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Poor sleep quality and duration among health care professionals have negative impacts on worker safety, work readiness, and well-being. However, the consequences of impaired sleep among long-term care (LTC) workers remain understudied. The current integrative review sought to explore associations between sleep and occupational outcomes in LTC workers. Multiple database searches yielded 1,543 articles; nine articles met inclusion criteria. Results synthesized from included articles revealed sleep-associated occupational outcomes across three themes, Burnout/Fatigue , Mental and Physical Health , and Well-Being , which may affect performance measures and predict injuries/errors. Exploring outcomes of poor sleep quality and duration among LTC workers has highlighted the needs of this population and may inform future intervention development. LTC organizations should consider implementing strategies to better support the sleep quality of their workforce. In addition, further research is needed to explore how impaired sleep contributes to negative worker outcomes and patient care quality. [ Journal of Gerontological Nursing, 49 (1), 27–33.]

Nearly 1 in every 14 youth have had a parent incarcerated at some point. In any given year, over 9 million adults from jail and 700,000 adults from prison return to their families and communities. However, few studies have explored the family experiences during re-entry or have provided suggestions on how to best support children during this time. The goal of this qualitative study was to describe family experiences and provide their considerations on how to better support children during the period of parent's re-entry. Qualitative data was gathered from 26 participants using semi-structured, in-depth phone interviews from March to August 2020. The sample included 10 youth (12-18 years) who have had a parent incarcerated, 10 custodial caregivers of youth who have had incarcerated parents, and 6 parents released from incarceration. Qualitative content analysis and open-coding procedures were used to determine themes across raters. Experiences centred on the challenges of assimilating to new family roles upon the parent returning home and to the community. Families also shared the difficulty in navigating parole restrictions and managing fears surrounding the recidivism of the parent. Three primary themes were deduced as relationship-building obstacles, unaligned family expectations and parole-related family burdens. Results from this study revealed suggestions that may address youth, caregiver and returning parent's needs during the re-entry phase. Family counselling and peer support groups may improve the process of mending or forming relationships. Access to re-entry programs, mental health services, and parental education may better align family expectations. Transparent wrap-around social services and decreasing legal challenges may reduce the parole-related burdens on the family.

Emergency department healthcare workers are known to face a unique combination of pressures from their careers and work environments regularly. Caring for dying patients and making difficult lifesaving decisions not only continued but also became more prevalent for emergency department healthcare workers during the COVID-19 pandemic. A growing body of literature revealed that the mental and emotional toll of COVID-19 has been tremendous. However, the burden of COVID-19 on the overall physical health and work–life balance on this group needs to be understood. This study aimed to describe the impact of stress on wellbeing and health across the globe among emergency department healthcare workers. A cross-sectional survey comprising work–family and family–work conflict scale, work–life balance, physical symptoms inventory, Oldenburg Burnout Inventory, satisfaction with job and life, and life change index scale was distributed to a convenience sample through listservs and social media. In total, 287 participants responded, 109 completing all questions. Fatigue was the most common symptom reported to occur daily (28.4%, n = 31), followed by muscle pain (13.8%, n = 15) and backache (11.9%, n = 13). Nurse practitioners reported the highest number of physical symptoms and the highest average scores and counts of stressful life events, while registered nurses indicated the highest work–family conflict levels. Linear regressions showed that stressful life events are significantly associated with both physical symptoms and work–family conflict. Results underscore the need to better support emergency department workers to mitigate the risks associated with occupational stress. Protective organizational policies and increased support strategies may be employed to improve wellbeing and cultivate a more sustainable workforce.

Emergency department healthcare workers are known to face a unique combination of pressures from their careers and work environments regularly. Caring for dying patients and making difficult lifesaving decisions not only continued but also became more prevalent for emergency department healthcare workers during the COVID-19 pandemic. A growing body of literature revealed that the mental and emotional toll of COVID-19 has been tremendous. However, the burden of COVID-19 on the overall physical health and work-life balance on this group needs to be understood. This study aimed to describe the impact of stress on wellbeing and health across the globe among emergency department healthcare workers. A cross-sectional survey comprising work-family and family-work conflict scale, work-life balance, physical symptoms inventory, Oldenburg Burnout Inventory, satisfaction with job and life, and life change index scale was distributed to a convenience sample through listservs and social media. In total, 287 participants responded, 109 completing all questions. Fatigue was the most common symptom reported to occur daily (28.4%

The present study seeks to measure suppression effects in a canonical experimental configuration, featuring the exposure of a buoyant, turbulent, methane-fueled diffusion flame to a co-flowing oxidizer laden with a fine water mist (Sauter mean diameter of 6.6 µm). The carefully designed facility features well-characterized inlet and boundary conditions suitable for accurate representation in numerical simulations. Suppression performance is monitored via combustion efficiency (ηcomb), measured using species-based calorimetry techniques. As the mass fraction of water mist in the oxidizer ( Y w m o x ) is increased, visible flame emissions are reduced due to diminishing soot incandescence coupled with a reduction in visibility due to Mie scattering effects in the mist. Global flame extinction is observed at Y wm ext = 0.093 , a condition corresponding to 44% less water mass in the oxidizer than required for extinction due to dilution effects alone, suggesting that significant latent cooling effects contribute to the observed extinction limit. Despite visually observed suppression effects, η comb ≈ 1 across all tested Y w m o x , decreasing abruptly only at the extinction limit. Numerical simulations of the experiments are conducted using FireFOAM, an open source large eddy simulation solver incorporating a flame extinction model based on a critical Damkohler number and a flame reignition treatment based on a critical flame temperature. Though numerical results show qualitative agreement with the observed extinction behavior, the simulated extinction limit of Y wm ext = 0.20 significantly exceeds that measured in the experiment, but is itself consistent with an extinction limit due only to dilution effects.

Nurse practitioners will encounter patients with valvular heart disease (VHD) because 5 million Americans are diagnosed with VHD every year. The American Heart Association and the American College of Cardiology released VHD guidelines in 2014. Once VHD is recognized, evidence-based guidelines need to be used in the management of patients with VHD. Nurse practitioners must have an understanding of the latest guidelines in order to initiate treatment, collaborate with the heart team members, and monitor and follow up on patients with VHD. Timely referral to cardiology and cardiac surgery is imperative for optimal outcomes in patients with VHD.

Introduction: The following is a study of the impact of comorbid conditions on hospital length of stay following spinal fusion. Methods: Surgeries were identified from the 2016 Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-US-NIS) by Medicare Severity Diagnosis Related Group (MS-DRG) codes and subdivided for analysis by fusion location and procedure approach. Length of stay was evaluated in relation to comorbid disease status, fusion location, and surgical technique. Comorbidities of interest included hypothyroidism, diabetes mellitus, hypertension, hyperlipidemia, anxiety, obesity, chronic obstructive pulmonary disease, osteoarthritis, rheumatoid arthritis, major depression, coronary atherosclerosis, arrhythmia, congestive heart failure, osteoporosis, stroke, and transient ischemic attack. Patients hospitalized longer than two months were excluded from this analysis. Results: 185,216 patients undergoing an inpatient spinal fusion were identified (Cervical 32,753, Cervicothoracic 2,633, Thoracic 2,817, Thoracolumbar 4,761, Lumbar 32,316, Lumbosacral 17,326). Each comorbid disease was found to significantly increase the length of hospital stay for at least one procedure location (p

Background Government projections in the USA indicate that the country will need a million more science, technology, engineering, and mathematics (STEM) graduates above and beyond those already projected by the year 2022. Of crucial importance to the STEM pipeline is success in Calculus I, without which continuation in a STEM major is not possible. The STEM community at large, and mathematics instructors specifically, need to understand factors that influence and promote success in order to mitigate the alarming attrition trend. Previous work in this area has defined success singularly in terms of grades or persistence; however, these definitions are somewhat limiting and neglect the possible mediating effects of affective constructs like confidence, mindset, and enjoyment on the aforementioned markers of success. Using structural equation modeling, this paper explored the effect of participation on grades in freshman college calculus and investigated whether these effects were mediated by affective variables. Results Results indicated that participation had no significant direct effect on any of the success components in the final model—a finding that was not only counterintuitive but actually contradicted previous research done on this data. Participation was however highly correlated with two other exogenous variables indicating it would be inappropriate to dismiss it as being unrelated to success. Furthermore, the results suggested a cluster of affective success components and an achievement component with confidence being the intermediary between the two. Conclusions This paper extends upon previous work with this data set in which the effect of participatory behaviors on success was investigated wherein success was measured singularly with expected course grade and affective components of success were not considered. The limited explanatory power of the model, coupled with the seemingly contradictory results, indicates that participatory behaviors alone might be insufficient to capture the complexity of the success response variable. Published version

The objective of this study was to demonstrate the feasibility of timely multimodal MRI screening before thrombolysis in acute stroke patients.Quality improvement processes were initiated in 2013 to reduce door-to-needle (DTN) time at the 2 hospitals where the NIH stroke team provides clinical care. Acute ischemic stroke (AIS) patients who received IV tissue plasminogen activator (tPA) ≤4.5 hours from last known normal were identified. Demographic and clinical characteristics and timing metrics were analyzed comparing the time periods before, during, and after the quality improvement processes.There were 157 patients treated with IV tPA for AIS during 2012-2013, of whom 135 (86%) were screened with MRI. DTN time was significantly reduced by 40% during this period from a median of 93 minutes in the first half of 2012 to 55 minutes in the last half of 2013 (p0.0001) with a significant 4-fold increase in the proportion of treated patients with DTN time ≤60 minutes from 13.0% to 61.5%, respectively (p0.00001). Improvement in DTN time was associated with reduced door-to-MRI time, and there were no differences in demographic or clinical characteristics (p = 0.21-0.76).It is feasible and practical to consistently and rapidly deliver IV tPA to AIS patients within national benchmark times using MRI as the routine screening modality. The processes used in the SMART (Screening with MRI for Accurate and Rapid Stroke Treatment) Study to reduce DTN time have the potential to be widely applicable to other hospitals.

Objectives: Managed care plans under Medicaid are becoming a usual source of care for low-income pregnant women. This study describes an ancillary prenatal care service intervention developed by one managed care organization (MCO) for Medicaid-enrolled women, assesses the extent to which the intervention services were used, and appraises the influence of the intervention on prenatal care participation. Method: There were 226 intervention and 258 control women with a single live birth delivered between 28 and 44 weeks gestation who (1) were enrolled in the MCO's Medicaid program, (2) were high-risk based on a prenatal risk assessment, and (3) started prenatal care prior to 26 weeks gestation. Less than adequate and intensive prenatal care utilization were chosen as intervention outcomes measures. Results: Family planning, a 2-month postpartum baby visit, a maternal postpartum visit, and a WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) referral were among the most self-selected intervention services for this population; home health aide and breast-feeding support were the least requested services. Over 90% of those needing family planning or breast-feeding services received the services, while over 20% of the intervention group refused child care, food assistance and family violence referrals, and home health aide and smoking cessation services. The intervention group had a significantly lower risk of less than adequate utilization of prenatal care (OR = .32; 95% CI: 0.17–0.60) and was more likely to have an intensive number of prenatal care visits (OR = 1.61; 95% CI: 1.05–2.48). Conclusions: The ability of managed care organizations to provide ongoing prenatal care to Medicaid populations in a cost-effective manner depends partly on their development of packages of prenatal services that foster positive preventive health care utilization behaviors and good pregnancy outcomes. The results of this project suggest that the intervention was beneficial in the area of improving utilization of prenatal care.

Non-communicable diseases (NCD) have been identified as a health emergency in the US-affiliated Pacific Islands (USAPI).1 This assessment, funded by the National Institutes of Health, was conducted in the Federated States of Micronesia, State of Pohnpei and describes the burden due to selected NCD (diabetes, heart disease, hypertension, stroke, chronic kidney disease); and assesses the system of service capacity and current activities for service delivery, data collection and reporting as well as identifies the issues that need to be addressed. Findings reveal that the risk factors of poor diet, lack of physical activity, and lifestyle behaviors lead to overweight and obesity and subsequent NCD that are significant factors in the morbidity and mortality of the population. Leading causes of death were due to heart disease, diabetes, cancer, and hypertension. Population survey data show that 32.1% of the adult population had diabetes with a higher rate among women (37.1%) when compared to men (26.4%). The data also showed that 73.1% of the adult population was overweight or obese. Other findings show significant gaps in the system of administrative, clinical, data, and support services to address these NCD. There is no overall planning document for the prevention and control of NCDs or diabetes. There is evidence of little communication among the medical and health care providers which leads to fragmentation of care and loss of continuity of care. Based on some of the findings, priority issues and problems that need to be addressed for the administrative and clinical systems are identified.

In this descriptive study, the self-care limitations of persons who had experienced their first myocardial infarction were identified during the first 3 months of their convalescent period. The five most frequently occurring limitations identified were patterns of personal and family living that interfere with self-care; intense emotional states, likes or dislikes, overriding interest and concerns; perceptions, meanings, and appraisals not in accord in reality; inability to attend to self with respect to changing conditions; and new, unrecognized requirements for self-care associated with changed health. Assessment of limitation is a framework that nurses might use to evaluate the needs of post myocardial infarction patients.

Class II major histocompatibility complex (MHC) molecules bind peptides and present them to helper T lymphocytes as the initial step of an immune response. The specificity of peptide binding by class II molecules is determined by amino acid exchanges in the hypervariable regions. There are groups of HLA-DRB1 gene alleles, which differ from each other from members of another group by as many as 10-15 amino acid exchanges. The largest such group is DRB1*04, of which there are at present 20 different alleles known. In the process of HLA-DRB1*04 subtyping of patients with polychondritis, which is associated with DR4, we identified one patient (SMH), whose DNA displayed a novel pattern of oligonucleotide reactivity. The oligonucleotide typing results suggested one or more nucleotide differences in the region encoding amino acid 37 of the DRB1*0301 allele. 7 refs., 1 fig.

The action of proline and its analogs as glutamate antagonists was investigated in CNS tissue of the neonatal chick. Avian brain slices were incubated in low concentrations of l -proline, d -proline, dl -3,4-dehydro-proline, l -prolyl- l -proline, or in avian physiological salt solution before depolarization was induced by application of 45 mM K+. Glutamate was determined in the efflux material collected both before and after tissue stimulation. The release of endogenous glutamate was inhibited significantly by exposure to l -proline, dl -3,4-dehydroproline and l -prolyl- l -proline. The degree of glutamate inhibition correlated with the amnestic potency of these substances. The manner in which these results strengthen the hypothesis of glutamate involvement in memory processes is discussed.

Measurements of changes in NAD(P)H steady state levels following electrical pulse stimulation indicate that a component of brain cortex intermediary metabolism can be affected in vitro by dopamine and β- but not α-adrenergic agents. Acute morphine treatment inhibits this β-adrenergic response.

The influence of 1 mm-l-proline on electrically stimulated release of endogenous glutamate from slices of rat frontal cortex was measured. One mm-l-proline approximates the in vitro concentration that inhibits glutamate-induced spreading depression. Also, this l-proline level has been reported to be present in brain after an intraperitoneal injection that induced amnesia in chicks. l-Proline but not d-proline exhibits an inhibitory effect on glutamate release, thus supporting the suggestion that this mechanism may play a role in memory retention and/or formation.

Therapeutic touch (TT) is a modern derivative of the laying on of hands that involves touching with the intent to help or heal. This study investigated the effects of TT on tension headache pain in comparison with a placebo simulation of TT. Sixty volunteer subjects with tension headaches were randomly divided into treatment and placebo groups. The McGill-Melzack Pain Questionnaire was used to measure headache pain levels before each intervention, immediately afterward, and 4 hours later. A Wilcoxon signed rank test for differences indicated that 90% of the subjects exposed to TT experienced a sustained reduction in headache pain, p less than .0001. An average 70% pain reduction was sustained over the 4 hours following TT, which was twice the average pain reduction following the placebo touch. Using a Wilcoxon rank sum test, this was statistically significant, p less than .01. Study results indicated that TT may have potential beyond a placebo effect in the treatment of tension headache pain.