DNP-PhD Collaboration in NINR-Funded Physical Activity Trials: A Series of Case Studies.

Collaboration between Doctor of Nursing Practice (DNP) scholars and Doctor of Philosophy (PhD) scholars is crucial to efficiently advance and disseminate nursing science. Also, DNP-PhD collaboration can help achieve priorities outlined in the recent National Institute of Nursing Research (NINR) Strategic Plan. The purpose of this series of case studies is to describe exemplars of ongoing DNP-PhD collaborations across three NINR-funded trials (1 completed, 2 ongoing) testing physical activity interventions for women at risk for cardiovascular disease. In our three physical activity intervention trials for women, we categorized examples of DNP-PhD collaboration by the four phases of the team-based research model (development, conceptualization, implementation, and translation). Across all three trials, DNP and PhD scholars contributed successfully to all phases of research in an iterative manner. Future work should focus on expanding DNP-PhD collaboration in behavioral trials, which can inform adapted, contemporary models of iterative DNP-PhD collaboration.

Supporting and Establishing Gender and Sexuality Alliances in Chicago Public Schools.

School nurses are uniquely positioned to support lesbian, gay, bisexual, transgender, and questioning/queer (LGBTQ) students. One approach is involvement in Gender and Sexuality Alliances (GSAs). GSAs have been found to improve outcomes for LGBTQ students. The purposes of this quality improvement project were to build infrastructure for GSAs by implementing a GSA Support Plan including a digital resource binder, GSA advisor trainings, and establishment of an Advisor Leadership Committee and increase the number of schools with a GSA. The binder was distributed electronically to 95 advisors. Forty-nine participants attending virtual trainings. A statistically significant increase in all measures of participant confidence occurred between the pre- and post-training surveys. The Advisor Leadership Committee was established. This paper adds to the literature by showing that support for GSAs is important to aiding LGBTQ students. Further, authors suggest ways in which school nurses can harness their expertise to be involved with GSAs.

Achieving Health Equity for LGBTQ+ Adolescents.

The lesbian, gay, bisexual, transgender, and queer (LGBTQ+) adolescent population experiences health disparities due to barriers to care, including lack of access to culturally competent health care providers. The purpose of this quality improvement project was to increase access to culturally competent care through continuing education, a physical makeover of clinic space, and a social marketing campaign. The impact of the project on the number of LGBTQ+ adolescent patients at the clinic and the rate of documentation of sexual orientation and gender identity data was evaluated via a chart audit. Changes in nurses' and health care providers' knowledge as a result of the continuing education were evaluated with a pretest and a posttest. The number of LGBTQ+ patients and provider knowledge increased following the continuing education. Sexual orientation and gender identity data were documented during 87.5% of visits. The participants' knowledge increased by 4.7% following the continuing education. Further, five physical changes to the clinic were completed and a social marketing campaign was launched. This quality improvement project demonstrates that continuing education can be an effective way to increase cultural competence for the care of LGBTQ+ individuals. [J Contin Educ Nurs. 2022;53(8):348-354.].

An Integrative Review of College Readiness Programs for Black High School Students; Opportunities for School Nurse Involvement.

Education is associated with improved health outcomes. However, fewer non-Hispanic Black Americans earn high school diplomas, baccalaureate, or advanced degrees than White Americans, placing them at higher risk for poor health outcomes. Racial disparities in education have been linked to social injustice and structural racism. Through the Framework for the 21st Century School Nursing PracticeTM, school nurses can impact academic success and college readiness for Black youth. An integrative review of the literature was conducted to describe programs to promote college readiness for Black high school students and evaluate school nurse involvement. Findings of the eighteen unique studies included in this review were: programs included mostly female participants, and most yielded improvements in students' non-cognitive skills (i.e. sense of belonging/confidence) and college knowledge. None of the programs included school nurse involvement. School nurses can advocate for anti-racist college readiness programs with intentional, asset-based approaches to position youth for success in college.

Development of a School Health Policy Implementation Survey: A Delphi Study.

Data on school health policy implementation are limited due to the absence of a validated measurement tool. The purpose of this study was to create and pilot a school health policy implementation survey. A modified, four-round Delphi process was used to achieve consensus on content and format of the survey. The final 76-item survey was piloted in 655 schools with a return rate of 57.1% (n = 378). Seven schools participated in environmental audits. Based on the audits, survey responses represented an accurate description of school practices for 84.2% (n = 64) of questions. The remaining 15.8% (n = 12) of survey items were eliminated or revised. This measurement tool begins to fill the research gap between the evaluation of written school health policy and implementation. Further, this tool may be used by school nurses in alignment with the Framework for 21st Century School Nursing Practice.

Teen pregnancy in Chicago: Who is at risk?

BACKGROUND: Teenage pregnancy, with its associated health and social consequences for young people and society as a whole, is one of the nation's most important public health issues. The purpose of this study was to use Youth Risk Behavior Survey (YRBS) data describe self-reported, pregnancy experiences in 9-12th grade Chicago Public Schools (CPS) students and identify teens at highest risk based on gender, grade-level, race, ethnicity, and sexual orientation. METHODS: Secondary data analysis of the 2017 CPS high school Youth Risk Behavior Survey was conducted. RESULTS: The survey response rate was 73% (n = 1,883). 4.9% (n = 91) of CPS students in grades 9 - 12 reported a pregnancy experience, and 1.9% (n = 34) reported being "unsure" of a pregnancy experience. Statistically significant differences in the likelihood of self-reporting a pregnancy experience were found based on grade level (p = .000), race (p = .023), and sexual orientation (p = .000). CONCLUSION: While risk for a teen pregnancy experience varies across all groups, public health nurses can use YRBS data to better understand pregnancy risk in the populations they serve and can leverage core competencies, and robust community relationships to adapt, implement and evaluate evidence-based teen pregnancy prevention programs for maximum impact on teens at greatest risk.

DNP and PhD scholarship: Making the case for collaboration.

BACKGROUND: The Institute of Medicine calls for meaningful collaboration between doctor of nursing practice (DNP)- and doctor of philosophy (PhD)-prepared nurses to improve health outcomes. PURPOSE: The purpose of this paper is to answer the questions: 1) how do Colleges of Nursing influence DNP and PhD collaboration for faculty and students? 2) how does DNP and PhD collaboration in an academic setting impact health care practices and patient outcomes? METHODS: Two examples of DNP and PhD collaboration (one faculty and one student) are presented. RESULTS: Shared faculty responsibilities and a supportive organizational culture influenced collaboration between faculty and students. Research and practice roles can complement and strengthen each other while improving health outcomes. CONCLUSION: Colleges of Nursing should build processes and culture that encourage faculty and students to collaborate across doctoral programs. Successful intraprofessional collaboration has the potential to positively impact healthcare quality, and outcomes, while advancing the nursing profession.

An academic practice partnership: Building capacity to meet sexual health education policy requirements of a public school system.

The purpose of this clinical concepts paper is to describe the development, implementation, and evaluation of a formal academic-practice partnership between a large, urban, public school system and a college of nursing, based on the American Association of Colleges of Nursing's Guiding Principles to Academic-Practice Partnerships. The overarching goal of the partnership was to increase the school district's capacity to meet sexual health education policy requirements while providing graduate nursing students with an opportunity to work with a diverse population of youth during a public health nursing practicum course. As a result of the partnership, over 2,000 public school students (grades 5-12) have received comprehensive sexual health education and increased their knowledge by an average of 19.7-32.7%. In addition, 79 prelicensure, graduate nursing students have been placed at the public school system for public health nursing practicum and 100% have met all clinical objectives. As with any partnership, successes and lessons learned were identified. Discussion of both is included in this paper and may benefit other organizations considering entering into similar partnerships. Ultimately, academic-practice partnerships are an important mechanism to simultaneously meet the growing needs of community practice partners and nursing education programs, while strengthening public health nursing practice.

Six to success: improving primary care management of pediatric overweight and obesity.

INTRODUCTION: Despite the existence of established guidelines addressing pediatric obesity, many primary care providers fail to successfully implement recommendations. This study measured the impact of Six to Success, a weight management program based on the Chronic Care Model, on primary care provider adherence to pediatric weight management guidelines. METHOD: We used comprehensive pre- and postimplementation chart audits (N = 396) to conduct a quality improvement study at a hospital-based pediatric outpatient clinic. Charts of patients with a body mass index percentile at or above the 85th percentile (preimplementation, n = 90; postimplementation, n = 97) were audited for 23 identification, assessment, and prevention measures recommended in the care of the pediatric overweight/obese patient. RESULTS: Statistically significant improvements to clinical guideline adherence were found in the following areas: correct diagnosis, physical examination, lifestyle assessment, use of motivational interviewing, and prevention strategies. DISCUSSION: These findings suggest that Six to Success can be an effective method of improving primary care provider adherence to established pediatric weight management guidelines.

Postinterventional pain and complications of sonographically guided interventions in the liver and pancreas.

PURPOSE: Sonographically guided interventions in abdominal organs are routine procedures with rare severe complications. However, potential patient discomfort or pain is frequently not addressed in the literature. MATERIALS AND METHODS: In a prospective 1-year study, the peri- and postinterventional pain of patients undergoing sonographically guided punctures of the liver and pancreas was analyzed. Data acquisition was done with a standardized questionnaire. This included three numeric rating scales (NRS) ranging from "0" to "10" to be answered at puncture and 1 hour and 4 hours later. Data concerning complications and administered analgesic medication was acquired from the patients' charts. RESULTS: 223/274 patients could be analyzed (83 %). 91 women (40.8 %) and 132 men (59.2 %) were included. The mean age was 56.0 yrs. Overall the average level of pain was 2.98  at puncture, 1.21 after 1 hour and 0.71 after 4 hours. In patients with diagnostic biopsies, the pain levels were 3.37(0  h)/1.33(1  h)/0.71(4  h) for liver parenchyma, 2.64(0  h)/0.95(1  h)/0.65(4  h) for focal liver lesions and 3.1(0  h)/1.9(1  h)/1.1(4  h) for pancreatic punctures. The pain levels at therapeutic interventions were 3.00(0  h)/2.00(1  h)/0.50(4  h). Female and younger (< 50 yrs) patients had statistically significantly more pain at puncture and 1 hour postintervention. Only minor complications occurred (0.9 %). CONCLUSION: Severe pain after sonographically guided interventions is rare. Most patients suffer only from mild pain postinterventionally.

Sweeping of alprenolol enantiomers with an organic solvent and sulfated ß-cyclodextrin in capillary electrophoresis.

Sweeping, an on-line sample concentration technique in CE, is the picking and accumulation of analytes by the pseudostationary phase or complexing additive. In the presence of an electric field, the analytes concentrated at the additive front that initially penetrated the sample zone. Here, we describe the sweeping of cationic alprenolol enantiomers using sulfated ß-CD and organic solvent. The separation solution contained the anionic additive while ACN was in the sample solution. With fused silica capillaries, positive polarity, and solutions buffered at pH 3, the direction of the enantiomers' effective electrophoretic mobility was the same as the electrophoretic mobility (or electrophoretic mobility without additive). When the amount of ACN in the sample was increased (i.e. 60%), the interaction between the analytes and additive became negligible. This caused the sweeping boundary to shift from the electrophoretically moving ß-CD front to the zone between the sample and separation solution. The equation that described the narrowing of injected sample zone was derived. The performance of sweeping with 60% ACN in the sample was then studied under different operating conditions (e.g. type of injection, injection time, and CD concentration). The low interaction between enantiomers and additive gave only moderate increases in sensitivity (approximately tenfold), but was improved when field enhancement was used during electrokinetic injection. With a conductivity difference (separation/sample solution) of 70 and a short injection time of 30 s at 20 kV, peak improvements of >100-fold was easily achieved.

Recent advances in enhancing the sensitivity of electrophoresis and electrochromatography in capillaries and microchips (2010-2012).

CE has been alive for over two decades now, yet its sensitivity is still regarded as being inferior to that of more traditional methods of separation such as HPLC. As such, it is unsurprising that overcoming this issue still generates much scientific interest. This review continues to update this series of reviews, first published in Electrophoresis in 2007, with updates published in 2009 and 2011 and covers material published through to June 2012. It includes developments in the field of stacking, covering all methods from field amplified sample stacking and large volume sample stacking, through to isotachophoresis, dynamic pH junction and sweeping. Attention is also given to online or inline extraction methods that have been used for electrophoresis.

Synergistic effect of field enhanced sample injection on micelle to solvent stacking in capillary electrophoresis.

Injection of a sodium dodecyl sulfate micellar plug prior to the sample solution induced transient micellar phase extraction of cationic drugs in capillary electrophoresis. Micelle to solvent stacking mechanism was utilized by preparing the sample in aqueous organic solvent. Synergism was achieved with field enhanced sample injection that allowed larger sample loads. Micelle to solvent stacking occurred concurrently with the enhanced injection after the fast moving analytes electrophoretically migrated into the micellar plug. This was different from stacking combinations with field enhancement where the electric field strength difference was involved in analyte focusing. Using a sample diluent that had one-tenth the conductivity of the background solution, the strategy afforded thousands-fold improvements in peak height and LODs (S/N=3) of as low as 1.1 ng/mL. The results were repeatable and linear. Adaptability to real sample analysis was evaluated using spiked urine sample after minimal sample clean-up.

Mesenteric transit time using contrast-enhanced ultrasound (CEUS) does not correlate with disease activity in Crohn's disease.

PURPOSE: Evaluation of mesenteric transit time (MTT) - measured by contrast-enhanced ultrasound - as a marker for inflammatory activity in Crohn's disease. MATERIALS AND METHODS: The time of maximum enhancement of the contrast agent in the superior mesenteric artery and vein was determined visually and by software analysis. The MTT was calculated as the difference between these two time points. Findings were correlated with the Harvey-Bradshaw Index (HBI) using the Pearson correlation coefficient (r). In addition, a healthy control group was evaluated both in the fasting state and 1, 2, 3 and 4 hours postprandially. RESULTS: In 20 healthy controls the mean visual MTT during fasting was 9.76 ± 2.83 sec and decreased to a minimum 1 hour after the meal (6.6 ± 2.27 sec). 45 patients with Crohn's disease (9 males, 36 females, mean age 35 years) had a mean HBI of 5.9 ± 4.7 points. The mean software-based MTT of 9.76 ± 3.7 sec was significantly higher (p = 0.034) than the mean visual MTT of 8.22 ± 3.05 sec. The two figures correlated well (r = 0.72, p < 0.001). The HBI correlated neither with the visual (r = 0.14, p = 0.371) nor with the software-based (r = 0.16, p = 0.293) MTT. CONCLUSION: The MTT decreases in the first two hours after eating. The visually assessed and the software-based MTT correlate well, however MTT does not correlate with disease activity in patients with Crohn's disease.

Capillary electrophoresis of natural products: highlights of the last five years (2006-2010).

An extensive search of the published research and review articles indicated a growing number of works that employed electroseparation techniques. Capillary zone electrophoresis (CZE) and electrokinetic chromatography (EKC), in particular, were found to be popular for the analyses of natural products. This review outlines the important developments in this field over the years, especially during the 2006-2010 period. An overview of the natural product applications such as pharmaceuticals/herbal products, fingerprinting and quality control, food and food contaminants, and toxicological compounds of interest to forensics were presented. Important areas of detection strategies, microchips, sample preconcentration, and chiral separations were also discussed. Hence, quick information was provided on the researches already undertaken and the possibilities of unexplored areas. In addition, fundamental concepts for the understanding of CZE and EKC and their suitability for natural products analyses were briefly discussed.

An abdominal and thyroid status with Acoustic Radiation Force Impulse Elastometry--a feasibility study: Acoustic Radiation Force Impulse Elastometry of human organs.

PURPOSE: Acoustic Radiation Force Impulse (ARFI) is a new method for the quantification of tissue elasticity. To date, ARFI technology has not been applied systematically to establish an abdominal and thyroid status. The aim of this prospective feasibility study was to evaluate ARFI elastometry performed on various healthy abdominal organs and the thyroid gland. MATERIAL AND METHODS: 94 patients (43 females, 51 males) with a mean age of 54 years and 20 healthy controls were enrolled in the study. A routine ultrasound examination of the abdomen was scheduled in 72, and of the thyroid in 25. ARFI elastometry was performed in liver, spleen, pancreas, prostate, kidneys and thyroid gland with the ultrasound system Acuson S2000. ARFI values are proportional to tissue elasticity. Patients with ultrasonic or anamnestic evidence of diseased organs were excluded from the analysis. ARFI measurements were compared with the aid of the t-test and correlated using Spearman's correlation coefficient. RESULTS: ARFI elastometry proved feasible and the measurements obtained in the various organs differed significantly. Among healthy organs the spleen showed the highest mean ARFI velocities, followed by the kidney, thyroid, pancreas and the prostate. The lowest ARFI values were regularly found in healthy liver. Measurements in the kidneys and the spleen showed high standard deviation. CONCLUSIONS: ARFI elastometry may describe parenchymal stiffness of various abdominal organs and the thyroid gland. Further investigations are needed to compare these baseline findings in healthy organs with those of various tumours or diseases affecting the individual organs.

Characterization of focal liver lesions (FLL) with acoustic radiation force impulse (ARFI) elastometry.

PURPOSE: The technology of acoustic radiation force impulse (ARFI) represents an innovative method for the quantification of tissue elasticity. The aim of this prospective pilot study was to evaluate the role of ARFI elastometry of focal liver lesions (FLL) and the surrounding liver parenchyma. MATERIALS AND METHODS: All patients with unclear FLL in B-mode ultrasound were assigned to ARFI elastometry (m/sec). Measurement sites were located within the FLL, in the peritumoral tissue and in hepatic segment VIII (intercostal approach). Histology and CEUS served as the reference for the characterization of the lesions. RESULTS: A total of 81 patients were enrolled, of whom 62 patients (39 females, 23 males; mean age 54 years) had FLL measurable by means of ARFI. The lesions were: 38 benign (61 %) and 24 malignant FLL (39 %). The ARFI elastometric values of the FLL differed significantly from those of the liver parenchyma (p < 0.001). Elastometry of benign lesions and of malignant tumors showed statistically comparable results (p = 0.28). The lowest ARFI values were observed in focal fatty sparing and the highest in CCC. Only focal fatty sparing and HCC showed negative differences between FLL and peritumoral tissue or liver parenchyma. In 23 % of the hepatic lesions, no reliable quantitative ARFI results were obtainable due to false, inconsistent or technically failed measurements. CONCLUSION: FLL vary in ARFI elastometry. However, high ARFI values occur in benign as well as in malignant lesions and do not permit differentiation between them.

Measurement of liver elasticity with acoustic radiation force impulse (ARFI) technology: an alternative noninvasive method for staging liver fibrosis in viral hepatitis.

PURPOSE: The acoustic radiation force impulse (ARFI) technology is a novel ultrasound method that provides information about the local elasticity of tissue in real-time. ARFI is integrated in a conventional ultrasound system. The aim of this exploratory study was to evaluate this new technique in the assessment of liver fibrosis in a cohort with chronic viral hepatitis B and C and to ascertain the most reliable hepatic segment for measurements. MATERIALS AND METHODS: 57 patients (27 female, 30 male, mean age 54 years) with chronic viral hepatitis B and C underwent ARFI imaging and consecutively liver biopsy. The results were compared to the histological fibrosis degree (F), which served as the reference. 20 healthy volunteers received ARFI quantification of different segments of the liver. RESULTS: The best ARFI assessments with the lowest rate of invalid measurements were carried out by an intercostal approach to segment VII/VIII of the liver. The ARFI velocities of the healthy group had a mean of 1.09 m/s (range 0.79 - 1.32 m/s), the means of the patient group ranged from 0.83 to 4.19 m/s. ARFI quantification correlated significantly with the histological fibrosis stage (p < 0.001). The area under the receiver operating characteristic (ROC) curves for the accuracy of ARFI imaging was 85 %, 92 % and 87 % for the diagnosis of moderate fibrosis (>or= F2), severe fibrosis (>or= F3) and cirrhosis ( = F 4), respectively. CONCLUSION: This study underscores the usefulness of ARFI as a quick method for assessing liver fibrosis or cirrhosis in patients with HBV or HCV. ARFI measurements of the liver should be performed via an intercostal access. Increasing ARFI velocities correlate with higher degree of hepatic fibrosis.

Serum tryptase and SCORMA (SCORing MAstocytosis) Index as disease severity parameters in childhood and adult cutaneous mastocytosis.

BACKGROUND: Skin lesions are the predominant clinical feature of the commonest form of mastocytosis. Mastocytosis is classified according to World Health Organization criteria. Determination of the levels of mast-cell mediators or their metabolites reflects the mast-cell burden. The extent of cutaneous mastocytosis can be assessed clinically using a scoring system (SCORing MAstocytosis; SCORMA Index) that we have developed. OBJECTIVE: Serum tryptase levels were compared with the SCORMA Index in a large group of paediatric and adult patients to investigate whether there was any correlation between the two. METHODS: The SCORMA Index in 64 patients (31 children and 33 adults) was compared with serum tryptase levels. The results of the first visit at which SCORMA and tryptase were evaluated were analysed. RESULTS: There was a positive correlation between the SCORMA Index and serum tryptase levels, indicating the value of the SCORMA Index in the assessment of mastocytosis with skin involvement. CONCLUSION: The results of this study showed that the SCORMA Index is a useful tool for evaluating the severity of cutaneous mastocytosis. The correlation between the SCORMA Index and serum tryptase levels underlines the benefit of the SCORMA Index as a clinical tool. Repeated SCORMA Index measurements can provide a rapid impression of changes in the clinical state of mastocytosis. This is particularly relevant in children, because taking blood samples from this group is much more difficult. The well-established methods for evaluation of disease severity may be expanded by the rapid SCORMA Index method.