The Nurse Practitioner Workforce in Western Canada: A Cross-Sectional Practice Analysis Comparison.

Regular examination of health workforce data is essential given the pace of health system and legislative changes. Health workforce studies pertaining to nurse practitioner (NP) practice are needed to examine the gaps between work activities, policy, human resource supply, or for population needs. Jurisdictional comparison studies can provide essential information about NP practice for governments to respond to health workforce deficiencies or engage in service planning. In Canada, there is limited provincial-territorial jurisdictional NP workforce data to support health planning or policy change. This descriptive cross-sectional study was to examine the similarities and differences in practice patterns of Canadian NPs. In 2016 and 2017, an electronic survey was sent to all 852 registered NPs in three Canadian provinces, yielding a large convenience sample of 375 NP respondents. The results of this study underscore the value of NPs' extensive registered nurse expertize as well as their ability to serve diverse patient populations, work in varied healthcare settings, and provide care to medically complex patients. The study findings also show that NPs in all three jurisdictions work to their full scope of practice, in both rural and urban settings. This study is the first to compare NP workforce data across multiple Canadian jurisdictions simultaneously. Studies of this type are valuable tools for understanding the demographics, education, integration, and employment activities of NPs and can aid governments in addressing workforce planning.

Disambiguating pharmacological mechanisms from placebo in neuropathic pain using functional neuroimaging.

BACKGROUND: A lack of objective outcome measures and overreliance on subjective pain reports in early proof-of-concept studies contribute to the high attrition of potentially effective new analgesics. We studied the utility of neuroimaging in providing objective evidence of neural activity related to drug modulation or a placebo effect in a double-blind, randomized, placebo-controlled, three-way crossover trial. METHODS: We chronically administered pregabalin or tramadol (first-line and second-line analgesics, respectively), recommended for neuropathic pain, in 16 post-traumatic neuropathic pain patients. We measured subjective pain reports, allodynia-evoked neural activity, and brain resting state functional connectivity from patients during the three sessions and resting state data at baseline from patients after washout of their current medication. All data were collected using a 3 T MRI scanner. RESULTS: When compared with placebo only, pregabalin significantly suppressed allodynia-evoked neural activity in several nociceptive and pain-processing areas of the brain, despite the absence of behavioural analgesia. Furthermore, placebo significantly increased functional connectivity between the rostral anterior cingulate and the brainstem, a core component of the placebo neural network. CONCLUSIONS: Functional neuroimaging provided objective evidence of pharmacodynamic efficacy in a proof-of-concept study setting where subjective pain outcome measures are often unreliable. Additionally, we provide evidence confirming the neural mechanism underpinning placebo analgesia as identified in acute experimental imaging studies in patients during the placebo arm of a clinical trial. We explore how brain penetrant active drugs potentially interact with this mechanism. CLINICAL TRIAL REGISTRATION: NCT0061015.

Maternal and fetal tissue accumulation of selected endocrine disrupting compounds (EDCs) following exposure to sewage sludge-treated pastures before or after conception.

Liver concentrations of selected pollutant classes were determined in groups of sheep fetuses and their dams, at 55 (Experiment 1) and 110 (Experiment 2) days of gestation (term = 145 d) following exposure, throughout their breeding lives and after mating, to pasture treated with either inorganic fertiliser (control, CC) or with sewage sludge (treated, TT). In a unique study designed to separate the respective contributions of environmental sources and mobilised tissue to the available EDC burden, in additional groups of animals, pollutant burdens at 110 days gestation were assessed following exposure to the respective treatments, either throughout their breeding lives until mating, but not thereafter (TC), or only between mating and slaughter (CT) (Experiment 3). With very few exceptions, maternal and fetal liver concentrations of diethylhexyl phthalate (DEHP) and selected polychlorinated biphenyls (PCBs), and polybrominated diphenyl ethers (PBDE) and polycyclic aromatic hydrocarbons (PAHs) were not significantly affected by sludge exposure in any group. In some cases, maternal and fetal tissue EDC concentrations were different but the differences were not consistent, and maternal and fetal concentrations of none of the classes of chemical were significantly correlated. It was not possible to identify a single chemical, or class of chemical, that may be responsible for previously observed physiological effects of exposure to sludge-treated pastures. It is concluded that exposure of sheep to pastures fertilised with sewage sludge was not associated with increased liver concentrations of EDCs, irrespective of the stage of development at which they were measured and of maternal tissue mobilisation and EDC release during gestation. Thus, retrospective measurements of EDC tissue burdens could not be used to accurately assess earlier fetal EDC insults.

Factors contributing to the time taken to consult with symptoms of lung cancer: a cross-sectional study.

OBJECTIVES: To determine what factors are associated with the time people take to consult with symptoms of lung cancer, with a focus on those from rural and socially deprived areas. METHODS: A cross-sectional quantitative interview survey was performed of 360 patients with newly diagnosed primary lung cancer in three Scottish hospitals (two in Glasgow, one in NE Scotland). Supplementary data were obtained from medical case notes. The main outcome measures were the number of days from (1) the date participant defined first symptom until date of presentation to a medical practitioner; and (2) the date of earliest symptom from a symptom checklist (derived from clinical guidelines) until date of presentation to a medical practitioner. RESULTS: 179 participants (50%) had symptoms for more than 14 weeks before presenting to a medical practitioner (median 99 days; interquartile range 31-381). 270 participants (75%) had unrecognised symptoms of lung cancer. There were no significant differences in time taken to consult with symptoms of lung cancer between rural and/or deprived participants compared with urban and/or affluent participants. Factors independently associated with increased time before consulting about symptoms were living alone, a history of chronic obstructive pulmonary disease (COPD) and longer pack years of smoking. Haemoptysis, new onset of shortness of breath, cough and loss of appetite were significantly associated with earlier consulting, as were a history of chest infection and renal failure. CONCLUSION: For many people with lung cancer, regardless of location and socioeconomic status, the time between symptom onset and consultation was long enough to plausibly affect prognosis. Long-term smokers, those with COPD and/or those living alone are at particular risk of taking longer to consult with symptoms of lung cancer and practitioners should be alert to this.

A structural equation model of empowerment factors affecting nurse practitioners competence.

Role competence and patient safety (PS) competence among healthcare professionals are rapidly developing issues due to increasing patient acuity and complexity in the healthcare system. Upon graduation, nurse practitioners (NP) provide autonomous healthcare for populations with complex health needs, thus role and PS competence is imperative. The study aim was to test a hypothesized model of the relationships between educational structural empowerment (SE), psychological empowerment (PE), NP role competence, and PS competence. The sample was drawn from newly graduated NPs from across Canada, accessed through twenty professional nurse organizations. The study survey included socio-demographic questions, the Conditions of Learning Effectiveness Questionnaire, the PE Scale, the NP Competence Survey, and the Health Processional Education in PS Survey. One hundred and ninety Canadian educated NPs who completed their studies in the preceding 2-year time period responded. The study model tested the effect of educational SE on NP role competence and PS competence partially mediated by PE. PE partially mediated the positive relationship for educational SE and PS competence, yet no mediation effect occurred for educational SE and NP role competence. Nurse educators need to consider educational SE strategies as NPs' positive perceptions of role competence have the potential to influence greater levels of PS competence.

Knowledge, motivation and barriers to diabetes control in adults in Jamaica.

In this descriptive study, individual structured interviews were conducted on a random sample of 35 men and 98 women from a population (n = 510) of clinic patients. Open questions sought to determine the extent of knowledge, motivation and barriers to lifestyle changes for control of diabetes mellitus (DM) in Jamaican adults. These were coded into themes and described. Other data were analysed using SPSS. Men (61.8 +/- 14.8 years) were older than women (54.9 +/- 13.7 years) and demonstrated less knowledge (p = 0.006). The respondents (71%) indicated the need for more education. Barriers to lifestyle changes and glycaemic control included a low education level (64%), inadequate knowledge (80%), lack of perceived risk (80.4%) and lack of self-monitoring (93%). Only 23% were controlled to HbA1c < or = 6.5%. The patients' reference to the physicians as a primary source of information indicated the need for a collaborative team approach, and the incorporation of diabetes education as an indispensable service at this clinic.

Self-care, compliance and glycaemic control in Jamaican adults with diabetes mellitus.

Appropriate self-care practices, including nutrition and medication compliance, are essential to satisfactory control of diabetes mellitus (DM). This descriptive study assesses self-care practices, and their relationships to glycaemic control in adults with DM in Jamaica. A pre-tested structured interview and anthropometric measurements were carried out on 98 women and 35 men, randomly selected from a population (n = 510) of adult clinic patients. HbA1c was used as the index of glycaemic control. Self-care practice scores indicated the extent of compliance with appropriate lifestyle practices. Data were analyzed using the Statistical Package for the Social Sciences (SPSS). Men (median age, 62 years) were significantly older (z = -2.64, p = 0.008) than the women (55 years). The median duration of DM was: men, seven years; women: 10.5 years. Sixty-nine per cent were being treated with insulin. Only 45% reported full compliance with medications. Their median body mass index (BMI) was 29.1, (16.6-47.4) kg/m2. Eighty-one per cent were overweight or obese. Forty-six per cent described diet and/or obesity as contributing to their diabetes. Eighty-five per cent had consulted a dietitian but only 56.4% reported being on a "special diet". Only 16.5% reported not taking any sugar. Self-care scores were inversely related to HbA1c% (p = 0.008), BMI (p = 0.001), sugar intake (p = 0.005) and were lowest in the area of weight control and exercise. Only 23% had blood glucose controlled to HbA1c < or = 6.5%. In women, HbA1c% levels were inversely related to compliance with medication (p = 0.004). Glycaemic control in adults with diabetes mellitus is related to their self-care practices, especially weight control, exercise and medication compliance.

A novel role for IRF-1 as a suppressor of apoptosis.

The tumour suppressor IRF-1 is a transcription factor involved in the induction of apoptosis in several in vitro systems. Post-lactational involution of the mammary gland is characterized by extensive apoptosis of the epithelial cells. We have previously shown that signal transducer and activator of transcription (Stat) 3 drives apoptosis and involution in the mouse mammary gland. Since one of the downstream targets of the Stat signalling pathway is IRF-1, we have used IRF-1 knockout mice to address the potential role of this transcription factor in involution. Surprisingly, in the absence of IRF-1 significantly higher numbers of apoptotic cells were found in involuting glands at 48 h compared to control glands. In addition, the alveolar structure in IRF-1 null mammary glands had collapsed whereas in control glands the alveoli remained intact and distended. However, by 72 h control and null glands were morphologically similar suggesting that IRF-1 suppresses apoptosis only during the early, reversible, stage of involution. This suggests a survival role for IRF-1 in mammary epithelia and demonstrates a novel role for IRF-1 in vivo--suppression of premature epithelial apoptosis during mammary gland involution.

The relative contribution of remobilization and root uptake in supplying nitrogen after defoliation for regrowth of laminae in four grass species.

Miniswards of Lolium perenne, Festuca rubra, Agrostis casteUana and Poa trivialis were grown in a sand-limestone mixture and fed with a complete nutrient solution containing 3 mol m-3 NH4 NO3 . The miniswards were cut weekly to a height of 4 cm until a steady state of growth, based on weight of clippings removed, was achieved. After clipping (day 0) the nutrient solution was replaced by one in which all the nitrogen (N) was enriched with 15 N to 5 atom per cent, but was otherwise identical. This allowed discrimination of remobilization from current root uptake when considering the supply of N for regrowth of laminae. Destructive harvests were made over the following 28-d period, while unharvested plants continued to receive a weekly clip. The proportion of the total uptake of labelled N which appeared in the clipped material was of the order L. perenne > P. trivialis > A. castellana > F. rubra. The change in unlabelled N in the roots plus leaf bases over time was modelled as a proportion of the amount present on day 0. A simple exponential model with a non-zero asymptote was found to model the data; the asymptote was assumed to represent the proportion of unlabelled N not readily available for remobilization. Species differences in the asymptotes were found, with F. rubra having a significantly larger asymptote than A. castellana and P. trivialis, which in turn both had significantly larger asymptotes than L. perenne. All species used both root uptake and remobilization to supply N for post-defoliation regrowth of laminae. However, the relative contribution of each source was species-dependent. The proportion of N in the clipped material derived from remobilization was significantly greater for F. rubra than A. castellana, which in turn had a significantly greater proportion derived from remobilization than P. trivialis and L. perenne.

The role of cholecystokinin in the expression of seasonal variation in the feed intake and eating pattern of red deer (Cervus elaphus).

The role of cholecystokinin (CCK) in the expression of seasonal variation in feed intake and feeding activity in ruminants was investigated by active immunisation of castrated male red deer (Cervus elaphus). In April, animals of two groups (five animals per group) were immunised against either CCK or vehicle solution only and booster injections were administered at 2-month intervals for the following year. Measurements were conducted for a period of more than a year from July. There were no significant effects of immunisation on mean daily food intake. However, there was a significant interaction (P<.01) between immunisation and month (season), with respect to rate of feed ingestion during meals, with animals immunised against CCK exhibiting higher mean rates of ingestion during October to May but lower mean rates during June to September. It is concluded that systemic CCK has a role in the expression of seasonal variation in the rate of feed ingestion during meals in ruminants and that this, in turn, may affect the pattern of seasonal change in daily feed intake. Since there was no evidence of differences with treatment in profiles of insulin, growth hormone (GH), thyroxine (T(4)), triiodothyronine (T(3)), insulin-like growth factor-1 (IGF-1) or prolactin, it is unlikely that this effect is expressed through changes in the profiles of these hormones.

Effect of long-term feed restriction on seasonal endocrine changes in soay sheep.

Groups of 15 adult, castrated, male Soay sheep were housed under natural daylength conditions at 57 degrees N and fed a complete diet ad libitum (AL) or at a restricted rate (R) of 35 g dry matter (DM)/kg(0.75) initial liveweight per day. The diet was based on barley and dried grass pellets and contained an estimated 11.6 MJ of metabolisable energy, 83% DM and 140 g crude protein/kg DM. In the AL animals, higher levels of feed intake during the periods of long daylength were associated with shorter inter-meal intervals (p<0. 001), a greater meal frequency (p<0.001), and a greater proportion of time spent eating (p<0.001) together with a greater rate of feed ingestion (p<0.001) and an increased meal size (p<0.001). Mean plasma concentrations of insulin, prolactin, insulin-like growth factor 1 (IGF-1), triiodothyronine (T(3)), and thyroxine (T(4)) were higher (p<0.001) in the spring or summer than in the autumn. Mean plasma GH concentrations did not differ with month. Compared with R animals, AL animals had higher mean plasma concentrations of insulin (p<0.001), prolactin (p<0.01), T(3) (p<0.01), and T(4) (p<0.01). Plasma GH and IGF-1 concentrations did not differ significantly with treatment. There was a greater increase in plasma insulin concentrations following feeding in R than AL animals (p<0.001) owing to higher pre-feeding concentrations in AL animals and the ingestion of larger amounts of feed by R than AL animals in the period after fresh feed was introduced. There were significant differences between months in this response, in R animals (p<0.01). Mean CSF insulin concentrations were significantly higher in AL than R animals (p<0.05) but were not affected by month. Neither was there a difference between pre-feeding concentrations and concentrations at approximately 12 h after feeding. It is concluded that the differences in the response of plasma insulin concentrations to feeding at different times of year, which were detected in R animals, were attributable, primarily, to differences in the vagally-induced insulin response to feeding and that these differences may provide important feedback signals to the appetite centre.

Seasonality of meal patterns and hormonal correlates in red deer.

Two groups of six adult, castrated, male red deer were housed under natural daylength conditions and at ambient temperature at 57 degrees N and fed ad lib. (AL) or at a fixed rate of 50 g/kg0.75 initial liveweight per day throughout the study (restricted, R). Mean daily intakes of AL animals were higher during periods of long daylength than during short daylength (p < 0.001). The higher rates of food intake during periods of long daylength were a function of greater meal durations (p < 0.001), shorter inter-meal intervals (p < 0.001) and higher (p < 0.001) mean rates of ingestion (g/min). In both groups mean plasma concentrations of prolactin, T3, T4, and insulin-like growth factor 1 (IGF-1) were higher (p < 0.001) during long daylength than short daylength although changes in thyroid hormone profiles were much less marked in AL animals. Insulin and growth hormone (GH) profiles exhibited no consistent seasonal trend. Mean plasma concentrations of T3 were higher in AL than in R animals. Mean plasma IGF-1 concentrations during long days were consistently greater in the AL than R animals. It is concluded that the effects of seasonal changes in daylength on appetite and food intake are expressed through changes in both the duration of daylight periods per se and in underlying seasonal changes in physiology and associated meal patterns and eating rates. It is concluded that the roles of T3, IGF-1, and prolactin in the expression of seasonal changes in appetite should be investigated further and, particularly, their effects on other hormone profiles and liver and gut function.

The effect of Luque segmental sublaminar instrumentation on the rib hump in idiopathic scoliosis.

The change in back shape after Luque segmental sublaminar instrumentation was assessed in the frontal, sagittal, and transverse planes in 61 patients with adolescent idiopathic scoliosis using the Integrated Shape Investigation System (ISIS) and standard radiographic techniques. Luque instrumentation was found to be an effective method of correcting thoracic and thoracolumbar curves in the frontal plane with a 59% and 63% respective reduction in the size of the preoperative Cobb angle. Despite the frontal plane correction, however, the ISIS scan showed that of the 40 single thoracic curves, the rib hump was reduced in only 6 patients, was unchanged in 27 patients, and was worsened slightly in 7 patients. By contrast, thoracolumbar and lumbar curves were corrected in all three planes with a significant cosmetic improvement.

The successive determination of chloride, fluoride and sodium in single samples of orthophosphate minerals by means of ion-sensitive electrodes.

A buffer system composed of perchloric acid, citric acid and triethanolamine has been used for the successive determination of chloride, fluoride and sodium in a single sample of an orthophosphate mineral. The conventional sodium-sensitive glass electrode compares favourably with the more expensive Orion sodium-sensitive electrode.

Potentiometric determination of chloride in inorganic orthophosphates in citrate-buffered media.

The chloride content of some inorganic orthophosphates and phosphate rock samples has been determined in a medium buffered to pH 2.5 with a mixture of perchloric acid, citric acid and trisodium citrate. The method has been compared with an earlier method which employed a mixture of perchloric acid, citric acid and triethanolamine. The present method is of similar reproducibility and does not suffer from decomposition of the reagents. The interference patterns of several metals are discussed.

The use of triethanolamine in a buffer for the determination of fluoride in calcium and transition metal orthophosphates, using a fluoride-selective el.

A method is described for the determination of fluoride in inorganic orthophosphates. Interference by complex-forming metal ions is avoided by the use of a citric acid-triethanolamine buffer, pH < 7.5.

Temporal changes in soil properties at an upland Scottish site between 1956 and 1997.

The aim of this study was to examine the frequency with which soil samples require to be taken in order to determine significant temporal changes in soil properties. The examination was carried out using data from Glensaugh Research Station in north-east Scotland where podzolic soils were sampled in 1956, 1977 and 1997, and by re-analysis of archived material. Significant differences in chemistry due to storage were detected, particularly decreases in pH of air-dried organic soils. In these cases original data were used for statistical analysis to establish changes between 1956 and 1997. Temporal changes were found for exchangeable Ca and Mg which generally decreased with time throughout the soil profile, whereas exchangeable H increased. Derived data, such as percent base saturation, declined dramatically due to decreases in exchangeable base cations. Similar podzolic soils were sampled at an adjacent Environmental Change Network (ECN) site in 1993. Application of statistical techniques to the ECN soil chemistry data allowed an estimation of the detectable change between any two years. These data along with the rates of temporal change from 1956 to 1997 allowed the calculation of the number of years required for measurable changes to be achieved. These changes and sampling intervals vary among different horizons and chemistries. Although they are site-specific, they do confirm that the current ECN protocols of a 5-year and 20-year sampling would be appropriate in order to detect changes in soil properties over time at this site.

Six-month hypertension intervention study. One year follow-up.

The aim of this study was to assess the long term impact of an educational and monitoring intervention on blood pressure control in patients (n = 80) who had blood pressure > 140/90 mm Hg in January 1999, and attended the Specialist Hypertension Clinic, the University Hospital of the West Indies. Forty-two of these patients (cases) attended the monthly educational and monitoring intervention for six months, in addition to their usual care. The other 38 (controls) attended only one educational intervention at the end of the six months. One year later, patients were traced by telephone or clinic attendance. Data were collected on 73 (91%) patients, 40 (95%) cases and 33 (87%) controls by clinic records or by direct measurement of blood pressure and weight. Three (7.5%) cases and two (6%) controls had died. One (2.5%) case and five (15%) controls had been referred to renal or cardiac clinics. Twenty-five (59.5%) cases, and 14 (36.8%) controls were still attending the clinic. At the end of the year, 26% (7/27) of the cases and 30% (6/20) of the controls had blood pressure (BP) controlled to < 140/90 mm Hg. These proportions compare to 28% (11/39) cases and 22% (8/36) controls at the end of the six-month intervention. At the end of one year, neither cases nor controls showed significant mean changes in BP, weight, nor body mass index (BMI). There was no significant difference between the median BMI of the cases, 31.2 kg/m2 and that of the controls, 29.3 kg/m2. Seventy-seven per cent (21/27) cases and 84.2% (16/19) controls had BMI > 25 kg/m2. These data, though limited, are consistent with reports that the impact of lifestyle interventions in chronic diseases may be short lived. This study suggests that therapeutic lifestyle intervention strategies need to be integrated with the overall management of patients so that the effect may be sustained.