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Universities are expected to engage with communities for the benefit of both. Based on the definition of scholarship advanced by Boyer in the 1990s, inclusive of the scholarship of discovery, integration, teaching, and application, the School of Nursing and Jewish Geriatric Services, Inc., have instituted a unique collaboration entitled the Scholar in Residence. Unlike traditional agreements between schools of nursing and agencies to provide clinical experience and educate students, this agreement is designed to build scholarship for both university and agency. Outcomes include building opportunities for faculty and staff scholarship at the agency, enhancing the integration of knowledge into practice, intensifying opportunities for the sharing of knowledge by providing opportunities for students to work with faculty and staff on individual projects, and enriching the application of knowledge by providing opportunities for faculty clinical practice and consultation. The Scholar in Residence is a model of collaboration between the university and the community that reflects the mission of the university and provides value to the community agency through strategic engagement of both entities. Copyright © 2010 Elsevier Inc. [ABSTRACT FROM AUTHOR]

Aim: Report the outcomes of pregnant women with type 1 and type 2 diabetes and to identify modifiable and non-modifiable factors associated with poor outcomes., Methods: Retrospective analysis of pregnancy preparedness, pregnancy care and outcomes in the Republic of Ireland from 2015 to 2020 and subsequent multivariate analysis., Results: In total 1104 pregnancies were included. Less than one third attended pre-pregnancy care (PPC), mean first trimester haemoglobin A1c was 7.2 ± 3.6% (55.5 ± 15.7 mmol/mol) and 52% received pre-conceptual folic acid. Poor preparation translated into poorer pregnancy outcomes. Livebirth rates (80%) were comparable to the background population however stillbirth rates were 8.7/1000 (four times the national rate). Congenital anomalies occurred in 42.5/1000 births (1.5 times the background rate). More than half of infants were large for gestational age and 47% were admitted to critical care. Multivariate analyses showed strong associations between non-attendance at PPC, poor glycaemic control and critical care admission (adjusted odds ratio of 1.68 (1.48-1.96) and 1.61 (1.43-1.86), p < 0.05 respectively) for women with type 1 diabetes. Smoking and teratogenic medications were also associated with critical care admission and hypertensive disorders of pregnancy., Conclusion: Pregnancy outcomes in women with diabetes are suboptimal. Significant effort is needed to optimize the modifiable factors identified in this study., (Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Current ESC guidelines recommend the use of intra-coronary pressure guidewires for functional assessment of intermediate-grade coronary stenoses. Angiography-derived quantitative flow ratio (QFR) is a novel method of assessing these stenoses, and guiding percutaneous coronary intervention (PCI)., Methods/design: The PIONEER IV trial is a prospective, all-comers, multi-center trial, which will randomize 2,540 patients in a 1:1 ratio to PCI guided by angiography-derived physiology or usual care, with unrestricted use in both arms of the Healing-Targeted Supreme sirolimus-eluting stent (HT Supreme). The stent's fast, biologically healthy, and robust endothelial coverage allows for short dual-antiplatelet therapy (DAPT); hence the antiplatelet regimen of choice is 1-month DAPT, followed by ticagrelor monotherapy. In the angiography-derived physiology guided arm, lesions will be functionally assessed using on-line QFR, with stenting indicated in lesions with a QFR ≤0.80. Post-stenting, QFR will be repeated in the stented vessel(s), with post-dilatation or additional stenting recommended if the QFR<0.91 distal to the stent, or if the delta QFR (across the stent) is >0.05. Usual care PCI is performed according to standard clinical practice. The primary endpoint is a non-inferiority comparison of the patient-oriented composite endpoint (POCE) of all-cause death, any stroke, any myocardial infarction, or any clinically, and physiologically driven revascularization with a non-inferiority risk-difference margin of 3.2%, at 1-year post-procedure. Clinical follow-up will be up to 3 years., Summary: The PIONEER IV trial aims to demonstrate non-inferiority of QFR-guided PCI to usual care PCI with respect to POCE at 1-year in patients treated with HT Supreme stents and ticagrelor monotherapy., Clinical Trial Registration: ClinicalTrials.gov UNIQUE IDENTIFIER: NCT04923191 CLASSIFICATIONS: Interventional Cardiology., (Copyright © 2022. Published by Elsevier Inc.)

Background: Smoking prevalence in Ireland is falling in all age groups, but the prevalence of roll-your-own (RYO) tobacco use is rising among young people. This qualitative study aims to explore and understand the factors associated with young people's use of RYO products., Methods: Semi-structured individual and focus group interviews were conducted with young people aged 16-22 years. Participants were recruited from a higher education institution and youth organisations working with early school leavers across Dublin. In total, there were 62 participants in the study, consisting of 22 individual interviews and eight focus group interviews with 40 participants. Categoric and thematic data analysis was used to generate the findings., Results: We identified two broad themes, incentivising and disincentivising factors. The lower cost of RYO products compared to pre-manufactured cigarettes was the most important incentive for users. However, other product characteristics, such as the artisanal factors associated with RYO products were also found. Social and environmental influences were apparent, in which certain groups and environments facilitated and normalised RYO practices. Amenities and facilities often provided smokers with normalised spaces which could be dedicated to the enactment of rolling practices and to the creation and maintenance of social bonds with other users. Disincentives included negative features related to the product itself, adverse health effects, and the effects of tobacco denormalisation., Conclusions: While the lower cost of RYO products is very important for young smokers, other product characteristics and influences also incentivise and disincentivise use. A more comprehensive understanding of the multi-dimensional appeal of these products will assist policymakers to target strategies to reduce the attractiveness to young smokers of these products.

Objective: We present a comprehensive systematic review of published literature to examine, whether arterial stiffness and wave reflection measurements during pregnancy differed between healthy patients and patients with placental-mediated diseases including preeclampsia (PET), small for gestational age (SGA), fetal death, and placental abruption, and a quantitative assessment of the findings using the meta-analysis approach., Methods: We searched Medline, Embase, and The Cochrane Library for studies of arterial stiffness in pregnancy, analyzed pregnancy outcomes and conducted the meta-analysis of data evaluated by trimesters of pregnancy. Hemodynamic parameters evaluated included: pulse wave velocity (PWV), augmentation index (AIx), and augmentation index-75 (AIx-75)., Results: We screened 2806 citations, reviewed 36 studies and included nine (n = 15 923) studies for further quantitative assessment. Compared with healthy pregnancy, measures of arterial stiffness and wave reflection were consistently increased among pregnant women who subsequently developed PET during all trimesters. In the first trimester, mean AIx-75 (%) in the PET group was significantly higher with estimated standardized mean difference (SMD) of 0.90 [95% confidence intervals (95% CI) 0.07-1.73; P = 0.034]. In the second trimester, the PET group had significantly higher PWV (m/s) with estimated SMD of 1.26 (95% CI 0.22-2.30; P = 0.018). Concerning the SGA group, mean AIx (%) was greater during the second trimester only: 65.5 (SD 15.6) vs. 57.0 (11.2), P < 0.01., Conclusion: There is significant increase in arterial stiffness and wave reflection parameters among pregnant women who subsequently developed PET and SGA fetuses. Larger studies with consistent methodological designs are required to evaluate the role and usefulness of arterial stiffness and wave reflection measurements as a screening tool for placental-mediated diseases during pregnancy.

Objective:  The aim of the present study was to develop a toolkit combining various risk factors to predict the risk of developing a postpartum hemorrhage (PPH) during a cesarean delivery., Study Design:  A retrospective cohort study of 24,230 women who had cesarean delivery between January 2003 and December 2013 at a tertiary care teaching hospital within the United Kingdom serving a multiethnic population. Data were extracted from hospital databases, and risk factors for PPH were identified. Hothorn et al recursive partitioning algorithm was used to infer a conditional decision tree. For each of the identified combinations of risk factors, two probabilities were calculated: the probability of a patient producing ≥1,000 and ≥ 2,000 mL blood loss., Results:  The Leicester PPH predict score was then tested on the randomly selected remaining 25% ( n  = 6,095) of the data for internal validity. Reliability testing showed an intraclass correlation of 0.98 and mean absolute error of 239.8 mL with the actual outcome., Conclusion:  The proposed toolkit enables clinicians to predict the risk of postpartum hemorrhage. As a result, preventative measures for postpartum hemorrhage could be undertaken. Further external validation of the current toolkit is required., Competing Interests: Conflict of Interest: None., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Background: The safety of vaginal breech birth depends on the skill of the attendant. The objective of this review was to identify, synthesize, and report the findings of evaluated breech birth training strategies., Methods: A systematic search of the following on-line databases: Medline, CINAHL Plus, PsychINFO, EBM Reviews/Cochrane Library, EMBASE, Maternity and Infant Care, and Pubmed, using a structured search strategy. Studies were included in the review if they evaluated the efficacy of a breech birth training program or particular strategies, including obstetric emergency training evaluations that reported differentiated outcomes for breech. Out of 1040 original citings, 303 full-text articles were assessed for eligibility, and 17 methodologically diverse studies met the inclusion criteria. A data collection form was used to extract relevant information. Data were synthesized, using an evaluation levels framework, including reaction, learning (subjective and objective assessment), and behavioral change., Results: No evaluations included clinical outcome data. Improvements in self-assessed skill and confidence were not associated with improvements in objective assessments or behavioral change. Inclusion of breech birth as part of an obstetric emergencies training package without support in practice was negatively associated with subsequent attendance at vaginal breech births., Conclusions: As a result of the heterogeneity of the studies available, and the lack of evidence concerning neonatal or maternal outcomes, no conclusive practice recommendations can be made. However, the studies reviewed suggest that vaginal breech birth training may be enhanced by reflection, repetition, and experienced clinical support in practice. Further evaluation studies should prioritize clinical outcome data., (© 2017 Wiley Periodicals, Inc.)

Smudge, a bacteriophage enriched from soil using Bacillus thuringiensis DSM-350 as the host, had its complete genome sequenced. Smudge is a myovirus with a genome consisting of 292 genes and was identified as belonging to the C1 cluster of Bacillus phages., (Copyright © 2016 Cornell et al.)

Purpose: Research has revealed the role of adverse behaviors during pregnancy on metabolic and cardiovascular health outcomes in offspring. However, minimal attention has been focused on positive prenatal behaviors, such as exercise, and the effect on offspring health outcomes. The objective of this investigation was to test the hypothesis that mothers who voluntarily exercise during pregnancy would improve endothelial function in offspring from exercising compared with sedentary mothers., Methods: Female Sprague Dawley rats were divided into sedentary (n = 10) or exercise (n = 9) groups with, the exercise group having voluntary access to a running wheel throughout gestation. Litter characteristics (weight and size) were taken 1 d after birth. After weaning, offspring were placed in sedentary cages where they remained until 4 or 8 months of age. Offspring food consumption and cage activity were assessed during a 72-h interval at 2, 4, 6, and 8 months of age. The abdominal aortas of offspring were harvested at 4 or 8 months of age, and vascular function was assessed using cumulative doses of endothelium-dependent (acetylcholine/10(-10)-10(-4) M) and independent (sodium nitroprusside/10(-10)-10(-4) M) vasodilators., Results: There were no significant differences in litter size and litter weight at weaning between the sedentary and exercise groups. Food consumption and wheel running activity did not differ between the sedentary and exercise offspring at 2, 4, 6, or 8 months of age. Vasorelaxation response to acetylcholine or sodium nitroprusside did not differ between the offspring from sedentary and exercise dams., Conclusions: Maternal voluntary wheel running during pregnancy does not significantly alter behavior or vascular function in adult offspring.

Breast cancer is the most common cancer among women. Emerging research indicates that modifying lifestyle factors during pregnancy may convey long-term health benefits to offspring. This study was designed to determine whether maternal exercise during pregnancy leads to reduced mammary tumorigenesis in female offspring. Pregnant rats were randomly assigned to exercised and sedentary groups, with the exercised group having free access to a running wheel and the sedentary group housed with a locked wheel during pregnancy. Female pups from exercised or sedentary dams were weaned at 21 days of age and fed a high fat diet without access to a running wheel. At 6 weeks, all pups were injected with the carcinogen N-methyl-N-nitrosourea. Mammary tumor development in all pups was monitored for 15 weeks. Pups from exercised dams had a substantially lower tumor incidence (42.9%) compared with pups from sedentary dams (100%). Neither tumor latency nor histological grade differed between the two groups. These data are the first to demonstrate that exercise during pregnancy potentiates reduced tumorigenesis in offspring. This study provides an important foundation towards developing more effective modes of behavior modification for cancer prevention.

The success of graduates with a doctor of nursing practice (DNP) degree in transforming health care will depend significantly on their leadership ability to think strategically, innovate, and engage stakeholders in meaningful system improvement. Known as adaptive work, these graduates will need a portfolio of adaptive leadership skills that prepare them to move health care from a volume-driven to value-based system. This article describes development of a core DNP leadership course in a postmaster's point of entry DNP program at an academic health science center school of nursing. The course, designed as DNP students' initial step on their professional development journey to becoming adaptive leaders capable of driving transformative change, created an alternative lens for students to undertake strategic adaptive change initiatives within themselves and their organizations., (© 2013.)

Objectives: Pre-eclampsia is a placental, inflammatory disease modified by maternal anti-oxidant status to give a syndrome. In its most severe forms pre-eclampsia is followed by maternal and neonatal mortality and morbidity. Bilirubin is a known antioxidant and as such is associated with a reduced risk of cardiovascular and respiratory disease. Hence we aimed to find an association between maternal bilirubin levels and the clinical severity of the disease., Study Design: A retrospective observational study of 50,712 pregnancies, 925 of which had pre-eclampsia (1999-2010), to examine the association between bilirubin level and perinatal outcome., Results: In women with pre-eclampsia, those with bilirubin levels in the lowest quintile were more likely to require caesarean section (p=0.001, aOR 2.59 (1.52-5.72)). The lowest quintile of bilirubin levels is associated with an increased risk of poor maternal (p=0.002, aOR 3.52 (95%CI 1.6-7.7)) and infant/fetal (p=0.001, OR=3.05 (95%CI=1.63-5.72)) outcome., Conclusions: Low levels of bilirubin were associated with poor maternal and infant outcomes in women diagnosed with pre-eclampsia. Bilirubin may act as an anti-oxidant in this condition and thus modify the disease., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Unlabelled: TOPIC INVESTIGATED: The objectives of this project were to (a) identify best practice in academic-practice partnerships; (b) identify the needs and/or desire for greater collaboration and partnership between the University of Texas Health Science Center San Antonio School of Nursing (SON) and key stakeholders in San Antonio, TX; and (c) guide the work of a national task force., Methods: One-on-one open-ended interviews were conducted with deans of nursing and vice presidents of patient care services at the six major health systems in San Antonio. Focus groups were also conducted with individuals who included chief nursing officers, vice presidents of a hospital, nurse managers, clinical educators, and clinical researchers. Data were analyzed using content analysis., Results: Seventy-two individuals participated, and all expressed a desire for greater partnership with the SON. All identified characteristics of best practice in academic-service partnerships and the value or benefits of such partnerships. All participants believed that partnerships between academic and service were critical to the advancement of quality patient care., Conclusions: There has been limited research published to date that explicates the complexities of developing and sustaining partnerships between academia and practice. This article highlights preliminary findings on best practices in academic-service partnerships., (Copyright © 2011 Elsevier Inc. All rights reserved.)

This article outlines how one community's academic-practice partnership evolved over time as it sought to address the community's needs for a qualified competent nursing workforce. Both organization and system changes were essential in the establishment of formal structures to address nursing workforce shortage needs. Both practice and education leaders were actively engaged in setting the strategic priorities at multiple system levels in the creation of these formal structures. We anticipate that the formation of these new formal structures will advance and sustain our academic-practice partnerships. Five key lessons were learned: (a) change is inevitable, (b) leadership matters at all levels, (c) succession planning is essential, (d) persistence toward established goals is necessary, and (e) relationships are the glue to sustain forward movement., (Copyright © 2011. Published by Elsevier Inc.)

We sought to determine whether placental implantation site affects electromyographic (EMG) recordings of uterine activity in labor. We performed a prospective study of women randomly selected on admission to labor ward. There were acceptable recordings in 36 women, 18 in both the posterior and anterior placenta groups. There were 12 unacceptable recordings. This was mainly due to poor electrode contact. There was no difference in amplitude, frequency, activity integral, total activity integral, or power density in either group. EMG can be used to quantify uterine activity irrespective of placental position., (Thieme Medical Publishers.)

Research has suggested that recurrent maltreatment may be best predicted by a combination of factors that vary across families. The present study set out to determine whether a pattern-centered analytic approach would better predict families at high risk for recurrence when compared to logistic regression methods. Archival data from substantiated investigations during 2003 were collected from a Connecticut Department of Children and Families county branch. Families (n = 244) with a substantiated index case were followed for 18 months to identify the presence of additional substantiated cases within the CPS system. Classification and Regression Tree (CART) analyses revealed that prior CPS involvement was the best predictor of recurrent maltreatment. Further, risk items that were associated with recurrence were different for families with and without previous CPS investigations. Families with only prior unsubstantiated CPS investigations and poor child visibility within the community were at high risk for recurrence. Families without prior CPS involvement that were not actively involved in case planning and had a history of domestic violence were at high risk for recurrence. These findings suggest that pattern-centered analyses may be a useful approach to informing site-specific predictors of maltreatment recurrence by creating clear decision points that delineate high risk subgroups.

Flow cytometric analyses of immune cell proliferation, differentiation, and function are limited by the number of different fluorochromes that can be resolved simultaneously. Additional colors to expand functional analytic capability will facilitate higher dimensional analyses of heterogeneous cell populations by basic and clinical scientists. Our aim in these studies was to evaluate CellVue Claret, a fluorescent, far-red emitting, membrane intercalating dye (excitation maximum: 655 nm, emission maximum 677 nm), as an alternative and/or complementary probe to PKH26 and CFSE(1) for polychromatic studies of immune cell proliferation and function. Using a BD FACSCalibur and human peripheral blood mononuclear cells (PBMCs) from 8 different donors (2 donors studied twice), we compared CellVue Claret with the two most commonly used visible-emitting proliferation dyes, PKH26 and CFSE, in terms of: (1) compatibility with 7-Amino-actinomycin D (7-AAD) as a viability marker; (2) effect of dye labeling on lymphocyte viability; and (3) the proliferative response of CD3+ T lymphocytes from 0-96 hours as assessed by dilution of each of the 3 cell tracking dyes in cultures stimulated with anti-CD3 plus IL-2. Post-labeling recoveries and viabilities were similar for all 3 dyes, with modestly higher initial staining intensities and coefficients of variation for CellVue Claret than for CFSE or PKH26. Lymphocyte viabilities in stimulated or unstimulated cultures were also unaffected by choice of dye. Proliferative responses of viable CD3+ lymphocytes were comparable for all three dyes, whether results were reported as Proliferative Fraction (percent of cells that had divided one or more times) or as Precursor Frequency (percent of parent population that had gone on to proliferate in response to anti-CD3 plus IL-2). In summary, T cell proliferation analysis using CellVue Claret gives results equivalent to those obtained with PKH26 or CFSE, expanding the choice of proliferation dyes suitable for use in high dimensional polychromatic studies on flow cytometers with far red (633 nm-658 nm) excitation capabilities.

Purpose: To present a framework for nurse practitioners (NPs) who wish to engage in outcomes research., Data Source: Review of scientific literature on the design of outcomes research., Conclusion: The structure and process of outcomes research includes both the research protocol and the decisions related to designing and implementing a study. Each identified step of the presented framework incorporates issues related to decision making relevant for that specific component of the research protocol., Implications for Practice: Practical advice guides the NP in beginning to identify researchable problems within the clinical setting suited to outcomes research. Using a framework to design an outcomes study assists the NP in making key study decisions.