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Introduction Nurses are prone to fatigue and sleep disturbances due to extended hour or shiftwork schedules. Fatigue in nurses not only compromises their own health and safety, but jeopardizes patient care as well. Nurses' work hours and overtime are currently not federally regulated. Fatigue risk mitigation strategies for nurses would benefit from understanding the relationship between sleep duration and work patterns in order to develop tools and regulations to protect against fatigue in the nursing profession. Methods Thirteen (N=13) nurses wore a Fitbit Versa 2 and used the SleepTank™ mobile app during a 6-week work rotation. Nurses in this study selected their own work shifts but did have duty-hour limitations. Sleep data was extracted via the mobile app; work schedules were self-reported. Sleep duration data was summed by date to provide a 24-hour estimate of time in bed (TIB24). Repeated measures analysis of variance (rmANOVA) explored differences in TIB24 by number of consecutive days worked and time. Pearson’s correlations evaluated the relationship between work and sleep. Results Nurses (N=13) wore the device with the app for an average of 54±15 days. Forty percent (40%) of the study period were work days (22±10). Nurses slept longer on non-work days (525±153 min) compared to work days (481±143; t=3.21, p=0.001). Nurses worked 2 days in a row on average (Range: 1-5). TIB24 was ~30 minutes shorter with each consecutive day worked (F5, 81=8.11, η2=0.08, p=< 0.001). Routinely working a greater number of consecutive days was negatively correlated to TIB24 (r=0.71, p=0.009). Later average work start time was positively correlated with later bedtime (r=0.83, p< 0.001) and shorter TIB24 (r=0.65, p=0.01). Conclusion Working more days consecutively and working later shifts was related to shorter sleep duration and later bedtime in nurses. However, given that nurses in this study routinely slept longer than 7 hours per night, poor sleep hygiene does not appear to be an issue in this population. The ability to select their own work shifts may allow nurses to select a schedule that permits healthy sleep behavior. Support (if any) N/A

This study evaluated the diuretic, antioxidant, anti-inflammatory, and immunological effects of a commercial diuretic (CD) (composed of ammonium chloride, potassium citrate, sodium chloride, ascorbic acid, biotin, halfa bar extract, and hexamine) on chickens with induced urolithiasis. A total of 100 one-day-old white Hy-Line chicks were fed a basal diet containing 20% crude protein (CP) and 1% Ca until they reached 48 days of age. Then, the birds were divided into five groups (G1-G5). G1 was fed a basal diet and kept as a negative control, G2 was fed a high protein (HP) diet containing 25% crude protein, G3 was fed high calcium (HC) diet containing 5% Ca, G4 was fed HP diet supplemented with CD, and G5 was fed HC diet supplemented with CD. The CD was supplemented with drinking water (at a dose of 0.5 ml/ liter) for 1 week. The experiment was held for 78 days. Clinical signs, postmortem lesions, and mortality rates were observed. Biochemical analytes, redox status biomarkers, and expression of interleukin-6 (IL-6) and interferon-gamma (IFN-γ) were measured. Tissue samples were taken for histopathological examination. No signs of CD toxicity were observed during the toxicity test prior to the experiment. Compared to all groups, birds in G2 and G3 showed impaired renal function and alterations in biochemical, redox status, lipid peroxidation, post-mortem, and histopathological lesions along with upregulation of IL-6 and IFN-γ in the kidney and spleen. In conclusion, commercial diuretic supplementation for one week improves renal function, redox status, immune and anti-inflammatory responses in chickens with induced urolithiasis.

The aim of this study was to analyze the perceptions of core team members implementing patient-centered medical home (PCMH) within the Veterans Health Administration regarding delegation of work.Significant overlap exists in the performance of work tasks among PCMH team members (primary care providers, RNs, clinical associates, clerks), and scant literature exists on appropriate delegation within PCMH teams.This study conducted used a quantitative and qualitative analysis of 4254 respondents to a 2018 survey.Primary care providers rely heavily on team members, and nurses report being relied upon at high levels. Lack of role clarity and a perceived need for a team leader were concerns voiced by participants.Findings indicated a need for clear guidance on roles and responsibilities within the team. Patient-centered medical home team members need information about the scope of practice of each professional group to allow providers to function at the top of their scope of practice and ensure effective delegation.

Background Sleep is an essential biological function; insufficient sleep (quantity) and poor sleep (quality) are associated with negative occupational and health outcomes. Sleep deficiency among nurses has been linked to several negative nurse and patient safety outcomes. However, relatively few studies have comprehensively examined the relationship between nurses' work and personal factors, and sleep behavior (quality, quantity, and daytime sleepiness). Purpose The purpose of this study was to identify work and personal attributes influencing nurses' sleep behaviors. Methods This report is a secondary analysis of sleep data that were collected as a part of a mixed-methods study that was conducted in eight hospitals in a midwestern state. A self-report, paper-and-pencil questionnaire was used for data collection. Results Our participants reported sleeping for up to 6.6 hours, with 87% reporting poor sleep quality and 51% reporting excessive daytime sleepiness. Personal factors such as age, education, number of children, and exercise were other factors significantly associated with sleep behavior (p Conclusion A multifaceted approach designed around nurses' work characteristics and personal factors is needed to help nurses better manage their sleep.

Introduction Hospital nurses may experience substantial fatigue, yet there is limited empirical evidence about fatigue management strategies. Aim: The aim of this study was to describe how hospital nurses manage fatigue at home and at work. Methods This descriptive third-phase study of nurses in eight Midwestern hospitals used a maximum variation sampling strategy based on fatigue scores and self-reported medication error and near misses. Participant data from semi-structured interviews were thematically analyzed. Results Barriers to fatigue management included workload, pace, schedule, shift, and nutrition at work, as well as inadequate sleep and competing demands at home. Strategies for fatigue management at work included moving, drinking caffeine, keeping busy, eating, and taking breaks, whereas strategies at home included sleeping, performing activities, and relaxing. Participants suggested organizational approaches to support fatigue management related to staffing and workload, such as breaks, naps, and schedule and shift. Every nurse interviewed reported some degree of fatigue and could describe barriers to fatigue management they encountered. All nurses also could describe attempts to manage fatigue. Conclusions Fatigue management should be part of organizational policy review and nursing education and training to keep nurses and their patients safe and to enable a positive work-life balance.

Medication near-misses occur at higher rates than medication errors and are usually underreported. Reporting a medication near-miss is crucial, as it highlights areas of human and system failures. Identifying these incidents is particularly important in nursing home (NH) settings to help managers plan and initiate proactive measures to contain the errors. However, scarce evidence exists about predictors of nurses' willingness to report near-misses. Therefore, the purpose of this study was to test a proposed model for NH nurses' willingness to report medication near-misses. Data for this cross-sectional study were collected using a random sample of RNs working in NHs across one Midwestern state. The proposed model predicted a 19% variance in nurses' willingness to report medication near-misses, with the strongest predicators being non-punitive responses to errors ( β = 0.33, p < 0.001). According to the study results, system and social factors are needed to improve nurses' voluntary reporting of medication near-misses. [ Journal of Gerontological Nursing, 46 (4), 21–30.]

BackgroundLittle is known about how team processes impact providers’ abilities to prepare patients for a safe hospital discharge. Teamwork Shared Mental Models (teamwork-SMMs) are the teams’ organised understanding of individual member’s roles, interactions and behaviours needed to perform a task like hospital discharge. Teamwork-SMMs are linked to team effectiveness in other fields, but have not been readily investigated in healthcare. This study examines teamwork-SMMs to understand how interprofessional teams coordinate care when discharging patients.MethodsThis mixed methods study examined teamwork-SMMs of inpatient interprofessional discharge teams at a single hospital. For each discharge event, we collected data from the patient and their discharge team (nurse, physician and coordinator) using interviews and questionnaires. We quantitatively determined the discharge teams’ teamwork-SMM components of quality and convergence using the Shared Mental Model Scale, and then explored their relationships to patient-reported preparation for posthospital care. We used qualitative thematic analysis of narrative cases to examine the contextual differences of discharge teams with higher versus lower teamwork-SMMs.ResultsThe sample included a total of 106 structured patient interviews, 192 provider day-of-discharge questionnaires and 430 observation hours to examine 64 discharge events. We found that inpatient teams with better teamwork-SMMs (ie, higher perceptions of teamwork quality or greater convergence) were more effective at preparing patients for post-hospital care. Additionally, teams with high and low teamwork-SMMs had different experiences with team cohesion, communication openness and alignment on the patient situation.ConclusionsExamining the quality and agreement of teamwork-SMMs among teams provides a better understanding of how teams coordinate care and may facilitate the development of specific team-based interventions to improve patient care at hospital discharge.

Background Past studies have reported nurses working day shifts engage in high amounts of light and moderate-intensity occupational physical activity. However, little is known regarding how occupational physical activity and sedentary behavior is accumulated within shifts and/or over consecutive shifts. Objective This study compared occupational physical activity and sedentary behavior patterns of nurses working 12-h. day vs. 12 -h. night shifts. We hypothesized nurses working day shifts would be more active and less sedentary while at work compared to nurses working night shifts and that within shift and between shift differences would emerge. Design Prospective-cohort study design Setting(s) Midwestern trauma one academic medical center medical units (medical surgical, critical care, pediatrics, mother and baby, and other) Participants A total of 56 registered nurses working 12-h. day and night shifts participated in this study. Methods Occupational physical activity and sedentary behaviors (e.g., step count, time spent sitting, standing, and walking) were measured for 14 continuous days using the ActivPAL 3 micro activity monitor. Repeated measures mixed-effects regression models were used to examine the effects of shift type, consecutive shifts, and time within a shift on occupational physical activity and sedentary behaviors. Results Nurses spent more time standing and walking, and less time sitting overall during day shifts compared to night shifts. Nurses walked less during the third consecutive night shift and stood less and sat more during the second and third consecutive night shifts, compared to day shifts. Nurses tended to walk less and sit more during the middle portion of each night shift compared to day shifts. Conclusions Our findings suggest nurses spend more than half of each shift either standing or walking and that differential patterns of occupational physical activity and sedentary behavior exist between day and night shifts. These findings should be used to inform future interventions designed to advance the health and work performance of nurses.

This study explores nurses' and nursing students' knowledge, attitudes, and self-efficacy in caring for the elderly and addresses the factors contributing to nurses' perspectives. It also examines the nursing curriculum's contributions to nurses' knowledge, attitudes, and self-efficacy and provides suggestions to reconfigure the nursing curriculum for comprehensive geriatric nursing care. A mixed-method research design was used to address the purpose of the study. The results revealed that most nurses possess neutral attitudes toward caring for geriatric patients, and their knowledge ranged from average to above-average levels; most nurses had an above-average level of self-efficacy. Results also showed a statistically significant positive correlation between nurses' attitudes and knowledge level and between self-efficacy and knowledge level. Similarly, there was a statistically significant positive correlation between nurses' attitudes and self-efficacy and between self-efficacy and years of experience. This study demonstrated the positive impact of the Canadian nursing curriculum on nurses' knowledge, attitudes, and self-efficacy.

Background High rates of mental health conditions and poor healthy lifestyle behaviors are reported in nurses, other clinicians, and health science students but have not been compared across different professions. Purpose The purpose of this study was threefold: (1) describe rates of mental health problems and healthy lifestyle behaviors across the Big 10 health professional faculty and students, (2) compare the health and healthy lifestyle behaviors of the Big 10 health sciences faculty and students across health sciences' professions, and (3) identify factors predictive of depression, stress, and anxiety. Methods Faculty and students from eight health science colleges at the Big 10 Universities responded to the study survey, which included: demographics, healthy lifestyle behavior questions, and three valid/reliable mental health scales. Descriptive statistics described the findings and multiple linear regression identified factors associated with mental health conditions. Results Eight-hundred and sixty-nine faculty and 1087 students responded. Approximately 50% of faculty and students reported 7 h of sleep/night, a third achieved 150 min of physical activity/week; 5.5%–9.9% screened positive for depression; and 11.5%–25.5% had anxiety. Age, sleep, and physical activity were associated with lower depression and anxiety. Conclusions University leadership must build wellness cultures that make healthy lifestyle behaviors easy to engage in and enhance mental well-being.

The field of stem cells has attracted the attention of many researchers as a hope to treat many incurable diseases because of their ability of self-renewal and differentiation into a specific type of cells that compensates damaged cells. Many studies have been published to confirm their effectiveness but there are some obstacles that limit their clinical applications. One of these obstacles is xenogenic fetal bovine serum (FBS); the main proliferative source for stem cell culture with subsequent risk of infection transmission or immunogenic problems. So, in our study, we aimed to replace the xenogenic FBS with xeno-free blood derivative. We tested the effect of different concentrations of activated pure platelet rich plasma (P-PRP); one of the blood derivatives on proliferation of adipose derived mesenchymal stem cells (AD-MSCs) in comparison to FBS and found that 20% activated P-PRP followed by 10% activated P-PRP increased the proliferation rate of AD-MSCs more than 10% FBS. KEYWORDS AD-MSCs, P-PRP, FBS.

One of the major impacts of spinal cord injury (SCI) is the cerebellar neurological malfunction and deformation of its sub-layers. This could be due to the enormous innervation of the spinocerebellar tract from the posterior gray horn in the spinal cord to the ipsilateral cerebellum. Although the neuroprotective role of estradiol in spinal cord (SC) injuries, as well as its ability to delay secondary cell death changes, is well-known, its effect on cerebellar layers is not fully investigated. In this study, a SCI model was achieved by injection of Kainic acid into SC of adult Male Wistar rats in order to assess the effects of SCI on the cerebellum. The animals were classified into SCI group (animals with SCI), estradiol-treated group (animals with SCI and received estradiol), control groups, and sham control group. The microscopical examination 24 h after induction of SCI revealed that KA induced the most characteristics of neurodegeneration including astrocytic propagation and microglial activation. The estradiol was injected intraperitoneally 20 min after induction of SCI, and the samples were collected at 1, 3, 7, 14, and 30 days. Histologically, the estradiol reduced the inflammatory response, enhanced the recovery of molecular, granular, and Purkinje cell layers, and therefore aided in the restoration of layer organization. These findings were also confirmed by immunohistochemical staining and gene expression profiling.

Second-intention wound healing may be impaired by wound or host factors and thus more advanced therapies are required for a fast and satisfactory outcome. Platelet-rich fibrin (PRF), rich in growth factors that are essential for tissue repair, could improve wound healing. Twelve apparently healthy male donkeys were divided into two groups. Four full-thickness excisional skin wounds (2 × 2 cm) were created on lateral surfaces of the right metacarpal and left metatarsal of all donkeys (two wounds on each limb). Control wounds were left without treatment. Meanwhile, the wounds were treated topically with PRF. Wound healing was evaluated clinically, histologically, and through gene expression. The times required for complete wound closure were significantly shorter in PRF-treated wound compared with untreated wounds (36.00 ± 1.26 vs. 48.50 ± 1.87). All wounds of PRF groups healed faster than untreated wounds. Epithelization and wound contraction were observed earlier in PRF-treated wound compared with the control group (at second and third week, respectively). In PRF group, granulation tissue was regular, smooth, and observed earlier than in the control group. Histological and molecular evaluation confirmed the gross findings via early granulation tissue formation, higher epithelialization, collagen deposition, fibroblast proliferation, and angiogenic and myofibroplastic genes (collagen type 3α1, vascular endothelial growth factor, fibroblast growth factor 7, and transform growth factor β1) revealed significant overexpression in PRF-treated group when compared with the control at 15 and 30 days after wounding. Allogeneic PRF is considered a step forward in improving cutaneous wound healing in lower limb in donkeys via higher epithelialization, wound contraction, and could accelerate wound closure with smooth and regular granulation tissue.

Medication errors are common in health care settings. Safety motivation, such as willingness to report error, is needed to contain medication errors. Limited evidence exists about measures to enforce nurses’ safety motivation. The purpose of this study was to test a proposed model explaining the mechanism by which organizational and social factors influence nurses’ safety motivation. Survey for this cross-sectional study was mailed to a random sample of 500 acute care nurses. Data collection started in January 2014 and lasted 6 months. Path analysis results showed a good fitting final model with 15% of explained variance on nurses’ safety motivation. Safety climate dimensions of error feedback (β = .38, p ⩽ .00) and nonpunitive response to errors (β = .22, p = .01) significantly predicted the outcome. There is a need for both organizational and social factors to motivate nurses to report errors. Leadership practices emphasizing safety as a priority is needed to enhance nurses’ safety motivation.

Nurses function at the point of care and assume a significant role in intercepting errors. They work in a mentally and physically demanding profession that is comprised of shift-work, subjecting nurses to considerable fatigue. Yet, few studies constructed a comprehensive model that integrates personal and occupational factors to explore their relationship with various types of fatigue (acute, chronic, physical, mental, and total). Here, we examine this type of comprehensive fatigue-model, in a report that represents one aim of a larger, mixed-methods study. The study sample comprised of 1137 registered nurses working in eight hospitals in a Midwestern state. Nurses reported higher levels of acute and total fatigue than chronic and physical fatigue. Staffing and resource adequacy, exercise, and sleep were among the strongest predictors. Since fatigue is a multi-faceted construct, a comprehensive fatigue-management strategy that targets both day and night-shift nurses is the optimal way to manage nurse fatigue.

This paper presents a novel methodology to analyze nursing surveys. It is based on ELM and SOM. The goal is to identify which variables lead to the likelihood to report the medication errors. ELM are accurate by extremely fast prediction models. SOM are performing nonlinear dimensionality reduction to get an accurate visualization of the data. Combining both techniques reduces the curse of dimensionality and improves furthermore the interpretability of the visualization. The methodology is tested on a nursing survey datasets.

This study was carried out to evaluate the effects of induced urolithiasis by high dietary calcium (Ca) or protein levels on biochemical analyte levels, redox status, selected inflammatory cytokines and histopathology in chickens. A total of 90 one-day-old white Hy-Line chicks were fed basal control diets containing 20% crude protein (CP) and 1% Ca until they reached 44 days of age. After that, the birds were divided into three groups (30 birds per group). All management factors (light, temperature, ventilation, stock density and diet) were identical among the three groups throughout the study except for the dietary Ca and protein percentages. Group I was fed a control diet containing 20% CP and 1% Ca, group II was fed a high-Ca diet containing 5% Ca, and group III was fed a high-protein diet containing 25% CP. Our findings clearly demonstrated that dietary imbalance (caused by high-Ca or high-CP levels) per se in chickens was physiologically harmful, as it was accompanied by post-mortem lesions; biochemical, redox status and histopathological alterations; and upregulation of inflammatory cytokines (interleukin (IL)-1β and IL-6). In particular, the birds fed the high-Ca diet clearly exhibited the most obvious alterations in most of the endpoints. In conclusion, this study constitutes the first extensive investigation of the effects of high-Ca or high-protein diets induced urolithiasis on growth performance, redox status, inflammatory cytokine levels and pathological characterization in chickens.

Neural stem cells (NSCs) are multipotent self-renewing cells that could be used in cellular-based therapy for a wide variety of neurodegenerative diseases including Alzheimer's diseases (AD), Parkinson's disease (PD), amyotrophic lateral sclerosis (ALS), and multiple sclerosis (MS). Being multipotent in nature, they are practically capable of giving rise to major cell types of the nervous tissue including neurons, astrocytes and oligodendrocytes. This is in marked contrast to neural progenitor cells which are committed to a specific lineage fate. In previous studies, we have demonstrated the ability of NSCs isolated from human olfactory bulb (OB) to survive, proliferate, differentiate, and restore cognitive and motor deficits associated with AD, and PD rat models, respectively. The use of carbon nanotubes (CNTs) to enhance the survivability and differentiation potential of NSCs following their in vivo engraftment have been recently suggested. Here, in order to assess the ability of CNTs to enhance the therapeutic potential of human OBNSCs for restoring cognitive deficits and neurodegenerative lesions, we co-engrafted CNTs and human OBNSCs in TMT-neurodegeneration rat model. The present study revealed that engrafted human OBNSCS-CNTs restored cognitive deficits, and neurodegenerative changes associated with TMT-induced rat neurodegeneration model. Moreover, the CNTs seemed to provide a support for engrafted OBNSCs, with increasing their tendency to differentiate into neurons rather than into glia cells. The present study indicate the marked ability of CNTs to enhance the therapeutic potential of human OBNSCs which qualify this novel therapeutic paradigm as a promising candidate for cell-based therapy of different neurodegenerative diseases. This article is protected by copyright. All rights reserved

Introduction Medication errors are one of the most frequently occurring errors in health care settings. The complexity of the ED work environment places patients at risk for medication errors. Most hospitals rely on nurses' voluntary medication error reporting, but these errors are under-reported. The purpose of this study was to examine the relationship among work environment (nurse manager leadership style and safety climate), social capital (warmth and belonging relationships and organizational trust), and nurses' willingness to report medication errors. Methods A cross-sectional descriptive design using a questionnaire with a convenience sample of emergency nurses was used. Data were analyzed using descriptive, correlation, Mann-Whitney U, and Kruskal-Wallis statistics. Results A total of 71 emergency nurses were included in the study. Emergency nurses' willingness to report errors decreased as the nurses' years of experience increased ( r = –0.25, P = .03). Their willingness to report errors increased when they received more feedback about errors ( r = 0.25, P = .03) and when their managers used a transactional leadership style ( r = 0.28, P = .01). Discussion ED nurse managers can modify their leadership style to encourage error reporting. Timely feedback after an error report is particularly important. Engaging experienced nurses to understand error root causes could increase voluntary error reporting.

Mesenchymal stem cells (MSCs) are undifferentiated cells that have the ability of self-renewal and trans-differentiation into other cell types. They hold out hope for finding a cure for many diseases. Nevertheless, there are still some obstacles that limit their clinical transplantation. One of these obstacles are the xenogeneic substances added in either proliferation or differentiation media with subsequent immunogenic and infectious transmission problems. In this study, we aimed to replace fetal bovine serum (FBS), the main nutrient source for MSC proliferation with xeno-free blood derivatives. We tested the effect of human activated pure platelet-rich plasma (P-PRP) and advanced platelet-rich fibrin (A-PRF) on the proliferation of human adipose derived-MSCs (AD-MSCs) at different concentrations. For the induction of MSC neural differentiation, we used human cerebrospinal fluid (CSF) at different concentrations in combination with P-PRP to effect xeno-free/species-specific neuronal/glial differentiation and we found that media with 10% CSF and 10% PRP promoted glial differentiation, while media with only 10% PRP induced a neuron-like phenotype.

This paper presents a novel methodology to analyze nurses’ willingness to report medication errors. Parallel Extreme Learning Machines were applied to identify the top interpersonal and organizational predictors and Self-Organizing Maps to create comprehensive visualization. The results of the data analysis were targeted to improve the likelihood of nurses reporting of medication errors. ELMs are accurate by extremely fast prediction models. Self-Organizing Maps enable us to perform non-linear dimensionality reduction to get an accurate visualization of the selected variables. Combining both techniques reduces the curse of dimensionality and improves the interpretability of the visualization.

Purpose To describe work environment characteristics (leadership style and safety climate) of ambulatory surgical settings and to examine the relationship between work environment and nurses' willingness to report medication errors in ambulatory surgical settings. Design Descriptive correlational design using survey methodology. Methods The sample of this study consisted of 40 unit-based registered nurses, working as full time, part time, or as needed in four ambulatory surgical settings affiliated with one health care system located in Northeast Ohio. Findings The results of two separate regression analyses, one with three nurse manager's leadership styles and another with five safety climate dimensions as independent variables, explained 44% and 50%, respectively, on variance of nurses' willingness to report medication errors. Conclusion To increase nurses' willingness to report medication errors, ambulatory surgical settings administrators should invest in nurse manager leadership training programs and focus on enhancing safety climate aspects, particularly errors feedback and organizational learning.

Medication order discrepancies pose safety risks when nursing home residents transition between health care settings. In nursing homes, both registered nurses (RNs) and licensed practical nurses (LPNs) frequently are assigned to detect medication order discrepancies, using the process of medication reconciliation. This study was undertaken to examine the extent to which licensure (RN, LPN), years of experience performing medication reconciliation, and the perceived Need for Closure were related to differences in the detection of medication order discrepancies. The Multiple Segment Factorial Vignette design was used to explore and compare nursing home nurses’ detection of such discrepancies. RNs ( n = 32) and LPNs ( n = 70) from 12 Missouri nursing homes responded to four resident transfer vignettes embedded with medication order discrepancies. The study found that years of experience and the Need for Closure were not related to reports of discrepancies. However, RNs detected discrepancies involving orders for high-risk medications significantly more often than LPNs. No significant differences existed between RNs and LPNs when identifying discrepancies in orders for low-risk medications. These findings regarding the discrepancies detected in orders for high-risk medications and those detected in orders for low-risk medications have implications for resident safety.

Parkinson's disease (PD) is a neurological disorder characterized by the loss of midbrain dopaminergic (DA) neurons. Neural stem cells (NSCs) are multipotent stem cells that are capable of differentiating into different neuronal and glial elements. The production of DA neurons from NSCs could potentially alleviate behavioral deficits in Parkinsonian patients; timely intervention with NSCs might provide a therapeutic strategy for PD. We have isolated and generated highly enriched cultures of neural stem/progenitor cells from the human olfactory bulb (OB). If NSCs can be obtained from OB, it would alleviate ethical concerns associated with the use of embryonic tissue, and provide an easily accessible cell source that would preclude the need for invasive brain surgery. Following isolation and culture, olfactory bulb neural stem cells (OBNSCs) were genetically engineered to express hNGF and GFP. The hNFG-GFP-OBNSCs were transplanted into the striatum of 6-hydroxydopamin (6-OHDA) Parkinsonian rats. The grafted cells survived in the lesion environment for more than eight weeks after implantation with no tumor formation. The grafted cells differentiated in vivo into oligodendrocyte-like (25 ± 2.88%), neuron-like (52.63 ± 4.16%), and astrocyte -like (22.36 ± 1.56%) lineages, which we differentiated based on morphological and immunohistochemical criteria. Transplanted rats exhibited a significant partial correction in stepping and placing in non-pharmacological behavioral tests, pole and rotarod tests. Taken together, our data encourage further investigations of the possible use of OBNSCs as a promising cell-based therapeutic strategy for Parkinson's disease. J. Cell. Physiol. 230: 1614–1629, 2015. © 2014 Wiley Periodicals, Inc., A Wiley Company

In this study, we aim to demonstrate the fate of allogenic adult human olfactory bulb neural stem/progenitor cells (OBNSC/NPCs) transplanted into the rat hippocampus treated with ibotenic acid (IBO), a neurotoxicant specific to hippocampal cholinergic neurons that are lost in Alzheimer's disease. We assessed their possible ability to survive, integrate, proliferate, and differentiate into different neuronal and glial elements: we also evaluate their possible therapeutic potential, and the mechanism(s) relevant to neuroprotection following their engraftment into the CNS milieu. OBNSC/NPCs were isolated from adult human olfactory bulb patients, genetically engineered to express GFP and human nerve growth factor (hNGF) by lentivirus-mediated infection, and stereotaxically transplanted into the hippocampus of IBO-treated animals and controls. Stereological analysis of engrafted OBNSCs eight weeks post transplantation revealed a 1.89 fold increase with respect to the initial cell population, indicating a marked ability for survival and proliferation. In addition, 54.71 ± 11.38%, 30.18 ± 6.00%, and 15.09 ± 5.38% of engrafted OBNSCs were identified by morphological criteria suggestive of mature neurons, oligodendrocytes and astrocytes respectively. Taken together, this work demonstrated that human OBNSCs expressing NGF ameliorate the cognitive deficiencies associated with IBO-induced lesions in AD model rats, and the improvement can probably be attributed primarily to neuronal and glial cell replacement as well as the trophic influence exerted by the secreted NGF. J. Cell. Physiol. 230: 116–130, 2015. © 2014 Wiley Periodicals, Inc.

This study aims at: examining if leadership style and unit climate predict safety climate; and testing the direct, indirect, and total effect of leadership style, unit climate, and safety climate on nurses' safe medication practices.The Institute of Medicine and nursing scholars propose that safety climate is a prerequisite to safety practices. However, there is limited empirical evidence about factors contributing to the development of safety climate and about the association with nurses' safe medication practices.This cross-sectional study used survey data from 246 RNs working in a Magnet® hospital.Leadership style and unit climate predicted 20% to 50% of variance on all safety climate dimensions. Model testing revealed the indirect impact of leadership style and unit climate on nurses' safe medication practices.Our hypothesized model explained small amount of the variance on nurses' safe medication practices. This finding suggests that nurses' safe medication practices are influenced by multiple contextual and personal factors that should be further examined.

Mesenchymal stem cells (MSCs) are multipotent cells that can differentiate into various cell types such as cartilage, bone, and fat cells. Recent studies have shown that induction of MSCs in vitro by growth factors including epidermal growth factor (EGF) and fibroblast growth factor (FGF2) causes them to differentiate into neural like cells. These cultures also express ChAT, a cholinergic marker; and TH, a dopaminergic marker for neural cells. To establish a protocol with maximum differentiation potential, we examined MSCs under three experimental culture conditions using neural induction media containing FGF2, EGF, BMP-9, retinoic acid, and heparin. Adipose-derived MSCs were extracted and expanded in vitro for 3 passages after reaching >80% confluency, for a total duration of 9 days. Cells were then characterized by flow cytometry for CD markers as CD44 positive and CD45 negative. MSCs were then treated with neural induction media and were characterized by morphological changes and Q-PCR. Differentiated MSCs expressed markers for immature and mature neurons; β Tubulin III (TUBB3) and MAP2, respectively, showing the neural potential of these cells to differentiate into functional neurons. Improved protocols for MSCs induction will facilitate and ensure the reproducibility and standard production of MSCs for therapeutic applications in neurodegenerative diseases.

Background The Egyptian government introduced the first directly acting antivirals (DAAs) into Egypt through the government funded National Treatment Program. As yet, there has been no investigation into the effects of these new DAAs therapies on patient reported outcomes (PROs). This study aimed to (1) assess the PROs (health-related quality of life (HRQoL), mental health and perceived social support) of HCV patients receiving DAAs therapy prior, during and at the end of therapy; (2) evaluate PROs of Interferon-free (dual) users versus Interferon-containing (triple) users cross the three different time periods; and (3) identify the predictors of HRQoL of DAAs therapy users cross the three different time periods. Methods A prospective observational design was used. Patients with chronic HCV undergoing treatment following the Egyptian National Guidelines at one of the national treatment centers were approached. Data collection occurred in the period from February to October 2015. Data was collected at three time points: (1) baseline (time 0: T0), before initiating therapy); (2) 5/6 weeks after initiation of therapy (time 1 of therapy: T1) and at the end of the therapy (Time 2: T2). Four PROs questionnaires were utilized for data collection: (1) Multidimensional Scale of Perceived Social Support (MSPSS), (2) The Depression Anxiety Stress Scales (DASS-21), (3) the Liver Disease Symptom Index-2.0 (LDSI-2.0) for testing disease specific HRQoL and (4) the Center for Adherence Support Evaluation (CASE) Index, alongside the background data sheet. Results Sixty-two patients participated. There was a change in HRQoL, symptom experience and mental health across the three different time periods. HRQoL was impaired more after starting the course of therapy (T1) than at baseline (T0) and end of therapy (T2), z ≥ -2.04, p ≤ .04. Also, symptom experience deteriorated more during the treatment period than at the baseline, Z ≥ -1.97, p ≤ .04. Anxiety and stress were significantly higher during the treatment period than at the end of treatment. Perceived social support was significantly higher during the treatment period than at baseline and end of therapy, Z ≥ -2.27, p ≤ .023. During the course of therapy, triple users were more likely to report poorer HRQoL and anxiety than dual users (p ≤ .04). By the end of therapy, the two arms of therapy had no significant differences in any of the PROs. At baseline, the predictor model significantly (p = .000) explained 37.5% of the variation in the HRQoL prior to therapy. Depression was the main variable that contributed to (41.3%) predicting change in HRQoL prior to therapy. During therapy, the model significantly (p = .000) explained 76% of the variation in the HRQoL-T1. Stress-T1, body mass index (BMI)-T1 and HRQoL-T0 significantly and respectively predicted 44.4, 46.5 and 31.1% of the variation in HRQoL-T1. At the end of therapy, the model significantly (p = .000) predicted 80.5% of the variation in the HRQoL-T2. HRQoL-T1 and anxiety-T2 significantly predicted 72.3 and 61.6% of the variation in HRQoL-T2. Conclusions Baseline HRQoL, depression and BMI should be systematically assessed before starting the antiviral therapy for early detection and the improvement of the impairment before the initiation of therapy. Anxiety should be frequently assessed and followed up through the course of antiviral therapy. The triple group required more nursing and practitioner attention due to increased anxiety levels and impaired HRQoL during the treatment therapy.

Understanding how safety culture mechanisms affect nursing safety-oriented behavior and thus patient outcomes is critical to developing hospital safety programs. Safety priming refers to communicating safety values intended to activate patient safety goals. Safety priming through nursing handoff communication was tested as a means by which cultural safety values may affect nursing practice. The mixed-methods pilot study setting was an academic medical center’s high-fidelity simulation lab. Twenty nurses were randomized into intervention and control groups. The intervention group received a safety priming intervention; all participants were observed for completing appropriate actions in response to patient safety risks embedded in a scenario. Stimulated recall interviews were conducted following simulation completion. Nurses receiving the safety priming intervention performed slightly but non-significantly more safety actions than nurses who did not (60.5% vs. 57.9% of 43 actions). Implications for both research and practice are discussed for interventions targeting routine versus safety goal-directed nursing actions.

In this paper, an efficient feature extraction method based on local statistics features of block difference of inverse probabilities (BDIP) and the wavelet transform is proposed for face recognition. In the proposed method, the BDIPs are first computed in a face in order to overcome the variation of illumination and facial expressions. The obtained BDIP image is then decomposed into wavelet subbands. In order to reduce the dimensionality of the feature vector, each BDIP subband is partitioned into a set of blocks. The means and variances are then calculated from all the blocks in each subband and are fused into a feature vector. Experimental results on ORL and FERET databases show that the proposed method achieves higher recognition accuracies than the wavelet-based methods with higher dimensionality reduction of the feature vector. It also outperforms the other well known methods such as PCA and the DCT with the zigzag scanning. Index Terms—Face recognition (FR), discrete wavelet transforms (DWT), wavelet packet decomposition (WPD), block difference of inverse probabilities (BDIP), support vector machine (SVM).

This concurrent mixed-method study examines the nurse work environment of high-quality Medicare-certified home health agencies. High-quality ( n = 6) and low-quality ( n = 6) home health agencies were recruited using agency-level publicly reported patient outcomes. Direct care registered nurses (RNs) from each agency participated in a focus group and completed the Practice Environment Scale of the Nurse Work Index (PES-NWI). No significant differences were found in the PES-NWI results between nurses working in high- and low-quality agencies, though nurses in high-quality agencies scored higher on all subscales. Nurses working in all the high-quality agencies identified themes of adequate staffing, supportive managers, and team work. These themes were not consistently identified in low-quality agencies. Themes of supportive managers and team work are reflective of effective leadership at the manager level. Agencies struggling to improve quality of care might consider developing their managers’ leadership skills.

Aim To describe and compare how nurses representing four age cohorts perceive their manager’s leadership style and unit climate. Background The current workforce consists of nurses representing four generational cohorts. Nursing literature suggests that nurses from each age cohort think, behave and approach work differently. Limited empirical evidence, however, exists about how nurses from each age cohort perceive two aspects of their work environment: their managers’ leadership style and unit climate. Method This cross-sectional, descriptive survey was conducted using a convenience sample of 475 registered nurses working in different inpatient units in three community non-magnet hospitals. Results and conclusion Only nurses from Boomer and Gen-Xers had sufficient representation to be included in the data analysis. Nurses from the two main age cohorts did not differ in their perceptions of their manager’s leadership style. Significant differences were found in two unit climate dimensions. The Gen-Xers had a less favourable perception of their unit climate related to warmth and belonging and administrative support. Implications for nursing management Nurse manager’s might reflect on how they interact with different age cohorts; and to involve nurses from various age cohorts in the development of policies to create a flexible work environment.

STUDY DESIGN: Adult human olfactory bulb neural stem cells (OBNSCs) were isolated from human patients undergoing craniotomy for tumor resection. They were genetically engineered to overexpresses green fluorescent protein (GFP) to help trace them following engraftment. Spinal cord injury (SCI) was induced in rats using standard laminectomy protocol, and GFP-OBNSC were engrafted into rat model of SCI at day 7 post injury. Three rat groups were used: (i) Control group, (ii) Sham group (injected with cerebrospinal fluid) and treated group (engrafted with OBNSCs). Tissues from different groups were collected weekly up to 2 months. The collected tissues were fixed in 4% paraformaldehyde, processed for paraffin sectioning, immunohistochemically stained for different neuronal and glial markers and examined with bright-field fluorescent microscopy. Restoration of sensory motor functions we assessed on a weekly bases using the BBB score. OBJECTIVES: To assess the therapeutic potential of OBNSCs-GFP and their ability to survive, proliferate, differentiate and to restore lost sensory motor functions following their engraftment in spinal cord injury (SCI). METHODS: GFP-OBNSC were engrafted into a rat model of SCI at day 7 post injury and were followed-up to 8 weeks using behavioral and histochemical methods. RESULTS: All transplanted animals exhibited successful engraftment. The survival rate was about 30% of initially transplanted cells. Twenty-seven percent of the engrafted cells differentiated along the NG2 and O4-positive oligodendrocyte lineage, 16% into MAP2 and β-tubulin-positive neurons, and 56% into GFAP-positive astrocytes. CONCLUSION: GFP-OBNSCs had survived for >8 weeks after engraftment and were differentiated into neurons, astrocytes and oligodendrocytes, The engrafted cells were distributed throughout gray and white matter of the cord with no evidence of abnormal morphology or any mass formation indicative of tumorigenesis. However, the engrafted cells failed to restore lost sensory and motor functions as evident from behavioral analysis using the BBB score test. BRC, QU

Parkinson's disease (PD) is a neurological disorder characterized by the loss of midbrain dopaminergic (DA) neurons. Neural stem cells (NSCs) are multipotent stem cells that are capable of differentiating into different neuronal and glial elements. The production of DA neurons from NSCs could potentially alleviate behavioral deficits in Parkinsonian patients; timely intervention with NSCs might provide a therapeutic strategy for PD. We have isolated and generated highly enriched cultures of neural stem/progenitor cells from the human olfactory bulb (OB). If NSCs can be obtained from OB, it would alleviate ethical concerns associated with the use of embryonic tissue, and provide an easily accessible cell source that would preclude the need for invasive brain surgery. Following isolation and culture, olfactory bulb neural stem cells (OBNSCs) were genetically engineered to express hNGF and GFP. The hNFG-GFP-OBNSCs were transplanted into the striatum of 6-hydroxydopamin (6-OHDA) Parkinsonian rats. The grafted cells survived in the lesion environment for more than eight weeks after implantation with no tumor formation. The grafted cells differentiated in vivo into oligodendrocyte-like (25 ± 2.88%), neuron-like (52.63 ± 4.16%), and astrocyte -like (22.36 ± 1.56%) lineages, which we differentiated based on morphological and immunohistochemical criteria. Transplanted rats exhibited a significant partial correction in stepping and placing in non-pharmacological behavioral tests, pole and rotarod tests. Taken together, our data encourage further investigations of the possible use of OBNSCs as a promising cell-based therapeutic strategy for Parkinson's disease.