PLK1 localization with SUMO-1 but not with SUMO-2/3. Inhibition of SUMOylation disrupts proper meiotic bipolar spindle organization and spindle-kinetochore attachment. The data show that both temporal and SUMO-specific-SUMOylation play important roles in orchestrating functional dynamics of PLK1 during mouse oocyte meiosis, including subcellular compartmentalization.

SUMOylation regulates germinal vesicle breakdown and the Akt/PKB pathway during mouse oocyte maturation.

SUMOylation, a process of posttranslational modification of proteins by the small ubiquitin-related modifier (SUMO) family of proteins, is known to be involved in yeast and mammalian somatic cell-cycle regulation. However, the identities of the SUMO-modified oocyte targets are largely unknown and the functional role(s) for SUMOylation during mammalian oocyte maturation remains unclear. On the basis of studies in non-germline cells, protein kinase B/Akt is a potential SUMOylation target in the mouse oocyte, where it plays an essential role in cell-cycle resumption and progression during maturation. This study investigated the temporal patterns and prospective role(s) for interactions between SUMOylation and Akt serine-phosphorylation during oocyte meiotic resumption. Pharmacological inhibition of SUMOylation significantly decreased follicular fluid meiosis-activating sterol-induced cell-cycle resumption in oocytes matured in vitro and negatively affected the phosphorylation and nuclear translocation of Akt. Similarly, nuclear localization of cyclin D1, a downstream target of Akt activation, was significantly decreased following SUMOylation inhibition. Together these data show that SUMO and the posttranslational process of SUMOylation are involved in cell-cycle resumption during murine oocyte maturation and exert a regulatory influence on the Akt pathway during germinal vesicle breakdown.

A Bioenergetics Approach to Understanding the Population Consequences of Disturbance: Elephant Seals as a Model System.

Using long-term empirical data, we developed a complete population consequences of acoustic disturbance (PCAD) model and application for northern elephant seals. We assumed that the animals would not successfully forage while in a 100-km-diameter disturbance region within their foraging and transit paths. The decrease in lipid gain due to exposure was then translated to changes in birth rate and pup survival. Given their large foraging range, elephant seals were resilient to such a disturbance, showing no population-level effects. However, similar track analysis showed that given their more coastal nature, California sea lions were within a 25-km-diameter region of disturbance more often.

Pedagogical and teaching strategies used to teach writing to pre-licensure students enrolled in health professional programs: a scoping review protocol.

OBJECTIVE: The objective of this review is to map the existing literature on pedagogical approaches and teaching strategies used to teach academic and professional writing to pre-licensure students who are enrolled in health professional programs. INTRODUCTION: Health professional programs are intended to develop competence in both academic and professional writing. Effective academic writing skills prompt critical reflection and engagement with research communities, while professional writing skills are used to document interventions and communicate across health systems. Despite the importance of these 2 forms of writing, there are ongoing concerns that practitioners are entering practice without adequate writing skills. Given these concerns and the importance of writing across health disciplines, there is value in identifying the pedagogical strategies and approaches used in health professional programs to develop writing skills and to transfer such skills from one communicative context to another. INCLUSION CRITERIA: This review will consider research on the pedagogical approaches and teaching strategies used to teach academic and professional writing in pre-licensure health professional programs. METHODS: This review will be conducted in line with the JBI methodology for scoping reviews. The search strategy will aim to locate published literature using MEDLINE (Ovid), Embase, CINAHL with Full-Text (EBSCOhost), ProQuest Nursing & Allied Health (ProQuest), and ERIC (EBSCOhost), along with gray literature (using databases/search engines). Papers published from 2010 onward in English and in French will be included. Extracted data will be reported in tabular format and presented narratively to address each review objective. DETAILS OF THE REVIEW CAN BE FOUND IN OPEN SCIENCE FRAMEWORK: http://osf.io/9raxp.

Quantifying dispersal between two colonies of northern elephant seals across 17 birth cohorts.

Dispersal drives extinction-recolonization dynamics of metapopulations and is necessary for endangered species to recolonize former ranges. Yet few studies quantify dispersal and even fewer examine consistency of dispersal over many years. The northern elephant seal (Mirounga angustirostris) provides an example of the importance of dispersal. It quickly recolonized its full range after near extirpation by 19th century hunting, and though dispersal was observed it was not quantified. Here we enumerate lifetime dispersal events among females marked as pups at two colonies during 1994-2010, then correct for detection biases to estimate bidirectional dispersal rates. An average of 16% of females born at the Piedras Blancas colony dispersed northward 200 km to breed at Año Nuevo, while 8.0% of those born at Año Nuevo dispersed southward to Piedras Blancas. The northward rate fluctuated considerably but was higher than southward in 15 of 17 cohorts. The population at Piedras Blancas expanded 15-fold during the study, while Año Nuevo's declined slightly, but the expectation that seals would emigrate away from high density colonies was not supported. During the 1990s, dispersal was higher away from the small colony toward the large. Moreover, cohorts born later at Piedras Blancas, when the colony had grown, dispersed no more than early cohorts. Consistently high natal dispersal in northern elephant seals means the population must be considered a single large unit in terms of response to environmental change. High dispersal was fortuitous to the past recovery of the species, and continued dispersal means elephant seals will likely expand their range further.

Nursing students' experiences of a post-licensure practical nurse bridging program: a qualitative systematic review.

OBJECTIVE: The objective of this systematic review was to synthesize qualitative evidence on students' experiences of a post-licensure practical nurse to registered nurse bridging program. INTRODUCTION: A worldwide shortage of registered nurses has prompted governments and educational institutions to develop alternate pathways to nursing licensure. One strategy used to increase the supply of registered nurses is bridging programs. Such programs grant practical nurses academic credit for previous educational and practical experience, which allows them to complete a bachelor of nursing degree in a shorter length of time. Understanding the experience of students enrolled in bridging programs will help identify their specific needs and the educational support needed for them to successfully transition into the registered nurse role. INCLUSION CRITERIA: This review considered qualitative studies that examined the experiences of practical nurses enrolled in bridging programs. METHODS: The literature search was conducted in CINAHL, MEDLINE, Embase, and ERIC. The search for unpublished articles included ProQuest Dissertations & Theses and GreyNet International. Studies published in English were included with no date limits applied to the searches. Papers were screened independently by 2 reviewers against the inclusion criteria. Papers that met the criteria were appraised using the JBI critical appraisal checklist for qualitative research. Key findings were extracted from the included studies using a standardized tool and assigned a level of credibility. The review followed principles of meta-aggregation in line with the JBI approach. The final synthesized findings were graded according to the ConQual approach for establishing confidence in the output of qualitative research synthesis. RESULTS: Twenty-four studies, published between 1989 and 2020, were included in the review. A total of 83 findings were extracted and aggregated into 11 categories. From the 11 categories, 4 synthesized findings were developed and are summarized as: i) growth through professional advancement reflects that bridging students report personal growth and professional transformation when they return to school and study to become a registered nurse; ii) need for support indicates that bridging students recognize and appreciate a need to have positive support networks in their lives, mainly with their family, coworkers, and classmates; iii) expecting more reflects that, as adult learners with prior nursing experience, bridging students anticipate receiving more support from the educational institutions and higher levels of clinical expertise and competence amongst faculty than what is provided; and iv) finding balance indicates that bridging students struggle to balance and manage multiple roles and responsibilities in their lives as they return to school to study to become a registered nurse. CONCLUSION: The findings of this review highlight that, as adult learners with prior nursing experience, when post-licensure practical nurses return to study there is often a need to balance multiple roles and responsibilities. It is with the support of family, coworkers, classmates, and faculty that bridging students are able to manage competing personal and academic demands. While many bridging students express disappointment with some of the learning opportunities and/or faculty expertise associated with the nursing program, they ultimately achieve growth through both personal and professional advancement upon completing the program and becoming a registered nurse. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42021278408. SUPPLEMENTAL DIGITAL CONTENT: A French-language version of the abstract of this review is available as Supplemental Digital Content [ http://links.lww.com/SRX/A10 ].

Education and training for infection prevention and control provided by long-term care homes to family caregivers: a scoping review protocol.

OBJECTIVE: The objective of this review is to map the infection prevention and control education and training that long-term care homes use with families during a pandemic or infectious outbreak. INTRODUCTION: During the COVID-19 pandemic, restrictions were imposed on visits to long-term care homes to decrease the risk of virus transmission. These restrictions had negative consequences for both residents and families. A scoping review of infection prevention and control education and training used with families will inform family visitation practices and policies during future infectious outbreaks. INCLUSION CRITERIA: This review will examine literature describing infection prevention and control education and training provided to families in long-term care homes. Research and narrative papers, including experimental; quasi-experimental; descriptive observational quantitative and qualitative studies; and reviews, text, policy, and opinion papers, will be considered for inclusion. METHODS: A 3-step approach will be followed, in line with the JBI methodology for scoping reviews. Published literature will be searched for in databases, including CINAHL, Embase, ERIC, MEDLINE, and AgeLine. Published and unpublished papers will be considered from 1990 to the present, in English or French. The World Health Organization, Centers for Disease Control, and the Public Health Agency of Canada websites will be searched for unpublished and gray literature. Two authors will independently review and assess studies for inclusion and extract the data. The findings will be charted in a narrative summary and tables.

A novel class of small RNAs bind to MILI protein in mouse testes.

Small RNAs bound to Argonaute proteins recognize partially or fully complementary nucleic acid targets in diverse gene-silencing processes. A subgroup of the Argonaute proteins--known as the 'Piwi family'--is required for germ- and stem-cell development in invertebrates, and two Piwi members--MILI and MIWI--are essential for spermatogenesis in mouse. Here we describe a new class of small RNAs that bind to MILI in mouse male germ cells, where they accumulate at the onset of meiosis. The sequences of the over 1,000 identified unique molecules share a strong preference for a 5' uridine, but otherwise cannot be readily classified into sequence families. Genomic mapping of these small RNAs reveals a limited number of clusters, suggesting that these RNAs are processed from long primary transcripts. The small RNAs are 26-31 nucleotides (nt) in length--clearly distinct from the 21-23 nt of microRNAs (miRNAs) or short interfering RNAs (siRNAs)--and we refer to them as 'Piwi-interacting RNAs' or piRNAs. Orthologous human chromosomal regions also give rise to small RNAs with the characteristics of piRNAs, but the cloned sequences are distinct. The identification of this new class of small RNAs provides an important starting point to determine the molecular function of Piwi proteins in mammalian spermatogenesis.

Breast molecular imaging: a retrospective review of one institutions experience with this modality and analysis of its potential role in breast imaging decision making.

Breast Molecular Imaging (or Breast-Specific Gamma Imaging) has been previously shown to be both sensitive and specific for the detection of breast cancer. The purpose of our study was to retrospectively review all cases of Breast Molecular Imaging (BMI) performed at our institution to determine BMI's potential role in Breast Imaging decision making. A total of 416 cases of BMI from January 2007 to November 2009 were analyzed and the following data were collected: indication for examination, BIRADS assignment after BMI, biopsy outcomes, sensitivity and specificity of the modality and patient follow-up. Fifty-six percent of cases were ordered for an indeterminate asymmetry or focal asymmetry, 14% for evaluation of calcifications, and less than 10% each for the remainder of the indications including palpable lumps with negative imaging, evaluation of extent of disease in patients with known breast cancer and screening of high risk patients who could not undergo MRI. BMI was also shown to be helpful in evaluation of lesions that were difficult to biopsy or for patients that desired further testing rather than biopsy or short term follow-up of abnormalities. Seventy percent of BMI cases performed completed the diagnostic evaluation with BIRADS 1 or BIRADS 2 designations. Only 14% of cases ultimately resulted in biopsy. Contra-lateral findings were discovered in 10% of patients, more than half of which were occult malignancies or high-risk lesions. Of the lesions for which biopsy was recommended, 43% were malignant and 15% were high-risk lesions. Sensitivity of the test at our institution was 93% and specificity 78.9%. Our results show that BMI is both a sensitive and specific test which is useful as an adjunct to standard breast imaging modalities for problem solving in indeterminate cases.

Iatrogenesis in the Context of Residential Dementia Care: A Concept Analysis.

Background and Objectives: This concept analysis aims to explore iatrogenesis within the context of residential dementia care and to distinguish this phenomenon from similar phenomena, such as abuse and inadvertent harm. Research Design and Methods: Walker and Avant's method for concept analysis was used to define critical attributes of iatrogenesis within residential dementia care, and to explore antecedents and consequences of its occurrence. A review of the literature about iatrogenesis in the context of residential dementia was conducted across 4 electronic databases. Texts about iatrogenesis in surgery, medicine, social work, psychology, and other relevant disciplines were also reviewed to provide additional context for the concept. Results: Iatrogenesis takes a unique form in residential dementia care. The final definition of the concept proposed in this article is habituated, forceful, hands-on care provided to residents who exhibit responsive behaviors that result in emotional, physical, spiritual, social harm, and/or gradual functional decline, that is provided with the intention of supporting the resident's safety and dignity. Discussion and Implications: The definition of iatrogenesis proposed in this article is an initial step toward developing evidence-based practice for the provision of nonconsensual assistance in residential dementia care. A theoretical definition like the one proposed in this article may serve as a starting point for the operationalization of the concept, which would promote future empirical research into staff and residents' experiences of health care-inflicted harms in this context. Theoretically, it contributes to critical conversations about the narratives, myths, and misperceptions that facilitate the provision of nonconsensual care.

Experiences of faculty and staff nurses working with nursing students during clinical placement in residential aged care facilities: a systematic review of qualitative evidence.

OBJECTIVE: The objective of this review was to synthesize evidence on the experiences of faculty and staff nurses working with nursing students in clinical placement in residential aged care facilities. INTRODUCTION: Nursing education helps prepare students to provide quality care to older adults. Nursing programs across the globe are championing the integration of content on the care of older adults into their curricula as well as recognizing the value of clinical placements that focus exclusively on this population. Staff nurses who work in residential aged care facilities often work alongside students. In this role, they can support faculty and mentor students. This review explored faculty and staff experiences of nursing student placements in such facilities. INCLUSION CRITERIA: This review considered qualitative studies that address the experiences of faculty and staff nurses working with nursing students in residential aged care facilities. Studies published in English from 1995 onward were included. METHODS: The literature search was conducted in CINAHL, MEDLINE, Embase, and ERIC. The search for unpublished articles included Proquest Dissertations and Theses and Google searches of the Canadian Nurses Association and American Nurses Association websites. Papers were screened by two reviewers independently against the inclusion criteria. Those meeting the criteria were appraised using the JBI critical appraisal checklist for qualitative research. Key findings from included studies were extracted using a standardized tool and classified as unequivocal, credible, or not supported. This review followed the principles of meta-aggregration in line with the JBI approach. RESULTS: Six studies, published between 2001 and 2017, were included in the review. A total of 32 findings were extracted and aggregated into nine categories. From the nine categories, four synthesized findings were developed: i) students enhance the environment, whereby faculty and staff perceive that student presence enhances the residential aged care work and living environment, ii) effort is required by faculty and staff to make the experience work, reflecting a need for faculty and staff to accept and work with negativities, iii) residential aged care facilities provide rich learning experiences, indicating an appreciation for available learning opportunities, and iv) importance of a residential aged care-academic partnership for a collaborative approach in creating positive experiences for faculty and staff working with students in this setting. CONCLUSION: Faculty and staff experiences highlight that residential aged care has the potential to provide students with valuable learning experiences, including how to provide comprehensive and quality nursing care to older adults. A lack of resources in residential aged care inspires faculty and staff to be creative in how they work with students. However, working with students can be challenging for faculty who lack interest and expertise in caring for older adults in this setting. Additionally, staff can become frustrated when they perceive that students do not value the learning opportunities that are available or do not appreciate the expertise required to work with older adults. Partnerships between residential aged care facilities and academic programs can ensure that faculty and staff have the support and resources required to optimize the clinical placements for students. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020168698.

Nursing students' experiences of a post-licensure practical nurse bridging program: a qualitative systematic review protocol.

OBJECTIVE: This systematic review will synthesize the qualitative literature on students' experiences of a post-licensure practical nurse to registered nurse bridging program. INTRODUCTION: The worldwide shortage of registered nurses has prompted governments and educational institutions to develop alternative pathways to nursing licensure. One strategy used to increase the supply of registered nurses is bridging programs. These grant practical nurses academic credit for previous educational and practical experience, which allows them to complete a Bachelor of Nursing degree in a shorter period of time. However, attrition in bridging programs is a concern. Understanding the experiences of students enrolled in bridging programs will help identify their specific needs and the educational support needed for them to successfully transition into the registered nursing role. INCLUSION CRITERIA: This review will include published and unpublished studies that examine the experiences of practical nurses enrolled in bridging programs. Studies published in English will be considered, with no date limitations. METHODS: Databases to be searched include CINAHL, MEDLINE, Embase, and ERIC. Gray literature will be searched for in ProQuest Dissertations and Theses and GreyNet International. Reference lists of included studies will also be reviewed to identify additional studies. The critical appraisal of selected studies and the extraction of data will be independently undertaken by two reviewers using JBI methodology. The findings will be pooled using meta-aggregation to produce comprehensive synthesized findings. A ConQual Summary of Findings will also be presented. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42021278408.

The Functional Resonance Analysis Method as a health care research methodology: a scoping review.

OBJECTIVE: The objective of this review was to examine and map the literature on the use of the Functional Resonance Analysis Method (FRAM) in health care research. INTRODUCTION: The FRAM is a resilient health care tool tat offers an approach to deconstruct complex systems by mapping health care processes to identify essential activities, how they are interrelated, and the variability that emerges, which can strengthen or compromise outcomes. Insight into how the FRAM has been operationalized in health care can help researchers and policy-makers understand how this method can be used to strengthen health care systems. INCLUSION CRITERIA: This scoping review included research and narrative reports on the application of the FRAM in any health care setting. The focus was to identify the key concepts and definitions used to describe the FRAM; the research questions, aims, and objectives used to study the FRAM; the methods used to operationalize the FRAM; the health care processes examined; and the key findings. METHODS: A three-step search strategy was used to find published and unpublished research and narrative reports conducted in any country. Only papers published in English were considered. No limits were placed on the year of publication. CINAHL, MEDLINE, Embase, PsycINFO, Inspec Engineering Village, ProQuest Nursing & Allied Health were searched originally in June 2020 and again in March 2021. A search of the gray literature was also completed in March 2021. Data were extracted from papers by two independent reviewers using a data extraction tool developed by the reviewers. Search results are summarized in a flow diagram, and the extracted data are presented in tabular format. RESULTS: Thirty-one papers were included in the final review, and most (n = 25; 80.6%) provided a description or definition of the FRAM. Only two (n = 2; 6.5%) identified a specific research question. The remaining papers each identified an overall aim or objective in applying the FRAM, the most common being to understand a health care process (n = 20; 64.5%). Eleven different methods of data collection were identified, with interviews being the most common (n = 21; 67.7%). Ten different health care processes were explored, with safety and risk identification (n = 8; 25.8%) being the most examined process. Key findings identified the FRAM as a mapping tool that can identify essential activities or functions of a process (n = 20; 64.5%), how functions are interdependent or coupled (n = 18; 58.1%), the variability that can emerge within a process (n = 20; 64.5%), discrepancies between work as done and work as imagined (n = 20; 64.5%), the resiliency that exists within a process (n = 12; 38.7%), and the points of risk within a process (n = 10, 32.3%). Most papers (n = 27; 87.1%) developed models representing the complexity of a process. CONCLUSIONS: The FRAM aims to use a systems approach to examine complex processes and, as evidenced by this review, is suited for use within the health care domain. Interest in the FRAM is growing, with most of the included literature being published since 2017 (n = 24; 77.4%). The FRAM has the potential to provide comprehensive insight into how health care work is done and how that work can become more efficient, safer, and better supported.

Estimating population size when individuals are asynchronous: A model illustrated with northern elephant seal breeding colonies.

Our aim was to develop a method for estimating the number of animals using a single site in an asynchronous species, meaning that not all animals are present at once so that no one count captures the entire population. This is a common problem in seasonal breeders, and in northern elephant seals, we have a model for quantifying asynchrony at the Año Nuevo colony. Here we test the model at several additional colonies having many years of observations and demonstrate how it can account for animals not present on any one day. This leads to correction factors that yield total population from any single count throughout a season. At seven colonies in California for which we had many years of counts of northern elephant seals, we found that female arrival date varied < 2 days between years within sites and by < 5 days between sites. As a result, the correction factor for any one day was consistent, and at each colony, multiplying a female count between 26 and 30 Jan by 1.15 yielded an estimate of total population size that minimized error. This provides a method for estimating the female population size at colonies not yet studied. Our method can produce population estimates with minimal expenditure of time and resources and will be applicable to many seasonal species with asynchronous breeding phenology, particularly colonial birds and other pinnipeds. In elephant seals, it will facilitate monitoring the population over its entire range.