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Aim: The purpose of this article was to evaluate the ability of an interactive virtual reality (VR) platform guided by standards of best practice to provide an effective immersive learning environment. We specifically evaluated usability of the platform and learners' perceptions of the experience. Background: A variety of strategies are needed to train a highly competent nursing workforce. Methods: We conducted a quantitative cross-sectional study to evaluate the VR experience using the System Usability Scale (SUS) ® and the Simulation Effectiveness Tool-Modified (SET-M). Results: Post-simulation evaluations were completed by 127 prelicensure and 28 advanced practice students. On the SUS scale, students found the overall VR system easy to navigate, and on the SET-M, they rated the VR experience positively. Conclusion: Immersive technology such as VR with a defined curriculum and facilitated debriefing can be valuable for student learning and may ultimately effect patient care. [ J Nurs Educ . 2023;62(X):XXX–XXX.]

Background Simulation education is needed to train a highly competent nursing workforce. In-person simulation requires many resources, such as faculty, space, and time, that can negatively affect its feasibility. These barriers have prompted educators to seek new technologies to provide experiential learning opportunities, such as virtual simulation (VS). The COVID-19 pandemic further highlighted the need for educators to investigate alternative learning opportunities. Methods A quantitative cross-sectional study was conducted with pre-licensure and advanced practice nursing students. They participated in a VS learning experience that was evaluated using the System Usability Scale (SUS)®, the Clinical Learning Environment Comparison Survey (CLECS 2.0), and the Simulation Effectiveness Tool-Modified (SET-M). Result 197 pre-licensure and 11 advanced nursing practice students completed post-simulation evaluations. The results from the SUS scale found the overall virtual system effective. Evaluating the CLECS tool found students’ perceived experience was relatively similar for face-to-face simulation and screen-based simulation. The SET-M indicated students rated the VS simulation experience positively. Conclusion VS for nursing education can be an effective experiential learning tool.

The ability to manage patient telephone calls competently and confidently is an important skill for nurse practitioners (NPs). A curriculum intervention was implemented in a pediatric NP program to promote this skill. Thirty-nine NP students participated in a mock telephone triage experience to determine whether triage, involving student/faculty mock parent telephone calls, would increase the student’s confidence and competence. A Likert scale pre/post questionnaire surveying perceived confidence, competence, and readiness to practice revealed an increase in students’ confidence in decision making, assessing the patient, and making a diagnosis over the phone.

Clinical competency validation is essential for nurse practitioner (NP) education and public accountability. While there has been robust discussion around what constitutes clinical competency and assessment, clear and consistent definitions and measurements remain elusive.This article describes the PRIME-NP clinical competency model that is scalable, reproducible and accurately documents NP student competency across clinical courses.To develop the model, work in 5 discrete domains was necessary: (a) model development, (b) assessment tool to be used in Objective Structured Clinical Exams (OSCE), (c) rubrics to accompany the OSCE exam, (d) faculty education, and (e) evaluating the model use.Faculty and student outcomes reveal that the model and assessment tool acceptability and effectiveness of the model, especially for early identification for at risk students.The PRIME-NP offered faculty the opportunity to identify at-risk students, identify a more nuanced remediation plan, and assess student competency in simulated environments.

Purpose The COVID-19 pandemic has had a profound impact on American life. However, the burden of the pandemic has not been distributed equally. The purpose of this study was to investigate whether racial and economic residential segregation were associated with COVID-19 related factors in the nation's capital, Washington D.C., during the first year of the pandemic. Methods Racial, economic, and racialized economic segregation were assessed using the Index of Concentration at the Extremes measure and data from the 2014–2018 American Community Survey. COVID-19 related factors (i.e., incidence, testing rate, and percent positivity) were assessed using data from the Washington D.C. government. Spearman rank correlation was used to assess the relationship between each segregation measure and each COVID-19 related factor. Results Washington D.C. neighborhoods with a higher concentration of African Americans, lower income residents, and African Americans with low income had a higher incidence of COVID-19 and greater percent positivity, but lower testing rates compared to their counterparts. Conclusions There is a geographic mismatch between neighborhoods most vulnerable to COVID-19 and the neighborhoods where the testing resources are being used. More resources should be allocated to the most vulnerable neighborhoods to address the COVID-19 pandemic in an equitable manner.

Pyramiding resistance genes (R genes) in potato generally provides improved field resistance against late blight (LB). Potato breeders may implement pyramiding by targeting breeding schemes according to LB genetic profiles. This study interrogated LB resistant elite germplasm for pyramided late blight R genes using DNA-based markers, which were then challenged against contemporary LB races. Five late blight R gene markers were used in this study. LB resistance ratings were determined using detached leaf assay (DLA) and field data from multiple locations and years. The clone J117, found to have the Rpi-blb1/RB gene, showed high resistance against US-23 in the laboratory and field. Several varieties positive for the R3b gene showed at least moderate resistance in the DLA and in the field. While two varieties were found to be pyramided with the R1 and R3b genes and also showed good field resistance, DLA results indicate that the combination is likely non-additive. LB resistance may be broadened by incorporating novel R gene combinations.

Purpose We examined if childhood socioeconomic status (SES) was related to adult leucocyte telomere length (TL) using the data of 361 African American (AA) participants from the GENE-FORECAST Study. We also assessed the mediating role of behavioral and psychosocial factors in the association between childhood SES and adult TL. Methods Childhood SES was assessed individually by using participant’s mother’s education and occupation, father’s education and occupation, parental home ownership, and family structure. TL was assessed using the quantitative polymerase chain reaction method. Information on potential confounders and mediators were collected. The associations of childhood SES with TL were assessed using multivariable linear regression models. We used path analysis to quantify and test the share of these associations that was statistically explained by each of the mediators (participant’s educational attainment, smoking status, physical activity, dietary habit, perceived stress, and depressive symptoms). Results Mother’s education was associated with longer average TL (β: 0.021; 95% CI: 0.001, 0.04, p=0.038) in confounder adjusted models. Once mediators were introduced in the model, the estimates were reduced and remained marginally significant (β: 0.017; 95% CI: −0.003, 0.038, p=0.061). According to path model, approximately 19% of the effect of mother’s education on TL (β: 0.004; 95% CI: −0.001, 0.01, p < 0.10) was mediated through participant’s own education level. No significant mediation effect was observed for any other mediators. Conclusions These data provide evidence that participant’s mother’s education was positively linked to adult TL in AA population. Participant’s own educational level partially explained this association.

Introduction Pediatric patients who develop acute kidney injury (AKI) while hospitalized have longer hospital stays, increased morbidity and mortality, and are at an increased risk for developing chronic kidney disease. Early recognition of AKI is becoming a major clinical focus. There is little research focusing on nursing interventions that may affect a pediatric patient's risk for developing AKI. The purpose of this review is to summarize reported predictors of AKI to improve its early recognition and treatment among hospitalized pediatric patients. Methods A review of research was conducted to further identify risk factors of AKI among noncritically ill hospitalized pediatric patients. Results The current literature demonstrated inconsistent findings in early recognition of AKI among hospitalized pediatric patients. Discussion Interventions for early recognition and treatment of AKI should consider other variables, such as previous history of AKI and fluid status as risk factors, warranting additional research.

Background and purpose Nurse practitioners (NPs) perform diagnostic and clinical procedure skills in the acute, specialty, urgent, and primary care settings. Nurse practitioners surveyed on readiness for practice report a lack of confidence and education preparation for performing selected advanced diagnostic and skills. As NPs gain independent, full practice scope, it is imperative advanced diagnostic and procedure skills used in practice are taught in nurse practitioner curriculum. The purpose of this review is to document a systematic review of the literature, answering the following question: Among primary care NPs, does current program curriculum align with current procedures and skills in theclinical setting? Methods PubMed, Cochrane, Scopus, CINAHL, and Embase were searched between inception and 2018 using the search terms "advanced practice nursing, clinical competence, diagnostic techniques or procedures, and primary health care." Following the preferred reporting items for systematic reviews and meta-analysis guidelines, nine articles were included in the synthesis. Conclusion There is scant research regarding NP educational preparation of skills and procedures. Study findings indicate that programs are not teaching all the procedures deemed important. Education should promote improved congruence between the skills and procedures taught in program curricula and those used in clinical practice. Implications for practice It is critical to complete an education practice survey measuring skill and procedure preparation and competency at graduation. Survey results will determine whether skill and procedure guidelines are indicated for NP education. A recommendation may include minimal skills and procedure for all nurse practitioner curricula.

Background Simulation is increasingly used to identify latent threats to patient safety, such as delays in recognition and management of time-sensitive conditions. The Rapid Cycle Deliberate Practice teaching method may facilitate “nano” (brief) in situ simulation training in a critical care setting to improve multidisciplinary team performance of time-sensitive clinical tasks. Objective To determine whether nano–in situ simulation training with Rapid Cycle Deliberate Practice can improve pediatric intensive care unit team proficiency in identifying and managing postoperative shock in a pediatric cardiac patient. Methods A quality improvement educational project was conducted involving nano–in situ simulation sessions in a combined pediatric and pediatric cardiac intensive care unit. The Rapid Cycle Deliberate Practice method was used with an expert-driven checklist for 30-minute simulation scenarios. Results A total of 23 critical care providers participated. The proportion of time-sensitive tasks completed within 5 minutes increased significantly from before to after training (52% [13 of 25] vs 100% [25 of 25]; P ≤ .001). Using a 5-point Likert scale, with higher scores indicating higher levels, the participants reported high degrees of performance confidence (mean, 4.42; SD, 0.20) and satisfaction with the simulation experience (mean, 4.96; SD, 0.12). Conclusion The Rapid Cycle Deliberate Practice method was used to facilitate nano–in situ simulation training and identify areas requiring additional education to improve patient safety. In situ simulation can educate providers in a cost-effective and timely manner.

STATEMENT Rapid-cycle deliberate practice (RCDP) is a learner-centered simulation instructional strategy that identifies performance gaps and targets feedback to improve individual or team deficiencies. Learners have multiple opportunities to practice observational, deductive, decision-making, psychomotor, and crisis resource management skills. As its implementation grows, simulationists need to have a shared mental model of RCDP to build high-quality RCDP-based initiatives. To compare and make general inferences from RCDP data, each training needs to follow a similar structure. This article seeks to describe the fundamentals of RCDP, including essential components and potential variants. We also summarize the current published evidence regarding RCDP's effectiveness. This article serves to create a shared understanding of RCDP, provide clear definitions and classifications for RCDP research, and provide options for future RCDP investigation.

Acute care pediatric nurse practitioners have become frontline providers in the critical care environment and are expected to provide leadership in acutely critical situations. We describe a 2-day, high-fidelity, simulation-based curriculum focused on training the pediatric nurse practitioners for leadership in critical care scenarios.This prospective pre-post interventional study used simulation-based pedagogy. Knowledge tests, time-to-task, and a follow-up survey were used to determine the effectiveness of the training.Participants (n = 23) improved their knowledge scores by 27% (pretest: 35.2% [standard deviation = 12.1%]; posttest: 62.2% [standard deviation = 13.8%], p.001). In addition, time-to-task for resuscitation variables improved significantly. At 3 months, 100% of the participants who responded either agreed (15.4%) or strongly agreed (84.6%) that the boot camp prepared them to lead in a critical emergency.Simulation-based training is an effective strategy for educating critical care pediatric nurse practitioners and improves their ability to manage pediatric emergencies rapidly, which can be lifesaving.

Simulation has been utilized widely in nurse practitioner programs for competency development and training. With the growing number of online educational programs, innovative solutions need to be developed to assess student competency for a variety of clinical situations and scenarios. An innovative method is the implementation of telepresence robots for multiple patient scenarios in a simulated environment. This article demonstrates the use of multiple patient scenarios using telepresence robots in an online post master's acute care pediatric nurse practitioner program.

BackgroundExposure to psychosocial stress and employment of high effort coping strategies have been identified as risk factors that may partially explain the high prevalence of hypertension among African Americans. One biological mechanism through which stress and coping may affect risk of hypertension is via epigenetic modifications (e.g., DNA methylation) in blood pressure-related genes; however, this area remains understudied in African Americans.MethodsWe used data from the ongoing Intergenerational Blood Pressure Study, a longitudinal study designed to investigate factors that contribute to hypertension risk in African American women (n = 120) and their young children, to investigate the association between stress overload, problem-solving coping, avoidance coping, and social support coping with DNA methylation in 25 candidate genes related to blood pressure. Multivariable linear regression and multilevel modeling were used to conduct methylation site-level and gene-level analyses, respectively.ResultsIn site-level analyses, stress overload, problem-solving coping, social support coping, and avoidance coping were associated with 47, 63, 66, and 61 sites, respectively, at p ConclusionsAs human social epigenomics is an emerging, evolving area of research, there is much to be learned from studies with statistically significant findings as well as studies with null findings. Factors such as characteristics of the social stressor, source of DNA, and synchronization of exposure and outcome are likely important considerations as we move the field forward.

Introduction: Cigarette smoking has been associated with adverse health outcomes for mothers and children and is a major contributor to heart disease. Although cigarette smoking is known to affect the epigenome, few studies have been done in African American populations. In this study, we investigated the association between cigarette smoking and DNA methylation (DNAm) among African Americans from the Intergenerational Impact of Genetic and Psychological Factors on Blood Pressure Study (InterGEN), and the Genetic Epidemiology Network of Arteriopathy (GENOA). Methods: The InterGEN study aims to examine the effects of genetic and psychological factors on blood pressure among African American women and their children. Current cigarette smoking was assessed at baseline. DNAm of saliva was assessed using the 850K EPIC Illumina BeadChip for Epigenome-Wide Association analyses. A replication study was conducted among 1100 participants in the GENOA study using the same BeadChip. Results: After controlling for age, body mass index, population structure and cell composition, 26 epigenome-wide significant sites (FDR q

Background Exposure to adverse social factors has been associated with an altered inflammatory profile, a risk factor for several acute and chronic diseases. Differential gene expression may be a biological mediator in the relationship. In this study, associations between a range of social factors and expression of inflammation-related genes were investigated. Methods Social factor and gene expression data were collected from 1,264 individuals in the Multi-Ethnic Study of Atherosclerosis (MESA). Inflammation-related genes were identified from the Gene Ontology database. The associations between social factors and gene expression were first assessed using the Global Analysis of Covariance (Global ANCOVA) gene set enrichment test. When the global test was significant, linear regression and elastic net penalized regression were employed to identify the individual gene transcripts within each gene set associated with the social factor. Results Loneliness (p = 0.003), chronic burden (p = 0.002), and major or lifetime discrimination (p = 0.045) were significantly associated with global expression of the chronic inflammatory gene set. Of the 20 transcripts that comprise this gene set, elastic net selected 12 transcripts for loneliness, 8 for chronic burden, and 3 for major or lifetime discrimination. Major or lifetime discrimination was also associated with the inflammatory response (p = 0.029), regulation of the inflammatory response (p = 0.041), and immune response (p = 0.025) gene sets in global analyses, and 53, 136, and 26 transcripts were selected via elastic net for these gene sets respectively. There were no significant associations in linear regression analyses after adjustment for multiple testing. Conclusions This study highlights gene expression as a biological mechanism through which social factors may affect inflammation.

Nurses play a critical role in the life of the child with congenital heart disease (CHD) and their families. This chapter describes the advanced skills and knowledge needed by nurses who care for the child with CHD, discusses the various complex and challenging roles and responsibilities of the pediatric cardiac nurse, explores the psychosocial impact of CHD on children and families, and discusses the nurse's role in assisting family adaptation at each phase of the illness and treatment. The postoperative management of CHD patients should be directed at optimizing oxygen delivery to maintain end-organ function and decrease the risk of complications. An understanding of the early signs of impaired cardiac output (CO) and implementation of appropriate treatments by the provider improves patient outcomes. It has been established that provider recognition and treatment of the early signs and symptoms of an acute deterioration leads to improved patient outcomes and prevents mortality. The management of these complex patients should be directed at educating nurses who care for these patients.

BackgroundGene expression may be an important biological mediator in associations between social factors and health. However, previous studies were limited by small sample sizes and use of differing cell types with heterogeneous expression patterns. We use a large population-based cohort with gene expression measured solely in monocytes to investigate associations between seven social factors and expression of genes previously found to be sensitive to social factors.MethodsWe employ three methodological approaches: 1) omnibus test for the entire gene set (Global ANCOVA), 2) assessment of each association individually (linear regression), and 3) machine learning method that performs variable selection with correlated predictors (elastic net).ResultsIn global analyses, significant associations with the a priori defined socially sensitive gene set were detected for major or lifetime discrimination and chronic burden (p = 0.019 and p = 0.047, respectively). Marginally significant associations were detected for loneliness and adult socioeconomic status (p = 0.066, p = 0.093, respectively). No associations were significant in linear regression analyses after accounting for multiple testing. However, a small percentage of gene expressions (up to 11%) were associated with at least one social factor using elastic net.ConclusionThe Global ANCOVA and elastic net findings suggest that a small percentage of genes may be "socially sensitive," (i.e. demonstrate differential expression by social factor), yet single gene approaches such as linear regression may be ill powered to capture this relationship. Future research should further investigate the biological mechanisms through which social factors act to influence gene expression and how systemic changes in gene expression affect overall health.

Background: Nearly 30% of U.S. adults are hypertensive with a high prevalence existing among Black Americans (42%). Exposure to psychosocial stress has been identified as a risk factor for hypertension and may explain part of the observed racial disparities. One pathway through which stress exposure may mechanistically alter biological functioning in a manner that affects risk of hypertension is via epigenetic modifications in hypertension-related genes, but this area remains understudied. Aims and Hypothesis: In the present study, we investigate the relationship between stress exposure and methylation of 25 genes that have been associated with blood pressure in Blacks in previous genetic research. We hypothesize that stress exposure is associated with DNA methylation of blood pressure related genes. Methods: We conducted an epigenetic association study using data from the ongoing InterGEN Study, a longitudinal investigation of the psychological, environmental, and genetic factors that contribute to hypertension risk in African American mothers (n=74) and their young children. Stress exposure was measured using the 24-item Stress Overload Scale (α=0.95), and a summary score was calculated by summing the Likert scale responses. Methylation was measured using the Illumina Infinium MethylationEPIC Beadchip, and M-values (i.e. log2 ratio of the intensities of methylated probe versus unmethylated probe) were calculated for association analysis. Linear regression was employed to assess the association between stress exposure and methylation in the a priori defined genes. Results: At pIGFBP3 ), calcium voltage-gated channel subunit alpha1 H ( CACNA1H ), and solute carrier family 4 member 5 ( SLC4A5 ) (p=0.001, p=0.002, and p=0.006, respectively). Conclusion: This study provides biological insight into DNA methylation as a mechanism whereby exposure to psychosocial stress affects risk of hypertension in Black women. Additional replication studies with a larger sample size and includes men are needed to validate and generalize the findings. Future research should further investigate the biological mediators between DNA methylation and hypertension manifestation.

Assess the effect of a simulation "boot camp" on the ability of pediatric nurse practitioners to identify and treat a low cardiac output state in postoperative patients with congenital heart disease. Additionally, assess the pediatric nurse practitioners' confidence and satisfaction with simulation training.Prospective pre/post interventional pilot study.University simulation center.Thirty acute care pediatric nurse practitioners from 13 academic medical centers in North America.We conducted an expert opinion survey to guide curriculum development. The curriculum included didactic sessions, case studies, and high-fidelity simulation, based on high-complexity cases, congenital heart disease benchmark procedures, and a mix of lesion-specific postoperative complications. To cover multiple, high-complexity cases, we implemented Rapid Cycle Deliberate Practice method of teaching for selected simulation scenarios using an expert driven checklist.Knowledge was assessed with a pre-/posttest format (maximum score, 100%). A paired-sample t test showed a statistically significant increase in the posttest scores (mean [SD], pre test, 36.8% [14.3%] vs post test, 56.0% [15.8%]; p0.001). Time to recognize and treat an acute deterioration was evaluated through the use of selected high-fidelity simulation. Median time improved overall "time to task" across these scenarios. There was a significant increase in the proportion of clinically time-sensitive tasks completed within 5 minutes (pre, 60% [30/50] vs post, 86% [43/50]; p = 0.003] Confidence and satisfaction were evaluated with a validated tool ("Student Satisfaction and Self-Confidence in Learning"). Using a five-point Likert scale, the participants reported a high level of satisfaction (4.7 ± 0.30) and performance confidence (4.8 ± 0.31) with the simulation experience.Although simulation boot camps have been used effectively for training physicians and educating critical care providers, this was a novel approach to educating pediatric nurse practitioners from multiple academic centers. The course improved overall knowledge, and the pediatric nurse practitioners reported satisfaction and confidence in the simulation experience.

This study examined the differential effects of both parents’ religious service attendance on adolescent substance use. A secondary data analysis of the National Longitudinal Survey of Youth, 1997, Round 1 was conducted using a sample of 4,828 adolescents ages 12 to 16 (mean age 14 years). Results suggest that attending religious services more than once a week by both parents is associated with adolescents being less likely to use substances. Adolescents residing in households where the father never attended religious services and the mother attended religious services once a month and adolescents residing in households where the father never attended religious services and the mother attended more than once a week were almost 4 times more likely to use substances than adolescents residing in households where both parents attended religious services more than once a week. There was no evidence to support that having one parent attending religious services more than the other compensated for the effects of...

We present the use of a low-resistance membrane oxygenator (Quadrox D, Maquet) in series with a pulsatile right ventricular assist device (Berlin Heart EXCOR, Berlin Heart) in a patient with biventricular support who required high-frequency oscillatory ventilation (HFOV), due to refractory acute respiratory distress syndrome associated with Cytomegalovirus pneumonia. The high mean airway pressure associated with the use of HFOV resulted in a significant negative impact on left ventricular assist device (LVAD) filling that led to a combined respiratory and metabolic acidosis and the need for vasopressor support. Oxygenator placement enabled transition to conventional ventilation and the discontinuation of vasopressor support. This case demonstrates the feasibility and safety of the use of this lung support system in patients requiring ventricular assist device (VAD) support.

2. 0 keV 11B+, 2.2 keV 49BF2+ ion implanted and 1.0 kV Plasma Doped (PLAD) wafers of a dose of 1E15/cm2 were annealed at various times and temperatures in a variety of ambiente: 600 to 50,000 ppm O2 in N2; 5% NH3 in N2; N2O; N2 or Ar, in order to investigate the effects of the annealing ambient on the formation of ultra-shallow junctions. RGA data was collected during some (if the anneals to assist in identifying the complex surface chemistry responsible for boron out-diffusion. Subsequent to the anneals, ellipsometric, XPS, four-point probe sheet resistance and SJJVIS measurements were performed to further elucidate the effects of the different ambients on the r etained boron dose, the sheet resistance value, the RTP grown oxide layer and the junction depth. In the cases where oxygen was present, e.g. N2O and O2 in N2, an oxidation enhanced diffusion of the boron was observed. This was most dramatic for the N2O anneals, which at 1050°C 10s diffused the boron an additional 283 to 427 Å, depending on the particular doping condition and species. For the case of BF2 implants and PLAD, anneals in 5% NH3 in N2 reduced the junction depth by a nitridation reduced diffusion mechanism. RGA data indicated that the out-diffusion mechanisms for B and BF2 implanted wafers are different, with the BF2 exhibiting dopant loss mechanisms during the 950°C anneals, producing F containing compounds. B implants did not show doping loss mechanisms, ais observed by the RGA, until the 1050°C anneals and these signals did not contain F containing compounds. Equivalent effective energy boron implants of 8.9 keV BF2 vs. 2.0 keV B, however, indicated that the overall effect of the F in the BF2 implants is very beneficial in the creation of ultra-shallow junctions (compared to B implants): reducing the junction depth by 428 Å, and increasing the electrical activation (determined by SRP) by 11.7%, even though the retained dose (resulting from an increased out-diffusion of B), was decreased by 5.4%.