Understanding vessel noise across a network of marine protected areas.

Protected areas are typically managed as a network of sites exposed to varying anthropogenic conditions. Managing these networks benefits from monitoring of conditions across sites to help prioritize coordinated efforts. Monitoring marine vessel activity and related underwater radiated noise impacts across a network of protected areas, like the U.S. National Marine Sanctuary system, helps managers ensure the quality of habitats used by a wide range of marine species. Here, we use underwater acoustic detections of vessels to quantify different characteristics of vessel noise at 25 locations within eight marine sanctuaries including the Hawaiian Archipelago and the U.S. east and west coasts. Vessel noise metrics, including temporal presence and sound levels, were paired with Automatic Identification System (AIS) vessel tracking data to derive a suite of robust vessel noise indicators for use across the network of marine protected areas. Network-wide comparisons revealed a spectrum of vessel noise conditions that closely matched AIS vessel traffic composition. Shifts in vessel noise were correlated with the decrease in vessel activity early in the COVID-19 pandemic, and vessel speed reduction management initiatives. Improving our understanding of vessel noise conditions in these protected areas can help direct opportunities for reducing vessel noise, such as establishing and maintaining noise-free periods, enhancing port efficiency, engaging with regional and international vessel quieting initiatives, and leveraging co-benefits of management actions for reducing ocean noise.

A Non-Classical Presentation of Erythema Migrans in a 51-Year-Old Woman With Early Manifestation of Lyme Neuroborreliosis (Bannwarth Syndrome).

The authors present a case of a 51-year-old female who presented to the emergency department with general malaise, headache, neck stiffness, and an expanding rash consistent with Lyme neuroborreliosis. In this case report, the clinical presentation, diagnosis, and management of Lyme neuroborreliosis and different presentations of erythema migrans are discussed.

Leadership Development Activities and Benefits From the Robert Wood Johnson Executive Nurse Fellows Program.

The Robert Wood Johnson Foundation Executive Nurse Fellows (RJWF-ENF) program was the gold standard for executive career development of nurse leaders from 1997 to 2017. With more than two decades of experience, ENF program leaders encouraged the fellows to "trust the process" during the difficult times of leadership development and value the collegial relationships they could develop with other nurse fellows. This article describes the benefits of the Action Learning Model for leadership development through the experience of the Boom-X-2K action learning team from the RWJF-ENF final cohort of 2014-2017. The moniker Boom-X-2K was chosen to emphasize supporting the intergenerational development of nurse leaders from three generations: Baby Boomers (Boom), Generation X (X), and Millennials (2K). This article also describes the action learning team's end product: a self-assessment tool designed to evaluate leaders' self-assessed ability to influence. [J Contin Educ Nurs. 2021;52(7):344-348.].

A concept analysis of influence for nurse leaders.

BACKGROUND: To shape priorities for health and health care outcomes, it is essential for nurse leaders to be influential. The application and impact of influence are readily recognized, but not its characteristics. PURPOSE: The purpose of this project was to conduct a concept analysis of influence relative to nurse leaders. METHODS: The Walker and Avant method of concept analysis was utilized. FINDINGS: Attributes of influence include advocacy, communications skills, competency, confidence, credibility, and engagement. Antecedents of influence are authority, collaboration, integrity, and mentorship. Consequences of influence are action, change, commitment, compliance, decision-making, motivation, and resistance. DISCUSSION: By drawing upon a systematic understanding of the concept of influence, nurse leaders are urged to develop and leverage the attributes of influence to drive and achieve collective good for the future of health and health care in society.

Serum Procalcitonin Level Is Associated with Positive Blood Cultures, In-hospital Mortality, and Septic Shock in Emergency Department Sepsis Patients.

This study examines the accuracy of initial and subsequent serum procalcitonin (PCT) levels in predicting positive blood cultures, in-hospital mortality, and development of septic shock in emergency department (ED) patients with severe sepsis. This study includes all patients who presented to our ED with an admission diagnosis of severe sepsis over a period of nine months. The median initial PCT was 0.58 ng/mL, interquartile range (IQR) 0.16-5.39. The median subsequent serum PCT was 2.1 ng/mL, with an IQR of 0.3-11.1. The PCT trend over the initial three hours increased in 67% of the study population. Blood cultures were positive in 38% of the cohort. The median maximum PCT in those with a negative blood culture was 1.06 ng/mL compared to 4.19 ng/mL in those with a positive blood culture (p=0.0116). Serum PCT levels >2.0 ng/mL display significant correlation with positive blood cultures, in-hospital mortality, and development of septic shock and as such may serve as a biomarker for more serious infections.

Gelatinous Abdomen: A Rare Case of Pseudomyxoma Peritonei Arising from Metastatic Gastric Adenocarcinoma.

Pseudomyxoma peritonei (PMP) is a rare condition that is typically associated with appendicular adenocarcinoma. Other origins are rarely reported. Here, we report a rare case of abdominal PMP, which originated as gastric adenocarcinoma. The prognosis of the patient consisted of pathological diagnosis, with samples from exploratory laparotomy, radiological visualization, abdominal computed tomography (CT), and abdominal magnetic resonance imaging (MRI). We employed the standard treatment protocol for our patient, which was essentially surgical, applying a cytoreductive technique, in an attempt to remove all visible evidence of the disease, plus intraperitoneal chemotherapy.

Nursing's Leadership Role in Advancing Professional Practice/Work Environments as Part of the Quadruple Aim.

Development of healthy professional practice/work environments (PPWEs) for nursing practice is critical to optimizing patient safety and workforce satisfaction while limiting turnover. Healthy PPWEs are linked with improved outcomes for patients, the workforce, and organizations. Nurses constitute the greatest professional segment of the US health care workforce and influence PPWEs, patient experience, health care quality, and cost per capita, all aspects of the quadruple aim. This article shares a model of leadership identified by executive nurse leaders to address and foster healthy PPWEs. A focus group of 16 expert nurse leaders convened an invitational meeting in Richmond, Virginia, to discuss nurse leaders' roles in optimizing the quadruple aim. The discussions led to shared perceptions about the prevalence of barriers to optimizing PPWEs; nursing leaders' responsibility to address the barriers to supporting improvement of the work-life of nursing professionals; and the need for early integration of leadership education, theory, and practice in every nurse's career.

Development of the Leadership Influence Self-Assessment (LISA©) instrument.

PURPOSE: This study aims to describe the development and psychometric evaluation of the Leadership Influence Self-Assessment (LISA©) tool. BACKGROUND: LISA© was designed to help nurse leaders assess and enhance their influence capacity by measuring influence traits and practices and identifying areas of strength and weakness. METHODS: Concepts identified in the Adams Influence Model and input from content experts guided the development of 145 items for testing. Administered to 165 nurse leaders, the assessment was subjected to exploratory factor analysis (EFA). FINDINGS: EFA yielded a four-factor solution that comprised 80 items. Cronbach's alpha for factors ranged between 0.912 and 0.938. All factor loadings were >0.4; the smallest factor contained 14 items. Items grouped together in the theoretical model also clustered together in the EFA. CONCLUSIONS: Preliminary psychometric testing supports validity and reliability of the LISA© and its potential use as a tool to assess influence capacity for purposes of leadership development and research.

Quantifying the effectiveness of shoreline armoring removal on coastal biota of Puget Sound.

Shoreline armoring is prevalent around the world with unprecedented human population growth and urbanization along coastal habitats. Armoring structures, such as riprap and bulkheads, that are built to prevent beach erosion and protect coastal infrastructure from storms and flooding can cause deterioration of habitats for migratory fish species, disrupt aquatic-terrestrial connectivity, and reduce overall coastal ecosystem health. Relative to armored shorelines, natural shorelines retain valuable habitats for macroinvertebrates and other coastal biota. One question is whether the impacts of armoring are reversible, allowing restoration via armoring removal and related actions of sediment nourishment and replanting of native riparian vegetation. Armoring removal is targeted as a viable option for restoring some habitat functions, but few assessments of coastal biota response exist. Here, we use opportunistic sampling of pre- and post-restoration data for five biotic measures (wrack % cover, saltmarsh % cover, number of logs, and macroinvertebrate abundance and richness) from a set of six restored sites in Puget Sound, WA, USA. This broad suite of ecosystem metrics responded strongly and positively to armor removal, and these results were evident after less than one year. Restoration responses remained positive and statistically significant across different shoreline elevations and temporal trajectories. This analysis shows that removing shoreline armoring is effective for restoration projects aimed at improving the health and productivity of coastal ecosystems, and these results may be widely applicable.

Is 30-Day Mortality after Admission for Heart Failure an Appropriate Metric for Quality?

BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) model for publicly reporting national 30-day-risk-adjusted mortality rates for patients admitted with heart failure fails to include clinical variables known to impact total mortality or take into consideration the culture of end-of-life care. We sought to determine if those variables were related to the 30-day mortality of heart failure patients at Geisinger Medical Center. METHODS: Electronic records were searched for patients with a diagnosis of heart failure who died from any cause during hospitalization or within 30 days of admission. RESULTS: There were 646 heart-failure-related admissions among 530 patients (1.2 admissions/patient). Sixty-seven of the 530 (13%) patients died: 35 (52%) died during their hospitalization and 32 (48%) died after discharge but within 30 days of admission; of these, 27 (40%) had been transferred in for higher-acuity care. Fifty-one (76%) died from heart failure, and 16 (24%) from other causes. Fifty-five (82%) patients were classified as American Heart Association Stage D, 58 (87%) as New York Heart Association Class IV, and 30 (45%) had right-ventricular systolic dysfunction. None of the 32 patients who died after discharge met recommendations for beta-blockers. Criteria for prescribing angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and mineralocorticoid receptor blockers were not met by 33 of the 34 patients (97%) with heart failure with reduced ejection fraction not on one of those drugs. Fifty-seven patients (85%) had a do-not-resuscitate (DNR) status. CONCLUSION: A majority of heart failure-related mortality was among patients who opted for a DNR status with end-stage heart failure, limiting the appropriateness of administering evidence-based therapies. No care gaps were identified that contributed to mortality at our institution. The CMS 30-day model fails to take important variables into consideration.

Enhanced Influence Through Advancing Scope of Practice Policy Research: An Interview With Alex Hoyt.

This department highlights emerging nursing leaders who have demonstrated leadership in advancing innovation and patient care in practice policy, research, education, and theory. This interview profiles Alex Hoyt, assistant professor at Massachusetts Institute for Health Professions.

mGlu7 potentiation rescues cognitive, social, and respiratory phenotypes in a mouse model of Rett syndrome.

Rett syndrome (RTT) is a neurodevelopmental disorder caused by mutations in the methyl-CpG binding protein 2 (MECP2) gene. The cognitive impairments seen in mouse models of RTT correlate with deficits in long-term potentiation (LTP) at Schaffer collateral (SC)-CA1 synapses in the hippocampus. Metabotropic glutamate receptor 7 (mGlu7) is the predominant mGlu receptor expressed presynaptically at SC-CA1 synapses in adult mice, and its activation on GABAergic interneurons is necessary for induction of LTP. We demonstrate that pathogenic mutations in MECP2 reduce mGlu7 protein expression in brain tissue from RTT patients and in MECP2-deficient mouse models. In rodents, this reduction impairs mGlu7-mediated control of synaptic transmission. We show that positive allosteric modulation of mGlu7 activity restores LTP and improves contextual fear learning, novel object recognition, and social memory. Furthermore, mGlu7 positive allosteric modulation decreases apneas in Mecp2+/- mice, suggesting that mGlu7 may be a potential therapeutic target for multiple aspects of the RTT phenotype.

Leader Influence, the Professional Practice Environment, and Nurse Engagement in Essential Nursing Practice.

OBJECTIVE: The purpose of this study was to examine relationships between leaders' perceived influence over professional practice environments (PPEs) and clinical nurses' reported engagement in essential professional nursing practice. BACKGROUND: There is little empirical evidence identifying impact of nurse leader influence or why nursing leaders are not perceived, nor do they perceive themselves, as influential in healthcare decision making. METHODS: A nonexperimental method of prediction was used to examine relationships between engagement in professional practice, measured by Essentials of Magnetism II (EOMII) tool, and nurse leaders' perceived influence, measured by Leadership Influence over Professional Practice Environment Scale (LIPPES). A convenience sample of 30 nurse leaders and 169 clinical nurses, employed in a 247-bed acute care Magnet® hospital, participated. RESULTS: Findings indicated that leaders perceived their influence presence from "often" to "always," with mean scores of 3.02 to 3.70 on a 4-point Likert scale, with the lowest subscale as "access to resources" for which a significant relationship was found with clinical nurses' reported presence of adequate staffing (P < .004). Clinical nurses reported more positive perceptions in adequacy of staffing on the EOMII when nurse leaders perceived themselves to be more influential, as measured by the LIPPES, in collegial administrative approach (P = .014), authority (P = .001), access to resources (P = .004), and leadership expectations of staff (P = .039). Relationships were seen in the outcome measure of the EOMII scale, nurse-assessed quality of patient care (NAQC), where nurse leaders' perception of their authority (P = .003) and access to resources (P = .022) positively impacted and was predictive of NAQC. CONCLUSIONS: Findings support assertion that nurse leaders are integral in enhancing PPEs and their influence links structures necessary for an environment that supports outcomes.

Carrying Skills From One C-Suite to Another: An Interview With Dr Maureen Swick.

This interview of Dr Maureen Swick chronicles career development and preparation for a transition into the role of CEO of the American Organization of Nurse Executives. While there are an estimated 400 000 nurses in middle management roles in the United States and 5700 in the most senior nursing positions in US hospitals, Dr Swick has assumed a role leading the leaders and highlights those experiences that have influenced her and provides insights into her vision for nursing leadership.

Influencing Scope of Practice Policy and Health Literacy: An Interview With Dr Joy Deupree.

This department highlights emerging nursing leaders who have demonstrated leadership in advancing innovation and patient care in practice policy, research, education, and theory. This interview profiles Joy Deupree, assistant professor, School of Nursing, The University of Alabama at Birmingham.