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Evaluation of DNP program essentials of doctoral nursing education: A scoping review
No full textBackground: In 2021, the American Association of Colleges of Nurses revised the core competencies for professional nursing education. The revision includes a call for a transformation from a traditional approach to a competency-based approach for teaching and learning. Purpose: The purpose of this systematic scoping review was to provide a fuller understanding of how DNP programs have historically evaluated and documented attainment of the essentials of doctoral nursing education in a summative manner in order to inform developing methods for addressing the newly endorsed advanced-level competencies in nursing education. Methods: A systematic scoping review was completed using PRISMA for Scoping Reviews Guidelines. Databases searched included PubMed (MEDLINE), CINAHL, Education Full Text, Web of Science, and ProQuest Dissertations and Theses. Included reports needed to discuss student competencies and reflect the summative evaluation of the DNP essentials in a DNP program. Data extracted included title, lead author name, lead author affiliation, type of program, aims, design, process, results, competencies included, and DNP project inclusion. Results: Of the 2729 reports initially identified, five met inclusion criteria. These articles described diverse methods for documenting student attainment of DNP competencies including leadership narratives, electronic portfolios, and clinical logs. Conclusion: DNP programs have used summative evaluation methods to document fulfillment of the DNP essentials, but a competency-based education approach requires additional formative evaluations that incrementally support learners' progression toward achieving competencies. Faculty can modify exemplars presented from a review of the literature to serve as summative or formative evaluations of DNP advanced-level nursing competencies
Characterization of Basal Endfeet Reveals Roles for Local Gene Regulation in Radial Glia and Cortical Development
No full textRadial glial cells (RGCs) are essential for the generation and organization of neurons in the cerebral cortex. RGCs have an elongated bipolar morphology with basal and apical endfeet that reside in distinct niches. Yet, how this subcellular compartmentalization of RGCs controls cortical development is largely unknown. Here, we employ in vivo proximity labeling, in the mouse, using unfused BirA to generate the first subcellular proteome of RGCs and uncover new principles governing local control of cortical development. We discover a cohort of proteins that are significantly enriched in RGC basal endfeet, with MYH9 and MYH10 among the most abundant. Myh9 and Myh10 transcripts also localize to endfeet with distinct temporal dynamics. Although they each encode isoforms of non-muscle myosin II heavy chain, Myh9 and Myh10 have drastically different requirements for RGC integrity. Myh9 loss from RGCs decreases branching complexity and causes endfoot protrusion through the basement membrane. In contrast, Myh10 controls endfoot adhesion, as mutants have unattached apical and basal endfeet. Finally, we show that Myh9- and Myh10-mediated regulation of RGC complexity and endfoot position non-cell autonomously controls interneuron number and organization in the marginal zone. The first part of this study demonstrates the utility of in vivo proximity labeling for dissecting local control of complex systems, and reveals new mechanisms for dictating RGC integrity and cortical architecture. In the second portion of this work, we have developed a method for purification of endfeet from the embryonic mouse brain and employed it to discover the first global transcriptome of RGC endfeet. Analysis at E15.5 revealed that the network of localized mRNAs is much more extensive than previously appreciated. There are over 3,000 transcripts localized to RGC endfeet and 870 of them are highly enriched in the endfeet compared to the cell body. These data uncovered hundreds of new genes in endfeet and also reinforced our previous findings that cytoskeletal regulators and ECM components are especially important in endfeet. Exploration of the newly discovered localized transcripts will provide valuable insights into additional RGC functions and allow us to assess potential signaling interactions between endfeet and surrounding cells. We also propose a method for subcellular gene knockdown in which we can modulate mRNA levels of a gene of interest in the cell body and endfeet independently in vivo. Through these studies we have discovered vital roles for subcellular gene regulation in RGCs and developed tools to facilitate future studies.
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Multicenter assessment of outcomes and complications associated with transforaminal versus anterior lumbar interbody fusion for fractional curve correction.
No full textObjectiveFew studies have compared fractional curve correction after long fusion between transforaminal lumbar interbody fusion (TLIF) and anterior lumbar interbody fusion (ALIF) for adult symptomatic thoracolumbar/lumbar scoliosis (ASLS). The objective of this study was to compare fractional correction, health-related quality of life (HRQL), and complications associated with L4-S1 TLIF versus those of ALIF as an operative treatment of ASLS.MethodsThe authors retrospectively analyzed a prospective multicenter adult spinal deformity database. Inclusion required a fractional curve ≥ 10°, a thoracolumbar/lumbar curve ≥ 30°, index TLIF or ALIF performed at L4-5 and/or L5-S1, and a minimum 2-year follow-up. TLIF and ALIF patients were propensity matched according to the number and type of interbody fusion at L4-S1.ResultsOf 135 potentially eligible consecutive patients, 106 (78.5%) achieved the minimum 2-year follow-up (mean ± SD age 60.6 ± 9.3 years, 85% women, 44.3% underwent TLIF, and 55.7% underwent ALIF). Index operations had mean ± SD 12.2 ± 3.6 posterior levels, 86.6% of patients underwent iliac fixation, 67.0% underwent TLIF/ALIF at L4-5, and 84.0% underwent TLIF/ALIF at L5-S1. Compared with TLIF patients, ALIF patients had greater cage height (10.9 ± 2.1 mm for TLIF patients vs 14.5 ± 3.0 mm for ALIF patients, p = 0.001) and lordosis (6.3° ± 1.6° for TLIF patients vs 17.0° ± 9.9° for ALIF patients, p = 0.001) and longer operative duration (6.7 ± 1.5 hours for TLIF patients vs 8.9 ± 2.5 hours for ALIF patients, p ConclusionsOperative treatment of ASLS with L4-S1 TLIF versus ALIF demonstrated comparable mean fractional curve correction (66.7% vs 64.8%), despite use of significantly larger, more lordotic ALIF cages. TLIF cage height had a significant impact on leveling L4 coronal tilt, whereas ALIF cage lordosis had a significant impact on restoration of lumbosacral lordosis. The advantages of TLIF may include reduced operative duration and hospitalization; however, associated HRQL was inferior and more rod fractures were detected in the TLIF patients included in this study
Stress, the Superwoman Schema, and Cardiovascular Wellbeing Among Rural and Medically Underserved African American Women
No full textCardiovascular disease in the leading cause of death among African American women. CVD risk factors that contribute to poorer health are higher among rural and medically underserved communities; highlighting racial and geographic disparities exist. The ideal cardiovascular health (ICH) tool was developed by the American Heart Association (AHA) to serve as a measure of cardiovascular wellbeing and address the need for prevention and treatment of CVD. Meeting the ideal standard for these metrics is associated with lower CVD risk and overall improved cardiovascular wellbeing. Yet to date, there is a dearth of literature evaluating ICH scores among rural and medically underserved African American women.Further, social conditions such as neighborhood cohesion and safety can lead to chronic exposure to stress and have been associated with increased risk for CVD and earlier onset of disease. The Superwoman Schema is a multidimensional framework that provide further understanding on how African American women process stress, which may serve to enlighten the mechanisms in which chronic stress becomes biologically embedded among this population.This dissertation explored factors related to cardiovascular wellbeing among rural and medically underserved African American women for the purpose of better understanding and thus informing efforts to reduce cardiovascular health disparities among this population. In chapter 2, we completed a scoping review of psychometric scales evaluating the strong black woman/superwoman construct in relation to stress-related health disparities. In chapter 3, a pilot study was conducted to assess the feasibility of using the MyChart patient portal to collect electronic health data and recruit rural African American women to collect self-report data on social neighborhood conditions and the Superwoman Schema. Finding from this study revealed strengths and limitations of EHR recruitment and qualitative interviews reported the experience of African American women in using MyChart. Qualitative findings from Chapter 4 revealed emerging factors that are embedded within the Superwoman Schema that help to better understand the stress and coping experience of rural and medically underserved African American women. Chapter 5 summarizes the results across all three chapters and provides implications for future research and practice.</p
The bulbocavernosus reflex (BCR) has no prognostic features during the acute evaluation of spinal cord injuries.
No full textThe bulbocavernosus reflex (BCR) has been used during the initial evaluation of a spinal cord injury patient as a metric to determine prognosis and whether the patient is in "spinal shock". This reflex has been less utilized over the last decade and therefore, a review was performed to assess the value of BCR in patient prognosis. The North American Clinical Trials Network (NACTN) for Spinal Cord Injury is a consortium of tertiary medical centers that includes a prospective SCI registry. The NACTN registry data was analyzed to evaluate the prognostic implication of the BCR during the initial evaluation of a spinal cord injury patient. SCI patients were divided into those with an intact or absent BCR during their initial evaluation. Associations of participants' descriptors and neurological status on follow up were performed followed by associations with the presence of a BCR. 769 registry patients with recorded BCRs were included in the study. The median age was 49 years (32-61 years), majority were male (n=566, 77%), and white (n=519, 73%). Among included patients, high blood pressure was the most common comorbidity (n=230, 31%). Cervical spinal cord injury was the most common (n=470, 76%) with fall (n=320, 43%) being the most frequent mechanism of injury. BCR was present in 311 patients (40.4%), while 458 (59.6%) had a negative BCR within 7 days of injury or before surgery. At 6 months post-injury, 230 patients (29.9%) followed up, of which, 145 had a positive BCR while 85 had a negative BCR, respectively. The presence/absence of BCR was significantly different in patients with cervical (p=0.0015) or thoracic SCI (p=0.0089), or conus medullaris syndrome (p=0.0035), and in those who were AIS grade A (p=0.0313). No significant relationship was observed between BCR results and demographics, AIS grade conversion, motor score changes (p=0.1669), and changes in pin prick (p=0.3795) and light touch scores (p=0.8178). In addition, cohorts were not different in surgery decision (p=0.7762) and injury to surgery time (p=0.0681). In our review of the NACTN spinal cord registry, the BCR did not provide prognostic utility in the acute evaluation of spinal cord injury patients. Therefore, it should not be used as a reliable marker for predicting neurological outcomes post-injury
Validation of Attaining a Higher Threshold Using Double-Pass MWPM Decoding of CSS Codes Using X/Z Correlations
No full textIn this report we validate that Minimum Weight Perfect Matching (MWPM) decoding ofa surface code helps attain a higher code threshold than standard decoding by taking into
account the correlations of errors that occur on the lattice. Correlated decoding cannot be
directly performed using MWPM due to the presence of hyperedges in the graph.
Decomposing correlated errors into simultaneous X and Z excitations, along with considering an asymmetric code for optimal performance of this scheme, yields a codecapacity threshold of 15% for standard depolarizing error by updating the weights of one decoding graph based on the corrections of another.</p
Probability of severe frailty development among operative and nonoperative adult spinal deformity patients: an actuarial survivorship analysis over a 3-year period.
No full textBackgroundLittle is known of how frailty, a dynamic measure of physiological age, progresses relative to age or disability status. Operative treatment of adult spinal deformity (ASD) may play a role in frailty remediation and maintenance.PurposeCompare frailty status, severe frailty development, and factors influencing severe frailty development among ASD patients undergoing operative or nonoperative treatment.DesignRetrospective review with maximum follow-up of 3 years.SettingProspective, multicenter, ASD database.ParticipantsPatients were consecutively enrolled from 13 participating centers.Inclusion criteria≥18 years undergoing either operative or nonoperative treatment for ASD, exclusion criteria: spinal deformity of neuromuscular etiology, presence of active infection, or malignancy. The mean age of the participants analyzed were 54.9 for the operative cohort and 55.0 for the nonoperative cohort.Outcomes measuresFrailty status, severe frailty development, and factors influencing severe frailty development.MethodsASD patients (coronal scoliosis ≥20°, sagittal vertical axis (SVA) ≥5 cm, Pelvic Tilt (PT) ≥25°, or thoracic kyphosis ≥60°) >18 y/o, with Base Line (BL) frailty scores were included. Frailty was scored from 0 to 1 (not frail: 0.5) through the use of ASD-frailty index (FI) which has been validated using the International Spine Study Group (ISSG) ASD database, European Spine Study Group ASD database, and the Scoli-RISK-1 Patient Database. The ISSG is funded through research grants from DePuy Synthes and individual donations and supported the current work. Operative (Op) and Nonoperative (Non-Op) patients were propensity matched. T-tests compared frailty among treatment groups and BL, 1, 2, and ≥3 years. An actuarial Kaplan-Meier survivorship analysis with log-rank (Mantel-Cox) test, adjusting for patients lost to follow-up, determined probability of severe frailty development. Multivariate Cox Regressions gauged the effect of sagittal malalignment, patient and surgical details on severe frailty development.ResultsThe analysis includes 472 patients (236 Op, 236 Non-Op) selected by propensity score matching from a cohort of 1,172. Demographics and comorbidities were similar between groups (p>.05). Op exhibited decreased frailty at all follow-up intervals compared with BL (BL: 0.22 vs Y1: 0.18; Y2: 0.16; Y3: 0.15, all p1.0 and p value1.0 and p value ConclusionsNon-Op patients were more likely to develop severe frailty, and at a quicker rate. Baseline depression, increased NRS back pain scores, nonoperative treatment, and postoperative sagittal malalignment at 6-week follow-up significantly predicted severe frailty development. Operative intervention and postoperative sagittal balance appear to play significant roles in frailty remediation and maintenance in ASD patients. Frailty is one factor, in a multifactorial conservation, that may be considered when determining operative or nonoperative values for ASD patients. Operating before the onset of severe frailty, may result in a lower complication risk and better long-term clinical outcomes
LIDAR-based Analysis of Mangrove Forest Structure and Carbon Stocks of The Republic of Palau.
No full textThis study assesses mangrove structure and carbon stocks of the Republic of Palau, located in the Western Pacific Ocean, using existing in-situ data, aerial lidar, and RGB imagery. Palau is unique in that its coastal fringing mangrove forests have been expanding relatively uninterrupted since the end of the close of World War II. Palau faces new fiscal and development pressures while concurrently maintaining their role as a pioneer of new conservation models and a good steward of its environment. Palau’s mangroves generally don’t qualify for avoided conversion, afforestation, REDD+, or improved forest management carbon offsets as they are largely protected, healthy, and are not used as an extractive forest products resource base. However, as the nation’s mangroves have expanded, pressure has grown to reconsider mangrove clearing restrictions for fishing docks, resort shoreline access, and reclamation. There is not currently a robust and efficient means to annually assess mangrove expansion and spatially relate carbon density remotely, limiting an affordable means to conduct valuations of proposed development areas and associated cost-benefit analysis. This study evaluates existing in-situ data from a 2011 US Forest Service mangrove carbon stock analysis and explores techniques to assess carbon stocks remotely using scant field data. The primary in-situ data consists of biomass and carbon stocks data derived from fixed-radius plots of live mangrove trees, dead downed woody debris, and soil samples from the state of Airai, Palau. The existing in-situ data is evaluated against the nation’s first complete aerial LIDAR (Laser Imaging Detection and Ranging) point cloud and RGB imagery dataset which was acquired in 2021 by the Palau Automated Land and Resource Information System (PALARIS) office. This project aims to support national assessments of payments for ecosystem services, natural capital accounting, and carbon protocol monitoring
Three-phase Model of Visco-elastic Incompressible Fluid Flow and its Computational Implementation.
No full textEnergetic Variational Approach is used to derive a novel thermodynamically consistent three-phase model of a mixture of Newtonian and visco-elastic fluids. The model which automatically satisfies the energy dissipation law and is Galilean invariant, consists of coupled Navier-Stokes and Cahn-Hilliard equations. Modified General Navier Boundary Condition with fluid elasticity taken into account is also introduced for using the model to study moving contact line problems. Energy stable numerical scheme is developed to solve system of model equations efficiently. Convergence of the numerical scheme is verified by simulating a droplet sliding on an inclined plane under gravity. The model can be applied for studying various biological or biophysical problems. Predictive abilities of the model are demonstrated by simulating deformation of venous blood clots with different visco-elastic properties and experimentally observed internal structures under different biologically relevant shear blood flow conditions
The teleost anatomy ontology: anatomical representation for the genomics age.
No full textThe rich knowledge of morphological variation among organisms reported in the systematic literature has remained in free-text format, impractical for use in large-scale synthetic phylogenetic work. This noncomputable format has also precluded linkage to the large knowledgebase of genomic, genetic, developmental, and phenotype data in model organism databases. We have undertaken an effort to prototype a curated, ontology-based evolutionary morphology database that maps to these genetic databases (http://kb.phenoscape.org) to facilitate investigation into the mechanistic basis and evolution of phenotypic diversity. Among the first requirements in establishing this database was the development of a multispecies anatomy ontology with the goal of capturing anatomical data in a systematic and computable manner. An ontology is a formal representation of a set of concepts with defined relationships between those concepts. Multispecies anatomy ontologies in particular are an efficient way to represent the diversity of morphological structures in a clade of organisms, but they present challenges in their development relative to single-species anatomy ontologies. Here, we describe the Teleost Anatomy Ontology (TAO), a multispecies anatomy ontology for teleost fishes derived from the Zebrafish Anatomical Ontology (ZFA) for the purpose of annotating varying morphological features across species. To facilitate interoperability with other anatomy ontologies, TAO uses the Common Anatomy Reference Ontology as a template for its upper level nodes, and TAO and ZFA are synchronized, with zebrafish terms specified as subtypes of teleost terms. We found that the details of ontology architecture have ramifications for querying, and we present general challenges in developing a multispecies anatomy ontology, including refinement of definitions, taxon-specific relationships among terms, and representation of taxonomically variable developmental pathways