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Background: Advanced practice registered nursing (APRN) competencies exist, but there is no structure supporting the operationalization of the competencies by APRN educators. The development of a Mastery Rubric (MR) for APRNs provides a developmental trajectory that supports educational institutions, educators, students, and APRNs. A MR describes the explicit knowledge, skills, and abilities as performed by the individual moving from novice (student) through graduation and into the APRN career. Method: A curriculum development tool, the Mastery Rubric (MR), was created to structure the curriculum and career of the nurse practitioner (NP), the MR-NP. Cognitive task analysis (CTA) yielded the first of the three required elements for any MR: a list of knowledge, skills, and abilities (KSAs) to be established through the curriculum. The European guild structure and Bloom's taxonomy of cognitive behaviors provided the second element of the MR, the specific developmental stages that are relevant for the curriculum. The Body of Work method of standard setting was used to create the third required element of the MR, performance level descriptors (PLDs) for each KSA at each of these stages. Although the CTA was informed by the competencies, it was still necessary to formally assess the alignment of competencies with the resulting KSAs; this was achieved via Degrees of Freedom Analysis (DoFA). Validity evidence was obtained from this Analysis and from the DoFA of the KSAs' alignment with principles of andragogy, and with learning outcomes assessment criteria. These analyses are the first time the national competencies for the NP have been evaluated in this manner. Results: CTA of the 43 NP Competencies led to seven KSAs that support a developmental trajectory for instruction and documenting achievement towards independent performance on the competencies. The Competencies were objectively evaluable for the first time since their publication due to the psychometric validity attributes of the PLD-derived developmental trajectory. Three qualitatively distinct performance levels for the independent practitioner make the previously implicit developmental requirements of the competencies explicit for the first time. Discussion: The MR-NP provides the first articulated and observable developmental trajectory for the NP competencies, during and beyond the formal curriculum. A focus on psychometric validity was brought to bear on how learners would demonstrate their development, and ultimately their achievement, of the competencies. The MR-NP goes beyond the competencies with trajectories and PLDs that can engage both learner and instructor in this developmental process throughout the career. [ABSTRACT FROM AUTHOR]

BACKGROUND:Advanced practice registered nursing (APRN) competencies exist, but there is no structure supporting the operationalization of the competencies by APRN educators. The development of a Mastery Rubric (MR) for APRNs provides a developmental trajectory that supports educational institutions, educators, students, and APRNs. A MR describes the explicit knowledge, skills, and abilities as performed by the individual moving from novice (student) through graduation and into the APRN career. METHOD:A curriculum development tool, the Mastery Rubric (MR), was created to structure the curriculum and career of the nurse practitioner (NP), the MR-NP. Cognitive task analysis (CTA) yielded the first of the three required elements for any MR: a list of knowledge, skills, and abilities (KSAs) to be established through the curriculum. The European guild structure and Bloom's taxonomy of cognitive behaviors provided the second element of the MR, the specific developmental stages that are relevant for the curriculum. The Body of Work method of standard setting was used to create the third required element of the MR, performance level descriptors (PLDs) for each KSA at each of these stages. Although the CTA was informed by the competencies, it was still necessary to formally assess the alignment of competencies with the resulting KSAs; this was achieved via Degrees of Freedom Analysis (DoFA). Validity evidence was obtained from this Analysis and from the DoFA of the KSAs' alignment with principles of andragogy, and with learning outcomes assessment criteria. These analyses are the first time the national competencies for the NP have been evaluated in this manner. RESULTS:CTA of the 43 NP Competencies led to seven KSAs that support a developmental trajectory for instruction and documenting achievement towards independent performance on the competencies. The Competencies were objectively evaluable for the first time since their publication due to the psychometric validity attributes of the PLD-derived developmental trajectory. Three qualitatively distinct performance levels for the independent practitioner make the previously implicit developmental requirements of the competencies explicit for the first time. DISCUSSION:The MR-NP provides the first articulated and observable developmental trajectory for the NP competencies, during and beyond the formal curriculum. A focus on psychometric validity was brought to bear on how learners would demonstrate their development, and ultimately their achievement, of the competencies. The MR-NP goes beyond the competencies with trajectories and PLDs that can engage both learner and instructor in this developmental process throughout the career.

Microarrays based on gene expression profiles (GEPs) can be tailored specifically for a variety of topics to provide a precise and efficient means with which to discover hidden information. This study proposes a novel means of employing existing GEPs to reveal hidden relationships among diseases, genes, and drugs within a rich biomedical database, PubMed. Unlike the co-occurrence method, which considers only the appearance of keywords, the proposed method also takes into account negative relationships and non-relationships among keywords, the importance of which has been demonstrated in previous studies. Three scenarios were conducted to verify the efficacy of the proposed method. In Scenario 1, disease and drug GEPs (disease: lymphoma cancer, lymph node cancer, and drug: cyclophosphamide) were used to obtain lists of disease- and drug-related genes. Fifteen hidden connections were identified between the diseases and the drug. In Scenario 2, we adopted different diseases and drug GEPs (disease: AML-ALL dataset and drug: Gefitinib) to obtain lists of important diseases and drug-related genes. In this case, ten hidden connections were identified. In Scenario 3, we obtained a list of disease-related genes from the disease-related GEP (liver cancer) and the drug (Capecitabine) on the PharmGKB website, resulting in twenty-two hidden connections. Experimental results demonstrate the efficacy of the proposed method in uncovering hidden connections among diseases, genes, and drugs. Following implementation of the weight function in the proposed method, a large number of the documents obtained in each of the scenarios were judged to be related: 834 of 4028 documents, 789 of 1216 documents, and 1928 of 3791 documents in Scenarios 1, 2, and 3, respectively. The negative-term filtering scheme also uncovered a large number of negative relationships as well as non-relationships among these connections: 97 of 834, 38 of 789, and 202 of 1928 in Scenarios 1, 2, and 3, respectively. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is the most common arrhythmia. The most common diagnostic method, 12-lead electrocardiogram (ECG), can record episodes of arrhythmia from which the type and severity can be determined. The Heart Spectrum Blood Pressure Monitor (P2; OSTAR Meditech Corp., New Taipei City, Taiwan) is used to measure cardiovascular pressure change with fast Fourier transform (FFT) analysis to obtain heart rate frequency variability and accurate blood pressure data. We compared the diagnostic efficacy of the Heart Spectrum Blood Pressure Monitor to a 12-lead ECG (gold standard) for patients with AF. Three measurement methods were used in this study to analyze the heart index and compare the results with simultaneous 12-lead ECG: blood pressure; mean arterial pressure, which was calculated from individual blood pressure as a constant pressure; and a constant pressure of 60 mmHg. The physician used a 12-lead ECG and the Heart Spectrum Blood Pressure Monitor simultaneously. The Heart Spectrum Blood Pressure Monitor used FFT analysis to diagnose AF, and the findings were compared to the 12-lead ECG readings. This unblinded clinical trial was conducted in the emergency department of Taipei Medical University Hospital. Twenty-nine subjects with AF and 33 without AF aged 25 to 97 y (mean, 63.5 y) were included. Subjects who were exposed to high-frequency surgical equipment during testing, those with cardiac pacemakers or implantable defibrillators, and pregnant women were excluded. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 97%, 97%, 97%, and 97%, respectively, for method 1; 90%, 100%, 100%, and 91%, respectively, for method 2; and 100%, 94%, 94%, and 100%, respectively, for method 3. The sensitivity, specificity, PPV, and NPV for both methods ranged between 90% and 100%, indicating that the Heart Spectrum Blood Pressure Monitor can be effectively applied for AF detection. [ABSTRACT FROM AUTHOR]

Immune and endocrine responses play a critical role in allowing animals to adjust to environmental perturbations. We measured immune and endocrine related markers in multiple samples from individuals from two managed-care care dolphin groups (n = 82 samples from 17 dolphins and single samples collected from two wild dolphin populations: Indian River Lagoon, (IRL) FL (n = 26); and Charleston, (CHS) SC (n = 19). The immune systems of wild dolphins were more upregulated than those of managed-care-dolphins as shown by higher concentrations of IgG and increases in lysozyme, NK cell function, pathogen antibody titers and leukocyte cytokine transcript levels. Collectively, managed-care care dolphins had significantly lower levels of transcripts encoding pro-inflammatory cytokine TNF, anti-viral MX1 and INFα and regulatory IL-10. IL-2Rα and CD69, markers of lymphocyte activation, were both lower in managed-care care dolphins. IL-4, a cytokine associated with TH2 activity, was lower in managed-care care dolphins compared to the free-ranging dolphins. Differences in immune parameters appear to reflect the environmental conditions under which these four dolphin populations live which vary widely in temperature, nutrition, veterinary care, pathogen/contaminant exposures, etc. Many of the differences found were consistent with reduced pathogenic antigenic stimulation in managed-care care dolphins compared to wild dolphins. Managed-care care dolphins had relatively low TH2 lymphocyte activity and fewer circulating eosinophils compared to wild dolphins. Both of these immunologic parameters are associated with exposure to helminth parasites which is uncommon in managed-care care dolphins. Less consistent trends were observed in a suite of hormones but significant differences were found for cortisol, ACTH, total T4, free T3, and epinephrine. While the underlying mechanisms are likely multiple and complex, the marked differences observed in the immune and endocrine systems of wild and managed-care care dolphins appear to be shaped by their environment. [ABSTRACT FROM AUTHOR]