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Many physicians remain reticent to initiate or partake in discussions about their patients’ religious and spiritual needs during the clinical encounter. Reasons for this may be insufficient time, capacity, education or training but may also be a product of variance in physicians’ own religious or spiritual characteristics. The aim of this paper was to compare American and Danish physicians’ religious characteristics, and to explore and compare American and Danish physicians’ attitudes towards, and practices of, integrating religiosity and spirituality in the clinical encounter. We included data from two cross-sectional surveys: an American survey conducted in 2002 (n = 2000) and a Danish survey conducted in 2012 (n = 1485) to test four hypotheses. American physicians were significantly more religious, they more frequently inquired about religious or spiritual issues in the clinical encounter and they found it more appropriate to discuss religious or spiritual issues if the patients brought it up when compared to Danish physicians. A weak to moderate positive correlation between level of religiosity and frequency of inquiring about religious and spiritual issues were found in both populations. The findings are discussed in relation to the clinical importance of ensuring that health care practices stay patient centered. The findings may especially be relevant to consider in increasingly ethnically and culturally diverse contexts.

Den store, norske språkhistorien er nå fullført, i den forstand at samtlige fire bind har forlatt trykkpressen, sett dagens lys, og forhåpentligvis nådd et bredt utvalg lesere. Etter at bind 1 har presentert språkstruktur, og bind 2 praksis, står ideologier for tur i bind 3 (heretter NSH III). Tove Bull med kollegaer har gjort et pionerarbeid, for dette er første gang det er gitt ut et eget bind om ideologier i språkhistorie. Formålet er tydelig uttalt: «Føremålet med ideologianalyse i norsk språkhistorisk samanheng er å avdekkje premissar, førestillingar og haldningar som har lege til grunn for dei språklege og språksosiale endringane som har prega språkutviklinga her til lands gjennom tida.» (NSH III: 25). Med bindene Mønster, Praksis og Ideologi på plass er vi et skritt nærmere innsikt i det Michael Silverstein (1945–2020) kalte «the total linguistic fact» (Silverstein 1985). For å forstå språklig mening fullt ut må vi nettopp inkludere aspekter som angår både språklig form, språkbruk og språkideologi, og vi må se dem sammen i et gitt domene. ...

Our current economy necessitates attention to nursing professional development programs that positively impact the fiscal budget. This project evaluated the cost-effectiveness of the patient care internship program designed to attract and retain nursing talent in a Midwest hospital system. Nurse leaders partnered with nursing faculty to recruit student nurses and prepare them to transition to the registered nurse role. The programhad cost savings to the organization greater than $200,000 over a 2-year period. [ABSTRACT FROM AUTHOR]

Fibroblast growth factor 21 (FGF21) is a hormone secreted by the liver in response to metabolic stress. In addition to its well-characterized effects on energy homeostasis, FGF21 has been shown to increase water intake in animals. In this study, we sought to further explore the effects of FGF21 on fluid homeostasis in rats. A single dose of a long-acting FGF21 analog, PF-05231023, significantly increased water consumption, which was accompanied by an elevation in urine output that appeared prior to a significant change in water intake. We observed that FGF21 rapidly and significantly increased heart rate and blood pressure in telemeter-implanted rats, before changes in urine output and water intake were observed. Our data suggest that sympathetic activation may contribute to the pathogenesis by which FGF21 increases blood pressure as the baroreceptor unloading induced reflex tachycardia was significantly elevated in FGF21-treated animals. However, FGF21 was still capable of causing hypertension in animals in which approximately 40% of the sympathetic post-ganglionic neurons were ablated. Our data suggest that FGF21-induced water intake is in fact secondary to diuresis, which we propose to be a compensatory mechanism engaged to alleviate the acute hypertension caused by FGF21.

The article explores the use of the Jigsaw Technique (JT) to enhance student engagement and understanding of the RaDonda Vaught case, focusing on the criminalization of medical errors. Topics include cooperative learning, student-centered pedagogies, and the impact on nursing education. Students were grouped to become experts on specific aspects of the case, fostering collaborative learning and ethical reflection.

The new AACN Essentials: Core Competencies for Professional Nursing Education create an opportunity to nursing education to transform the educational preparation of our workforce with new standards for all member schools to implement into their academic programs as we prepare the future nursing workforce. With the advent of these updated academic standards, many nursing schools across the nation are reviewing program outcomes and transitioning from concepts to competencies. The purpose of the article is to describe the early phases of a quality improvement initiative to implement the new AACN Essentials within the undergraduate curriculum of a large school of nursing spanning multiple campuses. The article conveys lessons learned to help support and guide other schools of nursing. • A focus on competency-based education requires program and curricular evolution. • A gap analysis was helpful to inform the necessary update for curriculum. • The competency-based curricular approach is supported through teaching strategies. [ABSTRACT FROM AUTHOR]

Exposure of cells to the diarrhetic shellfish poison, okadaic acid, leads to a dramatic reorganization of cytoskeletal architecture and loss of cell-cell contact. When cells are exposed to high concentrations of okadaic acid (100–500 nM), the morphological rearrangement is followed by apoptotic cell death. Okadaic acid inhibits the broad acting Ser/Thr protein phosphatases 1 and 2A, which results in hyperphosphorylation of a large number of proteins. Some of these hyperphosphorylated proteins are most likely key players in the reorganization of the cell morphology induced by okadaic acid. We wanted to identify these phosphoproteins and searched for them in the cellular lipid rafts, which have been found to contain proteins that regulate cytoskeletal dynamics and cell adhesion. By using stable isotope labeling by amino acids in cell culture cells treated with okadaic acid (400 nM) could be combined with control cells before the isolation of lipid rafts. Protein phosphorylation events and translocations induced by okadaic acid were identified by mass spectrometry. Okadaic acid was shown to regulate the phosphorylation status and location of proteins associated with the actin cytoskeleton, microtubules and cell adhesion structures. A large number of these okadaic acid-regulated proteins have previously also been shown to be similarly regulated prior to cell proliferation and migration. Our results suggest that okadaic acid activates general cell signaling pathways that induce breakdown of the cortical actin cytoskeleton and cell detachment.

Introduction The size and composition of the European Union healthcare workforce are key drivers of expenditure and performance; it now includes new health professions and enhanced roles for established professions. This project will systematically analyse how this has contributed to health service redesign, integration and performance in 9 European countries (Scotland, England, Netherlands, Germany, Italy, Czech Republic, Poland, Norway, and Turkeyi). This paper describes the protocol for collection of survey data in 3 distinct care pathways, and sets it in the context of the wider programme.Methods Questionnaires will be distributed to healthcare professionals (n=14 580), managers (n=3564) and patients (n=19 440) in 3 care pathways (breast cancer; type 2 diabetes; and coronary heart disease) within 12 hospitals and associated primary care settings in each country. Questionnaire topics will include demography, the different professionals working on the care pathway, the tasks they do and the time taken, their decision-making abilities when considering skill mix, specialisation and integration of care. Patient satisfaction, healthcare utilisation and preferences will be explored. In later work, register data and data from patient records will be used to record clinical outcomes. Data will also be collected on workforce and procedure costs. Descriptive analysis will identify the different models of care and multivariate analysis will establish the most clinically and cost-effective models.Ethics and dissemination This protocol was approved by ethical committees in each country. Findings will be disseminated through national/international clinical, health services research and health workforce conferences, and publications in national/international peer-reviewed journals.

Rammeplanen for sykepleierutdanning er myndighetenes styringsredskap. Sykepleierutdanning fører fram til en autorisasjon og en bachelor-grad i sykepleie. Det første innvier studentene til en profesjon, det siste til en akademisk grad. Sykepleieryrket har klare profesjonstrekk og sentrale akademiske kjennetegn. Det blir vesentlig at rammeplanens innhold gjør det mulig å oppfylle utdanningens mandat – å utdanne selvstendige sykepleiere (Kunnskapsdepartementet, 2008c). Følgende problemstilling er reist: Hvordan bidrar rammeplanen til akademisk profesjonskompetanse i sykepleie? Hensikten med denne artikkelen er å vise på hvilke måter rammeplanen gir utdanningen føringer for utdanningsprogram som kan bidra både til profesjonskompetanse og til en akademisk bachelorgrad. Metoden som er benyttet er diskursanalyse. Resultatet av denne analysen har vist hvordan teksten i rammeplanen er instruerende i karakter. I en så vidt detaljstyrende tilnærming, kan den komme til å legge en tvangstrøye på utdanningen. En utdanning som detaljstyres og instrueres vanskeliggjør en kreativ og eksperimenterende utdanning som utdanner til selvstendige og fagkritiske aktører, noe som kjennetegner akademisk profesjonskompetanse.

Over the last years there has been an increased focus on the importance of knowing the effect of pre-analytical influence on the proteomes under study, particularly in the field of biomarker discovery. We present three proteomics studies examining the effect of blood contamination and the rostro-caudal gradient (RCG) on the cerebrospinal fluid (CSF) proteome, in addition to plasma/CSF protein ratios. The studies showed that the central nervous system (CNS) derived proteins appeared to be unaffected by the RCG, while the plasma-derived proteins showed an increase in concentration towards the lumbar area. This implies that the concentration of the plasma-derived proteins in CSF will vary depending on the volume of CSF that is collected. In the CSF samples spiked with blood, 262 of 814 quantified proteins showed an abundance increase of more than 1.5 fold, while 403 proteins had a fold change of less than 1.2 and appeared to be unaffected by blood contamination. Proteins with a high plasma/CSF ratio appeared to give the largest effect on the CSF proteome upon blood contamination. The results give important background information on how factors like blood contamination, RCG and blood-CNS-barrier influences the CSF proteome. This information is particularly important in the field of biomarker discovery, but also for routine clinical measurements. The data from the blood contamination and RCG discovery studies have been deposited to the ProteomeXchange with identifier PXD000401.

Background: The nursing faculty shortage challenges nursing educators, administrators, and staff to find innovative ways to understand and address faculty retention. Purpose: The purpose of this study was to examine nurse educators' perceptions of workplace collegiality and the possible correlation to role satisfaction and role persistence. Methods: Participants (n = 177) were recruited nationally from a Commission on Collegiate Nursing Education accredited schools listing. Three survey instruments were utilized: Survey of Collegial Communication, Job Satisfaction Survey, and Michigan Organizational Assessment Questionnaire. Results: The study found a positive relationship between collegiality and job satisfaction in academia. The Pearson correlation results indicated there was a significant negative correlation between the intent to remain and collegiality. Conclusion: The findings suggest nursing educators perceive collegiality as an important component of job satisfaction and intent to remain. [ABSTRACT FROM AUTHOR]

Mutations in PHEX (phosphate-regulating gene with homologies to endopeptidases on the X-chromosome) cause X-linked familial hypophosphatemic rickets (XLH), a disorder having severe bone and tooth dentin mineralization defects. The absence of functional PHEX leads to abnormal accumulation of ASARM (acidic serine- and aspartate-rich motif) peptide - a substrate for PHEX and a strong inhibitor of mineralization - derived from MEPE (matrix extracellular phosphoglycoprotein) and other matrix proteins. MEPE-derived ASARM peptide accumulates in tooth dentin of XLH patients where it may impair dentinogenesis. Here, we investigated the effects of ASARM peptides in vitro and in vivo on odontoblast differentiation and matrix mineralization. Dental pulp stem cells from human exfoliated deciduous teeth (SHEDs) were seeded into a 3D collagen scaffold, and induced towards odontogenic differentiation. Cultures were treated with synthetic ASARM peptides (phosphorylated and nonphosphorylated) derived from the human MEPE sequence. Phosphorylated ASARM peptide inhibited SHED differentiation in vitro, with no mineralized nodule formation, decreased odontoblast marker expression, and upregulated MEPE expression. Phosphorylated ASARM peptide implanted in a rat molar pulp injury model impaired reparative dentin formation and mineralization, with increased MEPE immunohistochemical staining. In conclusion, using complementary models to study tooth dentin defects observed in XLH, we demonstrate that the MEPE-derived ASARM peptide inhibits both odontogenic differentiation and matrix mineralization, while increasing MEPE expression. These results contribute to a partial mechanistic explanation of XLH pathogenesis: direct inhibition of mineralization by ASARM peptide leads to the mineralization defects in XLH teeth. This process appears to be positively reinforced by the increased MEPE expression induced by ASARM. The MEPE-ASARM system can therefore be considered as a potential therapeutic target.

Modern healthcare research has only in recent years investigated the impact of health care workers’ religious and other moral values on medical practice, interaction with patients, and ethically complex decision-making. Thus far, no international data exist on the way such values vary across different countries. We therefore established the NERSH International Collaboration on Values in Medicine with datasets on physician religious characteristics and values based on the same survey instrument. The present article provides (a) an overview of the development of the original and optimized survey instruments, (b) an overview of the content of the NERSH data pool at this stage and (c) a brief review of insights gained from articles published with the questionnaire. The questionnaire was developed in 2002, after extensive pretesting in the United States and subsequently translated from English into other languages using forward-backward translations with Face Validations. In 2013, representatives of several national research groups came together and worked at optimizing the survey instrument for future use on the basis of the existing datasets. Research groups were identified through personal contacts with researchers requesting to use the instrument, as well as through two literature searches. Data were assembled in Stata and synchronized for their comparability using a matched intersection design based on the items in the original questionnaire. With a few optimizations and added modules appropriate for cultures more secular than that of the United States, the survey instrument holds promise as a tool for future comparative analyses. The pool at this stage consists of data from eleven studies conducted by research teams in nine different countries over six continents with responses from more than 6000 health professionals. Inspection of data between groups suggests large differences in religious and other moral values across nations and cultures, and that these values account for differences in health professional’s clinical practices.

BACKGROUND: Interventions for T2DM have in part aimed to mimic exercise. Here, we have compared the independent and combined effects of a PPARdelta agonist and endurance training mimetic (GW501516) and a myostatin antibody and resistance training mimetic (PF-879) on metabolic and performance outcomes in obese insulin resistant mice. METHODOLOGY/PRINCIPAL FINDINGS: Male ob/ob mice were treated for 6 weeks with vehicle, GW501516, PF-879, or GW501516 in combination with PF-879. The effects of the interventions on body composition, glucose homeostasis, glucose tolerance, energy expenditure, exercise capacity and metabolic gene expression were compared at the end of study. GW501516 attenuated body weight and fat mass accumulation and increased the expression of genes of oxidative metabolism. In contrast, PF-879 increased body weight by driving muscle growth and altered the expression of genes involved in insulin signaling and glucose metabolism. Despite their differences, both interventions alone improved glucose homeostasis. Moreover, GW501516 more effectively improved serum lipids, and PF-879 uniquely increased energy expenditure, exercise capacity and adiponectin levels. When combined the robust effects of GW501516 and/or PF-879 on body weight, adiposity, muscle mass, glycemia, serum lipids, energy expenditure and exercise capacity were highly conserved. CONCLUSIONS/SIGNIFICANCE: The data, for the first time, demonstrate postnatal inhibition of myostatin not only promotes gains in muscle mass similar to resistance training,but improves metabolic homeostasis. In several instances, these effects were either distinct from or complimentary to those of GW501516. The data further suggest that strategies to increase muscle mass, and not necessarily oxidative capacity, may effectively counter insulin resistance and T2DM.

Assessment of dopamine nerve terminal function and integrity is a strategy employed to monitor deficits in Parkinson's disease (PD) patients and in preclinical models of PD. Dopamine replacement therapies effectively replenish the diminished supply of endogenous dopamine and provide symptomatic benefit to patients. Tyrosine hydroxylase (TH), dopamine transporter (DAT), vesicular monoamine transporter 2 (VMAT2), and amino acid decarboxylase (AADC) are widely used markers of dopaminergic neurons and terminals. The present studies were initiated to: (a) assess alterations in all four markers in the MPTP primate model of dopaminergic degeneration and (b) to determine whether L-DOPA treatment may itself modulate the expression of these markers. MPTP treatment induced a significant decline of dopaminergic immunoreactive fiber and terminal density in the basal ganglia. The amount of reduction varied between markers. The rank order of presynaptic marker loss, from most to least profound reduction, was TH > VMAT2 > DAT > AADC. Semiquantitative image analysis of relative dopaminergic presynaptic fiber and terminal density illustrated region-specific reduction of all four markers. Double immunofluorescence colocalization of two presynaptic markers on the same tissue section confirmed there was a more dramatic loss of TH than of VMAT2 or of DAT following MPTP treatment. L-DOPA treatment was associated with a significantly higher level of AADC and VMAT2 immunoreactivity in the caudate nucleus compared to placebo. These results illustrate that neurotoxic injury of the dopamine system in primates leads to altered and differential expression of presynaptic dopaminergic markers in the basal ganglia and that expression of such markers may be modulated by L-DOPA therapy. These findings have implications for the use of biomarkers of disease progression as well as for the assessment of neurorestorative strategies, such as cell replacement, for the treatment of PD.

The largest statewide hospital system collaborated with local nursing schools to provide a patient care internship program for nursing students. The goal was to create a pipeline of future nurses by equipping students for work in the clinical setting and promoting nurse retention. The purpose of this project was to determine the correlation between the student nurse internship program on the interns' NLCEX-RN pass rates, retention rates for the local hospitals, cost-savings, students' confidence, and program satisfaction. Nursing students (n = 25) were recruited from local nursing schools for unlicensed assistant personnel positions at the system hospitals. The program included a six-week intensive to educate nursing students as non-licensed staff members of hospital units, which continues as a mentored experience during the senior year of their baccalaureate program. Qualitative and quantitative data were collected and analyzed. The program had a pass rate of 96% for NCLEX-RN on first attempt. Additionally, 82% of participants were retained at the hospitals. Hospitals saved $216,993. Students reported increased role satisfaction with the program. Program results suggest benefits of supportive NCLEX-RN pass rates, nurse retention, and cost benefit. Findings can be used to support future program expansion and improve the experience of nursing students as they transition into professional practice. • Collaborative environments support greater understanding of the student intern transition into the professional nurse role. • The program stimulated critical thinking and reasoning in student interns through active learning strategies. • Participants in the patient care internship conveyed increased role satisfaction with their transition to a registered nurse. • Performance on the NCLEX-RN pass rates for all students was 96%. [ABSTRACT FROM AUTHOR]

Abstract Background The mechanisms behind formation and filling of intracranial arachnoid cysts (AC) are poorly understood. The aim of this study was to evaluate AC fluid by proteomics to gain further knowledge about ACs. Two goals were set: 1) Comparison of AC fluid from individual patients to determine whether or not temporal AC is a homogenous condition; and 2) Evaluate the protein content of a pool of AC fluid from several patients and qualitatively compare this with published protein lists of cerebrospinal fluid (CSF) and plasma. Methods AC fluid from 15 patients with temporal AC was included in this study. In the AC protein comparison experiment, AC fluid from 14 patients was digested, analyzed by LC-MS/MS using a semi-quantitative label-free approach and the data were compared by principal component analysis (PCA) to gain knowledge of protein homogeneity of AC. In the AC proteome evaluation experiment, AC fluid from 11 patients was pooled, digested, and fractionated by SCX chromatography prior to analysis by LC-MS/MS. Proteins identified were compared to published databases of proteins identified from CSF and plasma. AC fluid proteins not found in these two databases were experimentally searched for in lumbar CSF taken from neurologically-normal patients, by a targeted protein identification approach called MIDAS (Multiple Reaction Monitoring (MRM) initiated detection and sequence analysis). Results We did not identify systematic trends or grouping of data in the AC protein comparison experiment, implying low variability between individual proteomic profiles of AC. In the AC proteome evaluation experiment, we identified 199 proteins. When compared to previously published lists of proteins identified from CSF and plasma, 15 of the AC proteins had not been reported in either of these datasets. By a targeted protein identification approach, we identified 11 of these 15 proteins in pooled CSF from neurologically-normal patients, demonstrating that the majority of abundant proteins in AC fluid also can be found in CSF. Compared to plasma, as many as 104 proteins in AC were not found in the list of 3017 plasma proteins. Conclusions Based on the protein content of AC fluid, our data indicate that temporal AC is a homogenous condition, pointing towards a similar AC filling mechanism for the 14 patients examined. Most of the proteins identified in AC fluid have been identified in CSF, indicating high similarity in the qualitative protein content of AC to CSF, whereas this was not the case between AC and plasma. This indicates that AC is filled with a liquid similar to CSF. As far as we know, this is the first proteomics study that explores the AC fluid proteome.

• Collaboration between schools of nursing faculty and practice sites fosters collegial relationships, shared resources and expertise. • Decisions around the delegation of care are critical for quality patient outcomes. • Clinical site involvement in student education reinforced the importance of nursing clinical development, policy, and practice. • Short educational activities increase participant knowledge, allowing for teamwork and discussion to keep students engaged in active learning. A common goal for healthcare providers and nursing faculty is the provision of effective delivery of care and safe practice settings. Decisions around the delegation of care are critical for quality patient outcomes. The purpose of this collaborative project between schools of nursing and a local community healthcare facility was to provide educational training to prelicensure nursing students on the delegation expectations for nursing professionals. [ABSTRACT FROM AUTHOR]