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We surveyed 181 nursing research leaders from Magnet® hospitals, using mixed methods with the online Hospital-Based Nursing Research Clinical and Economic Outcomes survey, to describe the clinical and economic outcomes of nursing research conducted in hospital settings. We used descriptive statistics to analyze the quantitative findings and a qualitative descriptive approach to study the open-ended responses. Most respondents reported that findings from their hospital-based studies were implemented on their units (88.2%), improved health care processes (88.2%), and reduced hospital costs (79%). Over 50% reported positive impacts on core quality measures, including improving patient/family satisfaction (76.8%), nurse satisfaction (65%), length of stay (59.1%), and infection rates (56.5%). Four themes were identified: study evaluation, improvements in care delivery/clinical outcomes, economic impact, and intrinsic and extrinsic rewards. Much of the research reported by respondents focused on quality measures with findings that resulted in improved clinical and economic outcomes.

Given evidence that anemia in the first year of life is associated with long-term cognitive, motor, and behavioral deficits, reducing infant anemia is important. The primary objective of this research is to examine whether anemia in low income pregnant women in the United States is associated with anemia in the women’s infants. This cohort study linked Centers for Disease Control and Prevention surveillance data on pregnant women with incomes below 185% of the federal poverty level from 2010 and 2011 with data on 6–11 month olds from 2011, resulting in a sample of 21,246 uniquely matched mother-infant pairs. We examined bivariate and multivariate relationship between anemia severity in pregnant women and in their infants. Seventeen percent of women had anemia (13.1% mild and 3.9% moderate to severe) and 20.1% infants had anemia (16.4% mild and 3.7% moderate to severe). For both women and infants, blacks had substantially higher anemia rates than whites. In bivariate analysis and multivariate analyses maternal anemia showed a dose–response relationship to infant anemia. In predicted probabilities from the multivariate models, 27.2% of infants born to pregnant women with moderate to severe anemia had anemia, compared to 23.3% for infants whose mothers had mild anemia, and 18.3% for infants whose mothers did not have anemia. This study provides strong evidence of a relationship between maternal and infant anemia in the United States among people with low incomes. Efforts to reduce anemia during pregnancy may be an important strategy for minimizing childhood anemia.

Introduction Preeclampsia increases a woman's long-term risk of vascular disease and/or death including chronic hypertension, myocardial infarction, heart failure, stroke, and venous thromboembolism. The literature suggests that maternity care providers may be unaware of this association. Methods A database search was conducted examining the long-term effects of hypertensive disorders of pregnancy using MEDLINE, Scopus, CINAHL, ISI Web of Knowledge, and the Cochrane Database of Systematic Reviews. Inclusion criteria were: 1) English language, 2) peer-reviewed journals, 3) January 2000 to July 2015, 4) systematic reviews with or without meta-analyses, and 5) studies that addressed the relationship between hypertensive disorders of pregnancy and vascular disease such as hypertension, cardiovascular disease (CVD), and cerebrovascular diseases. Results Three systematic reviews with meta-analysis qualified for this review. They represented 48 unique studies from 20 countries and included a total of 3,598,601 women. Preeclampsia was associated with a 3-fold increased risk for developing chronic hypertension. Compared with normotensive women, those with preeclampsia experienced double the risk, or more, for CVD or CVD-related mortality. Preeclampsia was also associated with approximately double the risk for fatal or nonfatal stroke. Discussion Preeclampsia is associated with an increased risk for future chronic hypertension, CVD, cerebrovascular disease, and death. While evidence shows that women with cardiac risk factors may have a higher chance of developing preeclampsia, many women with preeclampsia have no CVD risk factors. Measures to prevent preeclampsia such as calcium supplementation for women with low calcium intake and low-dose aspirin for women with a history of more than one incident of preeclampsia or a preterm birth associated with preeclampsia are supported by evidence. Reduction of modifiable risks associated with CVD before, during, and after pregnancy is recommended. All care providers and women should be educated regarding these risks and the importance of pregnancy history to future health.

The causes of chest pain range from benign sources such as muscle strain to life-threatening diagnoses such as aortic dissection and myocardial infarction. The likelihood and presentations of disorders causing chest pain are different between women and men. This article highlights important features in determining a correct diagnosis.

Background and purpose While male nurses have been shown to earn considerably more than female nurses, there is less evidence on gender disparities in salary among nurse practitioners (NPs). This study examines whether the gender gap in NP salaries persists after controlling for differences in work setting and demographic factors. Methods We analyzed the relationship between gender and salary (2011 pretax earnings) among 6591 NPs working as NPs at least 35 h per week, using the 2012 National Sample Survey of Nurse Practitioners. We first conducted bivariate regression analyses examining the relationship between gender and earnings, and then developed a multivariate model that controlled for individual differences in demographic and work characteristics. Conclusions Male NPs earned $12,859 more than female NPs, after adjusting for individual differences in demographics and work characteristics. The gender gap was $7405 for recent NP graduates, and grew over time. Male NPs earned significantly more than female NPs across all clinical specialty areas. Implications for practice The gender disparities in NP salaries documented here regardless of professional seniority or clinical area should spark healthcare organizations to conduct pay equity assessments of their employees’ salaries to identify and ameliorate pay inequality.

CONTEXT: Advance care planning (ACP) improves alignment between patient preferences for life-sustaining treatment and care received at end of life (EOL). OBJECTIVES: To evaluate implementation of lay navigator-led ACP. METHODS: A convergent, parallel mixed-methods design was employed to evaluate implementation of navigator-led ACP across 12 cancer centers. Data collection included: (1) electronic navigation records, (2) navigator surveys (n=45), (3) claims-based patient outcomes (n=820), and (4) semi-structured navigator interviews (n=26). Outcomes of interest included (1) the number of ACP conversations completed, (2) navigator self-efficacy, (3) patient resource utilization, hospice use, and chemotherapy at EOL, and (4) navigator-perceived barriers and facilitators to ACP. RESULTS: From 6/1/14–12/31/15, 50 navigators completed Respecting Choices® First Steps ACP Facilitator training. Navigators approached 18% (1319/8704) of patients; 481 completed; 472 in process; 366 declined. Navigators were more likely to approach African American patients than Caucasian patients (20% vs. 14%, p < 0.001). Significant increases in ACP self-efficacy were observed after training. The mean score for feeling prepared to conduct ACP conversations increased from 5.6/10 to 7.5/10 (p

To become competent clinicians, nurse practitioner students must learn to think critically and interact effectively while applying advanced knowledge to complex situations. The Community of Inquiry framework is a prominent model guiding the design and assessment of online learning. In this study, the interrelated components of a Community of Inquiry—teaching, social, and cognitive presences—are analyzed in the context of four online nurse practitioner learning activities that used different teaching strategies to promote critical reflection and dialogue: asynchronous discussion; synchronous presentations; collaborative projects; and VoiceThread. The results of this analysis can assist nurse practitioner educators in developing high-quality online learning experiences.

Nurse practitioners (NPs) have reported aspects of their jobs that they are more and less satisfied with. However, few studies have examined the factors that predict overall job satisfaction. This study uses a large national sample to examine the extent to which autonomy and work setting predict job satisfaction.The 2012 National Sample Survey of Nurse Practitioners (n = 8311) was used to examine bivariate and multivariate relationships between work setting and three autonomy variables (independent billing practices, having one's NP skills fully utilized, and relationship with physician), and job satisfaction.NPs working in primary care reported the highest levels of autonomy across all three autonomy measures, while those working in hospital surgical settings reported the lowest levels. Autonomy, specifically feeling one's NP skills were fully utilized, was the factor most predictive of satisfaction. In multivariate analyses, those who strongly agreed their skills were being fully utilized had satisfaction scores almost one point higher than those who strongly disagreed. Work setting was only marginally related to job satisfaction.In order to attract and retain NPs in the future, healthcare organizations should ensure that NPs' skills are being fully utilized.

Background: There is limited evidence on whether prior RN clinical experience is predictive of academic success in graduate nurse practitioner (NP) programs. The purpose of this study was to explore whether the frequently held assumption that more prior clinical experience is associated with better academic success in The George Washington University online NP programs. Method: Applications ( n = 106) for clinical NP students entering from 2008–2010 were examined along with data on academic performance. Results: No relationship was found between years of prior RN clinical experience and three educational outcome variables (cumulative grade point average [GPA], clinical course GPA, and having failed any courses or been put on probation). However, students with the most prior RN clinical experience were less likely to graduate in 4 years, compared with those with the least experience. Conclusion: These findings serve as a building block of empirical evidence for admissions committees as they consider entry requirements for NP programs. [ J Nurs Educ. 2015;54(5):276–280.]

Volatile organic compound emissions from painting operations are of primary concern in the automotive industry and require costly control measures using vapor-phase activated-carbon adsorption. At Ford Research Laboratory, Dearborn, Michigan, a process modifica tion has been proposed as a supplemental or an alternative control measure to convert an existing paint-sludge pit, part of a spray-booth scrubber system, to an activated-sludge reactor. Under this scheme, water-soluble paint solvents, captured by the scrubber water from the booth air in the spray booth, are to be biologically degraded in the sludge pit. For this paper, the technical feasibility of the conversion was evaluated by conducting a laboratory experiment using bench-scale activated-sludge reactor fed with nine selected paint solvents; analyzing the experimental data with Monod kinetics for substrate utilization and a first-order kinetics for endogenous respiration; and estimating the performance of the paint-sludge pit as a bioreactor at a typical assembly plant. Results showed that a paint-sludge pit is sufficiently large to biologi cally destroy all captured paint solvents at a typical paint-spraying rate if the pit is converted to a bioreactor; most of the oxygen-supply require ment for degrading paint solvents, which is a significant operating cost item for activated sludge, could be provided by the existing spray-booth air circulation at no extra cost; the rate of biomass production was estimated to be comparable to the rate of accumulation of overspray paint polymers; and the data agreed well with the Monod and first-order respiration kinetics. Water Environ. Res., 69, 1211 (1997). KEYWORDS: automotive, paints, volatile organic compounds, sol vents, aerobic treatment, sludge, scrubbers.

A land-farming project to remove diesel fuel from soil, which showed extremely variable total-petroleum-hydrocarbon (TPH) concentrations, is presented. Experiments showed that the variability was not an artifact of the TPH analytical method, but reflected the random distribution of contaminant in the soil. It was found that the data were well fit by a lognormal distribution. The implications of the sampling statistics on the remediation standard are discussed using the data, the lognormal distribution, and the remediation standard imposed on this particular remediation project.

To determine whether a disease-specific planning process can improve surrogate understanding of goals of patients with life-limiting illnesses for future medical treatments.A multisite randomized controlled trial conducted between January 1, 2004 and July 31, 2007.Six outpatient clinics of large community or university health systems in three Wisconsin cities.Competent, English-speaking adults aged 18 and older with chronic congestive heart failure or chronic renal disease and their surrogate decision-makers.Trained health professionals conducted a structured, patient-centered interview intended to promote informed decision-making and to result in the completion of a document clarifying the goals of the patient with regard to four disease-specific health outcome situations and the degree of decision-making latitude granted to the surrogate.Surrogate understanding of patient goals for care with regard to four expected, disease-specific outcomes situations and of the degree of surrogate latitude in decision-making.Three hundred thirteen patient-surrogate pairs completed the study. As measured according to kappa scores and in all four situations and in the degree of latitude, intervention group surrogates demonstrated a significantly higher degree of understanding of patient goals than control group surrogates. Intervention group kappa scores ranged from 0.61 to 0.78, whereas control group kappa scores ranged from 0.07 to 0.28.Surrogates in the intervention group had a significantly better understanding of patient goals and preferences than surrogates in the control group. This finding is the first step toward ensuring that patient goals for care are known and honored.

Hadamard transform spatial multiplexing techniques are applied to laser densitometry in order to prevent the photo-induced degradation of sensitive materials. Photochemical and thermal degradations can often occur in point focused scanning laser densitometry. In spatial multiplexing, the excitation source is defocused and efficiently distributed throughout the sample, reducing local power density. In this paper, we describe the application of Hadamard transform spatial multiplexing to transverse photothermal deflection spectroscopy (PDS). Proteins western blotted on nitrocellulose membrane are line imaged using the Hadamard transform PDS densitometer. For comparison, the blots are imaged with a high-dynamic-range video densitometer.

Recently, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) implemented new national core measures, including tobacco-cessation interventions for patients hospitalized because of pneumonia or other pulmonary-related illnesses, acute myocardial infarction, or heart failure. All interventions performed for such patients must be documented in the patient's chart. Because the JCAHO standards for tobacco cessation are implemented hospital-wide, acute and critical care nurses must take an active role in their execution. This article discusses the challenges to integrating tobacco cessation in daily acute and critical care nursing practice and makes recommendations regarding cessation approaches designed to improve health outcomes for tobacco-dependent patients.

TOPIC. Advance care planning (ACP) is a term intended to describe the dynamic process of discussing wishes for future medical care. PURPOSE. To demonstrate how a behavior change model can be used to enhance ACP. SOURCES. Authors' personal experience, workshops, literature review. CONCLUSIONS. Incorporating behavioral change theory helps develop workable interventions and provides strategies for nurses to approach patients appropriately about planning for future medical care.

Plastocyanin can be detected in Synechocystis sp. PCC 6803 when 3 microM copper is added to the growth medium, BG-11. The plastocyanin gene (petE) was cloned from a genomic lambda EMBL 3 library by screening with the petE gene from Anabaena sp. PCC 7937. The Synechocystis 6803 petE gene is present as a single copy and, as deduced from the DNA sequence, encodes a precursor protein of 126 amino acids. The predicted 29 amino acid transit peptide shows substantial homology to the Anabaena 7937 transit peptide, thought to direct the plastocyanin precursor to the thylakoid lumen. Putative promoter sites -16 and -38 base pairs from the start of the petE gene have been identified. The deduced amino acid sequence has the greatest homology (61%) to the green alga Scenedemus obliquus plastocyanin. Despite the lower homology, the copper binding residues and certain aromatic residues remain highly conserved. Northern hybridization analysis indicates that the Synechocystis sp. PCC 6803 petE gene is not transcriptionally regulated since the accumulation of petE mRNA appears to be independent of the copper concentration in the growth media. The possibility of an additional polypeptide needed to facilitate the electron transfer from plastocyanin to P700+ is also discussed.