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The purpose of this manuscript is to examine traditional models of leadership in nursing, and to provide a roadmap and specific recommendations for nurses at all levels to lead our profession through the next decade in achieving health equity. We examine current leadership frameworks in nursing and discuss ways to contemporize these frameworks to more explicitly center the expertise of clinicians and communities from historically marginalized backgrounds. Next, we examine the racial, gender, and able-bodied biases that impact nurses, and call upon nurses to examine and dismantle these biases. We discuss the roles of health systems and academic organizations in developing inclusive leaders, including through community engagement and true service-learning partnerships. Finally, we provide a set of recommendations for all nursing leaders across career stages to embrace inclusivity as they work to improve health equity.

Adults living with sickle cell disease are at risk for experiencing severe illness from coronavirus disease 2019 (COVID-19) due to the complexity of their disease. Additionally, self-management and navigating the healthcare system may be challenging during the COVID-19 pandemic. Therefore, we conducted telephone interviews with 25 participants to explore the experiences of Black adults living with sickle cell disease during the early months of the pandemic in the United States. Three overarching themes characterize their experiences: management of sickle cell disease was further complicated by the pandemic, fear of the virus contributed to physical and social isolation, and employment and financial challenges affected well-being. The pandemic contributed to changes in health care maintenance and had a disproportionate impact on this population. Addressing social and structural determinants of health and disruptions in health care accessibility is critical to advancing health and health care equity for individuals living with sickle cell disease.

Purpose The aim of this paper is to examine complementary and alternative medicine (CAM) use among racially and ethnically diverse adolescents. Greater understanding of CAM use among this group is warranted to better inform health care providers in delivering a culturally relevant health promotion approach. Design and methods A secondary data analysis was conducted using the 2012 Child Complementary and Alternative Medicine Supplement of the National Health Interview Survey (CAM-NHIS) data, which was collected from a national sample of adolescents aged 12–17 years. A logistic regression test was employed to investigate the predictors associated with CAM use among racially and ethnically diverse adolescents. Results While Black and Hispanic adolescents were the least likely to use CAM compared to their White counterparts, families with higher incomes, higher education attainment, and adolescents who experienced pain were more likely to use CAM. Conclusions Findings suggest the need for future research to gain a greater understanding of CAM use among racially and ethnically diverse adolescents, and insights into how health disparities impact CAM use. Greater understanding of how CAM use intersects with health beliefs and outcomes is also warranted. Practice implications Based on the CAM-NHIS survey, few racially and ethnically diverse adolescents have reported use of CAM. Development of culturally appropriate instruments and methods to assess CAM use among racially and ethnically diverse adolescents may yield specific data for this population. Informed health care providers can advocate for improved access to CAM for minority adolescents and alter disparate use.

Spirituality is considered a universal phenomenon, but research addressing the spiritual needs of adolescents in the context of health and illness is limited. The aim of this article is to provide a description of how the spiritual development framework (SDF) was used in conducting research with adolescents. An exemplar of a qualitative descriptive study is provided to demonstrate applicability of the SDF. The SDF was used as a guiding theoretical framework in conducting research with adolescents living with sickle cell disease. The SDF is culturally applicable and methodologically appropriate. Additional research applying the SDF is warranted.

Significance: Problems with shoe fit are endemic, affect gait and balance and lead to falls. Falls are physically, emotionally, and economically costly. Low-cost, easily implemented interventions, that reduce pain and improve balance meet the “triple aim” of the Institute for Healthcare Improvement. Purpose: Evaluate the impact on community-dwelling adults (65+) of two nursing interventions involving foot repositioning and shoe relacing. Outcome measures: Toe pressures, experiences of pain and comfort. Method: Repeated-measures, mixed-methods lab-based study. Walk #1 Control. Intervention #1, participant’s heel secured to back of shoe, the participant’s chosen lacing pattern snugged. Intervention #2, heel secured to back of shoe, specific lacing pattern snugged. Results: 19 participants, aged 65-91(Av 74.7), 14 women, 5 men. When the participant’s heel was secured to back of shoe, and their chosen lacing was snugged (Intervention #1), there were 129/190 (68%) decreases in average peak toe pressures and 57% (11/19) stated there was an improvement in comfort. When the heel was secured to back of shoe, and a specific lacing pattern snugged. (Intervention #2) there were 148/190 (78%) decreases in average toe pressures and 133/190 (70%) decreases of Intervention #2 over Intervention #1. 63% (12/19) experienced greater comfort over Intervention #1. Orders of magnitude of the changes varied. ANOVA and two sample t-tests resulted in statistical significance on the 2nd and 4th left toes. This study was fueled by observations of nurses operating in the field doing foot care, who are trying to enhance mobility and quality of life for older people desiring to remain in their communities. The strength is the simplicity of the intervention and the focus on older adults and combination of qualitative and quantitative data that offset many of the weaknesses of each method. Limitations of this study were the sample was small, not diverse and the lab based nature of this study excluded those less able who are make up a large segment of the older adult population. Conclusion: Results supported the initial hypotheses that changing the foot position in a shoe and the lacing pattern can positively impact experiences of comfort/pain and reduce toe pressures.

Guitarist and songwriter Edward Clayton-Jones has had a long musical career beginning in the outer suburbs of Melbourne in the late 1970s. Here, he discusses aspects of his early life, his relocation from outer suburban Rowville to inner-city St Kilda in the late 1970s in a house with some parallels to the Dogs in Space domestic space and his early involvement in bands such as The Fabulous Marquises and Plays with Marionettes. Hugo Race, singer, guitarist and songwriter in Plays with Marionettes (and later The Wreckery), played the character of Pierre, based on Peter ‘Pierre’ Sutcliffe, the singer for The Fabulous Marquises. Clayton-Jones played the character of Davis, based on Ears guitarist Mick Lewis, in Dogs in Space.

Introduction: Due to advances in disease management, mortality rates in children with sickle cell disease (SCD) have decreased. However, mortality rates for young adults (YA) increased, and understanding of social and psychological factors is critical. The aim of this study was to explore factors associated with health care transition experiences for YA with SCD. Method: This was a qualitative descriptive study. A 45-minute semistructured interview was conducted with 13 YA ( M = 21.5 years, SD = 1.73). Results: Results suggest that social and psychological factors and self-management experiences influence health care transition. Eight themes emerged: “need for accessible support”; “early assistance with goal setting”; “incongruence among expectations, experiences, and preparation”; “spiritual distress”; “stigma”; “need for collaboration”; “appreciation for caring providers”; and “feeling isolated.” Discussion: Consideration of cultural contexts will guide nurses in supporting health care transition. Designing culturally relevant interventions that address unique needs for YA living with SCD is warranted.

Reviewed by the chair of the Veterinary History Society Gary Clayton Jones.

Antiretroviral therapy (ART) is important in HIV outcomes and HIV prevention. However, ART adherence remains suboptimal in people living with HIV/AIDS (PLWH). This study examined associations among...

Optimal adherence to antiretroviral therapy (ART) is associated with favorable HIV outcomes, including higher CD4 cell counts, HIV virus suppression and a lower risk of HIV transmission. However, only 25% of people living with HIV/AIDS (PLWH) in the USA are virally suppressed. Sub-optimal adherence (

Introduction: African American (AA) high school-age girls are more likely to have had sex before age 13 years and have higher rates of all sexually transmitted infections. Cognition and religion/spirituality are associated with adolescent sexuality, therefore, the purpose of this study was to identify cognitive and religious substrates of AA girls’ risky sexual behaviors. Method: A descriptive study was conducted with 65 AA girls aged 15 to 20 years using computerized questionnaires and cognitive function tasks. Results: Average age was 17.8 ± 1.9 years and average sexual initiation age was 15.5 ± 2.6 years. Overall, 57.6% reported a history of vaginal sex. Girls who reported low/moderate religious importance were significantly younger at vaginal sex initiation than girls for whom religion was very/extremely important. Girls who attended church infrequently reported significantly more sexual partners. Implications: Health care providers can use these findings to deliver culturally congruent health care by assessing and addressing these psychosocial factors in this population.

Coastal and ocean acidification can alter ocean biogeochemistry, with ecological consequences that may result in economic and cultural losses. Yet few time series and high resolution spatial and temporal measurements exist to track the existence and movement of water low in pH and/or carbonate saturation. Past acidification monitoring efforts have either low spatial resolution (mooring) or high cost and low temporal and spatial resolution (research cruises). We developed the first integrated glider platform and sensor system for sampling pH throughout the water column of the coastal ocean. A deep ISFET (Ion Sensitive Field Effect Transistor)-based pH sensor system was modified and integrated into a Slocum glider, tank tested in natural seawater to determine sensor conditioning time under different scenarios, and validated in situ during deployments in the U.S. Northeast Shelf (NES). Comparative results between glider pH and pH measured spectrophotometrically from discrete seawater samples indicate that the glider pH sensor is capable of accuracy of 0.011 pH units or better for several weeks throughout the water column in the coastal ocean, with a precision of 0.005 pH units or better. Furthermore, simultaneous measurements from multiple sensors on the same glider enabled salinity-based estimates of total alkalinity (AT) and aragonite saturation state (ΩArag). During the Spring 2018 Mid-Atlantic deployment, glider pH and derived AT/ ΩArag data along the cross-shelf transect revealed higher pH and ΩArag associated with the depth of chlorophyll and oxygen maxima and a warmer, saltier water mass. Lowest pH and ΩArag occurred in bottom waters of the middle shelf and slope, and nearshore following a period of heavy precipitation. Biofouling was revealed to be the primary limitation of this sensor during a summer deployment, whereby offsets in pH and AT increased dramatically. Advances in anti-fouling coatings and the ability to routinely clean and swap out sensors can address this challenge. The data presented here demonstrate the ability for gliders to routinely provide high resolution water column data on regional scales that can be applied to acidification monitoring efforts in other coastal regions.

Gliders have proven to be effective tools for sampling the ocean and their modular nature allows for a wide range of missions. Their modularity, adaptive sampling capabilities, and near-real-time data allow them to serve many different communities, from sensor engineers to education/outreach communities. The ability to incorporate new sensors onboard allows scientific capabilities to evolve. Their ability to operate for sustained periods under extreme conditions allows scientists to study processes not possible using ships. Finally, we have found robots are a particularly effective means of entraining students and the general public in ocean exploration. This chapter will highlight these applications.

Purpose: Sickle cell disease (SCD) is a serious debilitating chronic illness, affecting approximately 90,000 Americans and millions globally. Spirituality and religiosity (S/R) may ease the burden faced by persons living with SCD. The purpose of this study was to examine the role of S/R in adolescents and adults living with SCD in the research literature. Method: The electronic databases Cumulative Index to Nursing and Allied Health Literature, Health Source Nursing/Academic, ProQuest Health Module, PsycINFO, Medline, PubMed, and the American Theological Library Association were searched from January 1995 to December 2014. Findings: Of the 89 studies retrieved, 11 articles between 2001 and 2013 met the inclusion criteria and were reviewed. Four themes emerged. The themes included (a) S/R as sources of coping, (b) S/R enhance pain management, (c) S/R influence health care utilization, and (d) S/R improve quality of life. Discussion: Use of S/R may be significant in coping with SCD, managing pain, affecting hospitalizations, and affecting quality of life. This review can direct researchers exploring S/R in adolescents and adults living with SCD.

This study purports to address paucity in the literature regarding how adolescents with sickle cell disease (SCD) describe and experience spirituality and religiosity (S/R). This was a qualitative descriptive study. Two semi-structured interviews were conducted with nine adolescents ( Mage = 16.2 years). Data were analyzed using a template analysis style and a concurrent analysis process of data reduction. Three major themes encompassed the participants’ descriptions of the relationships between S/R, health and illness in their lives including S/R as sources for coping, influence of S/R beliefs on health and illness, and sharing S/R with Health Care Providers (HCPs). S/R as coping mechanisms included six threads: interconnecting with God, interconnecting with others, interconnecting with creative arts, scriptural metanarratives, transcendent experiences, and acceptance and finding meaning. Expectations of health providers included two threads: Religiosity is private/personal and sharing spiritual and religious beliefs is risky. S/R are particularly salient for adolescents with SCD.

Coastal and ocean acidification can alter ocean biogeochemistry, with ecological consequences that may result in economic and cultural losses. Yet few time series and high-resolution measurements exist to track the existence and movement of water low in pH and/or carbonate saturation. Past acidification monitoring efforts have either low spatial resolution (mooring) or high cost and low temporal and spatial resolution (research cruises). Therefore, there is a critical need to deploy new, cost-effective technologies that can routinely provide high resolution water column data on regional scales in our coastal ocean. We developed the first integrated glider platform and sensor system for sampling pH in the water column of the coastal ocean. A Deep-Sea ISFET (Ion Sensitive Field Effect Transistor) pH sensor system was modified and integrated into a Slocum G2 glider and tested during a deployment in the Mid-Atlantic Bight. Measurements of pH exhibited a time lag that shifted during the deployment, but shifts were applied to correct pH. Glider pH and spectrophotometric pH measured in discrete water samples were in good agreement for some comparisons but not others, and those offsets were likely the result of delayed or incomplete conditioning (at deployment start) or mismatches due to water sampling techniques. Glider pH data along the cross-shelf transect revealed higher pH associated with the depth of chlorophyll and oxygen maximums and a warmer, saltier water mass. Lower pH occurred in bottom waters of the middle shelf and slope, and nearshore following a period of heavy precipitation. These results demonstrate the application of glider-based acidification monitoring in other coastal regions, providing the foundation of what could become a national acidification monitoring network.

Classification of fractures is useful for a variety of reasons. Accurate description of a fracture enables surgeons to plan and discuss methods of treatment and prognosis, and allows more effective comparison of outcomes. The chapter looks at different methods of fracture description.

Results of Office of Naval Research (ONR)- and National Science Foundation (NSF)-sponsored collaborative coastal science experiments using underwater gliders were reported at the E.U./U.S. Baltic Sea conference in 2006. The National Oceanic and Atmospheric Administration (NOAA) recognized the parallel educational potential and issued a trans-Atlantic challenge—modify one of the coastal gliders and fly it across the Atlantic, entraining and inspiring students along the way. Leveraging the experience of the NSF Centers for Ocean Sciences Education Excellence, a needs assessment process guided the development of a new undergraduate research program based on the cognitive apprenticeship model. The generalized model was applied to the specific opportunities provided by the trans-Atlantic challenge, involving students in every aspect of the missions. Students participated in the modifications and testing required to increase glider endurance and in the development of the mission planning tools. Scientist and student teams conducted three long-duration missions: (1) RU15’s flight from New Jersey to Nova Scotia to test the lithium batteries and ruggedized fin technology in storms, (2) RU17’s first attempt at the Atlantic crossing that provided the lessons learned, and (3) RU27’s successful trans-Atlantic flight a year later. Post-flight activities included development of new intuitive glider data visualization software that enabled students to analyze the glider data and compare it with ocean forecast models, enabling students to create their own new knowledge. Lessons learned include the significant gains achieved by engaging students early, encouraging them to work as teams, giving them the tools to make their own discoveries, and developing a near-peer mentoring community for increasing retention and diversity. The success has inspired an even broader vision for international glider missions, that of a glider-enabled global classroom to repeat the track of the HMS Challenger and its first scientific circumnavigation of the globe.

With specialisation in its infancy, Professor Donald Lawson was instrumental in the initiation and development of a number of RCVS diplomas as well as the BVA’s canine health schemes.

In reply to Pauline Tolhurst’s letter ‘Benefits to breeds by using the hip and elbow health scheme’ ( VR , 28 July 2018, vol 183, p 136), many years ago at the …

In October of 2003 a fleet of autonomous underwater gliders began a time series of transects across the New Jersey shelf. The gliders are equipped with a conductivity-temperature-depth sensor, and some carry optical ECO-sensor pucks. The physical-optical data are used to examine storm-induced sediment resuspension. There are two types of storm response found. In summer, the seasonal stratification limits midshelf sediment resuspension to below the pycnocline even during hurricanes. In contrast, winter storms suspend sediment throughout the full water column. The transition between summer and winter seasons starts with surface cooling that preconditions the shelf for rapid mixing during fall storms. The mixing storm of October 2003 was a classic northeaster. Early in the storm when waves were high, sediment resuspension was limited to below the pycnocline. After the pycnocline eroded through growth of the bottom boundary layer, particles immediately filled the full water column. The spectral ratio of backscatter indicated that the particles were likely similar materials both before and after the stratification was eroded. The backscatter profiles in the bottom boundary layer decay with distance from the bed at rates consistent with theory but with variable slopes. The reduced slope of the backscatter profiles increased after stratification was lost, which is consistent with an increase in vertical transport or turbulent mixing. Wave bottom orbital velocities during this time were decreasing, and the glider vertical velocities showed no enhancement consistent with Langmuir cells. Enhanced mixing was related to the interaction of the surface and bottom boundary layers while the stratification was eroded, and the observed variability in the resuspension during the event was also due to the tide.

Underwater autonomous gliders have transitioned from exotic experimental systems to becoming a standard platform capable of collecting data over a critical range of spatial and temporal scales in the ocean. The data are proving to be extremely valuable for addressing a wide range of basic and applied research questions. These communities are growing from distributed research and/or education groups. It is crucial as systems continue to evolve that there is an effort to “harmonize” data products while preserving the diversity of approaches/science/experimentation. As the gliders have matured and new battery solutions provide additional energy, there is an increased focus on the integration of a wider range of sensors to be incorporated into gliders. Many of these new classes of sensors will be particularly effective for characterizing biological processes in the coastal ocean. As biological sensors generally provide proxy estimates of a parameter, developing robust quality control and assurance procedures is critical. These new sensors will be more power intensive thus requiring the development of planning tools for increasing energy efficiency during missions. Given the significant growth in the highly distributed glider community, efforts are now focusing on the development mission planning tools to allow for efficient operation of glider fleets. To further collaboration and standardization of the growing number of glider operators we have initiated a series of community efforts called glider paloozas. We had an exceptional turnout last year, encompassing 18 U.S. and Canadian partners, 28 gliders, 36 glider deployments, and spatial coverage from coastal regions of Newfoundland to the Gulf of Mexico and offshore to Bermuda. The coordinated effort focused on several research themes including continental shelf circulation, fish migrations, and storm activity. The main goals of last year's effort were to produce a seamless flow of real-time glider data into the Global Telecommunications System (GTS) via DMAC and into the regional ocean models and demonstrate the potential of a U.S. national glider network. This is in line with the goal to increase glider data accessibility from Federal and Academic oceanographic modeling communities, the U.S. Integrated Ocean Observing System (IOOS), and other federal funding agencies (i.e., NSF). In order to demonstrate the value and necessity of the planned U.S. national glider network and build on last years successes, we hope to continue these efforts and require that all glider data produced by Gliderpalooza 2015 participants be uploaded by the individual operators to the DAC 2.0 and into GTS.

In a common garden study, seedlings of Pseudotsuga menziesii (Douglas-fir) var. menziesii (coastal) from Lacomb, Oregon and P. menzeisii var. glauca (interior) from Clearwater National Forest, Idaho, and their F 2 hybrids were grown in nursery beds in the coastal climate near Corvallis, OR. The coastal variety was from an elevation of 245 m with a mean annual rainfall of 1400 mm. The interior variety was from an elevation of 871 m and a mean annual rainfall of 600 mm. Height, stem diameter, and bud burst percent were determined. Metabolic heat rate and respiration rate were measured on apical meristems at 30, 35, and 40 °C. Similar tissue was dried, ground, combusted, and analyzed for carbon isotope ratios. The two varieties differed from one another in growth traits, bud burst, carbon isotope ratios, and respiration traits. The F 2 hybrid progeny of the varieties had isotope ratios similar to the interior variety, but respiration traits of the hybrids were similar to the coastal variety. Respiratory heat rate and height growth were the only significant trait differences found between families within varieties. The faster growing coastal variety showed less carbon isotope discrimination relative to the slower growing and more stressed (when grown at Corvallis) interior variety.