Phylogenomics of Piranhas and Pacus (Serrasalmidae) Uncovers How Dietary Convergence and Parallelism Obfuscate Traditional Morphological Taxonomy.

The Amazon and neighboring South American river basins harbor the world's most diverse assemblages of freshwater fishes. One of the most prominent South American fish families is the Serrasalmidae (pacus and piranhas), found in nearly every continental basin. Serrasalmids are keystone ecological taxa, being some of the top riverine predators as well as the primary seed dispersers in the flooded forest. Despite their widespread occurrence and notable ecologies, serrasalmid evolutionary history and systematics are controversial. For example, the sister taxon to serrasalmids is contentious, the relationships of major clades within the family are inconsistent across different methodologies, and half of the extant serrasalmid genera are suggested to be non-monophyletic. We analyzed exon capture to reexamine the evolutionary relationships among 63 (of 99) species across all 16 serrasalmid genera and their nearest outgroups, including multiple individuals per species to account for cryptic lineages. To reconstruct the timeline of serrasalmid diversification, we time-calibrated this phylogeny using two different fossil-calibration schemes to account for uncertainty in taxonomy with respect to fossil teeth. Finally, we analyzed diet evolution across the family and comment on associated changes in dentition, highlighting the ecomorphological diversity within serrasalmids. We document widespread non-monophyly of genera within Myleinae, as well as between Serrasalmus and Pristobrycon, and propose that reliance on traits like teeth to distinguish among genera is confounded by ecological homoplasy, especially among herbivorous and omnivorous taxa. We clarify the relationships among all serrasalmid genera, propose new subfamily affiliations, and support hemiodontids as the sister taxon to Serrasalmidae. [Characiformes; exon capture; ichthyochory; molecular time-calibration; piscivory.].

Toxic epidermal necrolysis and concurrent granulomatosis with polyangiitis (Wegener's granulomatosis). Management of a rare case and review of the literature.

Toxic epidermal necrolysis (TEN) is a rare, acute life-threatening mucocutaneous disorder that is characterised by epidermal loss/exfoliation exceeding 30% total body surface area (TBSA) and is on a spectrum that includes erythema multiforme and Stevens-Johnson syndrome (SJS). It is estimated that 80% of TEN cases are related to medication reactions; the association based on the recognition that TEN usually develops 1-3 weeks following administration of the suspect drug. It is agreed that primary treatment consists of prompt withdrawal of causative drugs and transfer to a regional burn unit. Transfer to a burn unit, no more than 7 days after onset of symptoms, has been acknowledged as reducing the risk of infections, hospital length of stay and infection-related mortality. Due to the uncertainty surrounding TEN pathogenesis, several different modalities have been proposed for the treatment of TEN, including high-dose intravenous immunoglobulins, plasmapheresis, cyclophosphamide, cyclosporine and systemic steroids; however, these therapies are relatively ineffective. The use of systemic corticosteroids for treatment of TEN has in particular been deemed controversial due to associations with increased infections leading to greater length of hospital stay and increased mortality. Granulomatosis with polyangiitis (GPA), formerly known as Wegener's granulomatosis, is a rare relapsing-remitting disorder of unknown aetiology, characterised by granulomatosis inflammation and necrotising vasculitis predominantly affecting small- to medium-sized vessels. While a 5-year survival rate of 75-83% is now realised, relapse and associated morbidity is of concern. The established treatment for GPA follows the recommendations of the French National Authority for Health (HAS) for systematic necrotising vasculitis. With induction treatment, it is recommended that GPA be treated with a combination of systemic corticosteroids and immunosuppressants. A review of the literature failed to identify any previous case where both of these conditions coincide. Our search was conducted through databases which included MEDLINE, PubMed, Scopus, AMED, CINAHL and EMBASE, using keywords: toxic epidermal necrolysis, Wegener's granulomatosis, granulomatosis with polyangiitis. We submit the rare case of a 22-year-old woman who presented to our regional burn unit with both GPA and TEN, and we discuss the presentation, investigation and multidisciplinary management of the patient, as well as reviewing the literature regarding these two conditions.

The ultrastructure of mouse articular cartilage: collagen orientation and implications for tissue functionality. A polarised light and scanning electron microscope study and review.

Adult mouse articular cartilage (AC) has not been thoroughly described using high resolution imaging techniques, despite the fact that the availability of knockout mice with specific extracellular matrix (ECM) mutations have renewed interest in using the mouse as a model for a variety of different human conditions. With osteoarthritis affecting millions of people worldwide, investigations into the structure and, therefore, the ability of AC to act as a load-bearing tissue, are crucial for developing treatments and prevention techniques to limit the degree of severity in this condition. Cryofixation and formaldehyde fixation as well as chemical digestion of the uncalcified regions of AC were used in combination with bright field light, polarised light and scanning electron microscopy to image the structure of adult mouse AC. Chemical digestion of the tissue revealed unique insights into the structure of mouse AC and the high cellular density of the tissue. Tightly packed sheets of collagen fibrils formed the territorial matrix (TM) of the deep zone. These were observed closely surrounding the chondrons, after applying both chemical and cryofixation techniques. The interterritorial matrix (IM), in contrast, was more isotropically arranged. The results of the study have implications for the interpretation of biomechanical functionality of mouse AC with probable applications to other species.

Relationships between certification and job perceptions of oncology nurses.

PURPOSE/OBJECTIVES: To explore relationships between oncology nursing certification and oncology nurses' job perceptions. DESIGN: Descriptive, correlational. SETTING: Questionnaire mailed to homes of Oncology Nursing Society (ONS) members. SAMPLE: 703 certified and 514 noncertified ONS members (N = 1,217; 50% response rate). METHODS: Data were collected using survey methods and grouped by respondents' certification status for statistical analysis. MAIN RESEARCH VARIABLES: Certification, group cohesion, organizational commitment, and job satisfaction. FINDINGS: Certification was weakly correlated with cohesion, commitment, and satisfaction. Work setting, rather than certification, accounted for differences in job perceptions. Job perceptions were most positive in settings characterized by a high percentage of patients with cancer (> 75%), a high percentage of RNs (> or = 80%), and monetary support for continuing education. CONCLUSIONS: The hypothesis that oncology nurses' certification status is associated with job perceptions that are valued by employers was not supported. IMPLICATIONS FOR NURSING PRACTICE: Nurses' job perceptions have been linked to control over nursing practice and participation in organizational and clinical decision making. Managerial strategies that empower certified nurses to practice with more autonomy and participate in decisions that affect patient care should be emphasized.

Information needs of elderly postsurgical cancer patients during the transition from hospital to home.

PURPOSE: To describe information needs of elderly postsurgical cancer patients. Few reports have described learning needs of postsurgical cancer patients during the initial weeks after hospitalization. Responding to information needs during the transition to home is important for helping patients and families to appropriately manage illness. DESIGN: Descriptive, using records kept for patients assigned to the experimental group in a larger study completed in 1996. The sample was 148 American patients surgically treated for a new diagnosis of prostate, breast, gastrointestinal, lung, or head and neck cancer. Information needs were identified from topics addressed by advanced practice nurses during 4-week episodes of home care. METHODS: Content analysis of 3,280 statements of teaching interventions. FINDINGS: Teaching themes were instructing on postoperative self-care, advising on symptom management, clarifying the illness experience, discussing psychological responses, and preparing patients and families to coordinate follow-up care. Topics included describing the expected course of illness, informing about community resources, identifying events that require physician notification, and advising on pain management. Topic emphasis varied by site of cancer. CONCLUSIONS: Information needs of elderly postsurgical cancer patients during transition from hospital to home are extensive. Teaching interventions ranged from giving concrete instructions about care of a surgical wound to interpreting complex information about options for cancer treatment. Elderly postsurgical cancer patients need informational support during the transition from hospital to home.

Describing the work of nursing: the case of postsurgical nursing interventions for men with prostate cancer.

Nursing interventions were provided to older men following prostate surgery during a controlled clinical trial examining nursing care and its effects on quality of life outcomes. The Nursing Intervention Lexicon and Taxonomy (NILT), consisting of 7 categories of nursing interventions, was used to classify intervention statements extracted from 32 home care records. Two major categories of interventions were patient teaching (45%) and psychologically based interventions (20%). In a comparison of the types of interventions provided upon discharge from the hospital with those provided at the end of 1 month of home care, it appeared that patients had not yet shifted from the crisis to the chronic phase of their illness course based on Rolland's framework.

A national survey of certified, recertified, and noncertified oncology nurses: comparisons and contrasts.

PURPOSE/OBJECTIVES: To explore opinions about the OCN credential, the ways in which it was obtained and retained, and the extent to which it is valued by employers. DESIGN: A descriptive comparison study using a cross-sectional survey design. SAMPLE: Questionnaires were mailed to a nationwide sample of 2,429 RN members of the Oncology Nursing Society; 1,217 (50%) surveys were returned. The majority of respondents were female, 30-49 years of age. Caucasian, and had practiced nursing for more than 11 years. MAIN RESEARCH VARIABLES: Certification status, work role characteristics, preparation strategies for the certification examination, and motivation for obtaining certification. FINDINGS: Oncology nurses recognize the importance and value of OCN certification. The primary reasons oncology nurses obtain and retain certification include the desire for personal achievement, professional growth, and development. OCNs were more likely to work in a setting where the employer supports professional development through continuing nursing education. IMPLICATIONS FOR NURSING PRACTICE: Because health care is increasingly delivered in ambulatory/home settings and the population is aging, oncology certification needs to be encouraged among nurses who work in these settings or with geriatric populations. Certified nurses tended to experience more job satisfaction than noncertified nurses.

Caring interactions among nursing students: a descriptive comparison of 2 associate degree nursing programs.

Increasing emphasis has been given to the importance of caring as a curricular theme in nursing education and the value of developing students who will be able to function in a practice role as a caring nurse. The challenge for nurse educators is to understand and facilitate those processes through which students can be socialized to caring as a professional value in nursing. The findings from research that was conducted to investigate caring in nursing education suggest that caring can emerge during students' interactions with other students and during their interactions with faculty members. Therefore, it may be useful to capitalize on peer relationships as a strategy through which students can experience caring behaviors and develop skill in the practice of caring for others. The findings from this study support the need to investigate experiential learning strategies that are designed to promote the practice of caring among the student peer group. Additional research is needed to validate the effectiveness of such strategies as a method through which nursing students can learn caring.

Development of an instrument to measure caring peer group interactions.

The purpose of this study was to develop psychometric properties of the Peer Group Caring Interaction Scale (PGCIS) designed to measure caring during informal peer interactions as experienced by undergraduate nursing students. The PGCIS has two subscales that address caring peer behaviors and interactional events during which students assist their peers in the resolution of specific needs. PGCIS psychometric properties were developed using data from 873 junior students enrolled at 87 BSN schools of nursing. Internal consistency reliability was demonstrated for the 9-item Caring Behaviors and the 7-item Giving Assistance subscales with a coefficient alpha of .91 for each. Findings from an exploratory factor analysis supported the two subscale structure of the PGCIS. The PGCIS scores correlated positively with scores on the Intimacy subscale of the Organization Climate Description Questionnaire (OCDQ) and the Peer Group Interaction Scale and inversely with scores on the OCDQ Disengagement subscale. The findings from this study provide beginning support for the PCGIS as a valid and reliable approach to the measurement of caring in academic settings. Additional studies are recommended to continue the psychometric evaluation of this instrument.

Nursing terminology: a comparison of the ICNP and the nursing intervention lexicon and taxonomy.

The purpose of this paper is to provide an overview of nursing terminology work done to date and to compare the labels and subsumed terms of the recent alpha version of the International Classification of Nursing Practice (ICNP) with the verb terms (n = 147) of the interventions in a dataset of interventions (n = 7292) categorized using the Nursing Intervention Lexicon and Taxonomy (NILT). Two estimates were used to evaluate the adequacy of the ICNP terms for representing intervention terminology. Term matches were done using the NILT categories most similar to the ICNP action types. The ICNP action type 'observing' (and its subsumed terms) was best, accounting for 20% of the NILT verbs. The ICNP label 'observing' (and its subsumed terms) ranked first in accounting for 69% of the interventions in the NILT categories (CND & CV). The remaining action types had many fewer matches for the verbs and interventions in the NILT dataset. Thus it is possible to conclude that a relatively small subset of the verb terms, and interventions in a dataset of natural language interventions categorized using NILT have been captured by the INCP alpha version of Axis A.

Using key informant methods in organizational survey research: assessing for informant bias.

Specification of variables that reflect organizational processes can add an important dimension to the investigation of outcomes. However, many contextual variables are conceptualized at a macro unit of analysis and may not be amenable to direct measurement. In these situations, proxy measurement is obtained by treating organizational members as key informants who report about properties of the work group or organization. Potential sources of bias when using key informant methods in organizational survey research are discussed. Statistical procedures for assessment of rater-trait interaction as a type of informant bias are illustrated using data from a study in which multiple key informants were sampled to obtain proxy measurement of the organizational climate for caring among baccalaureate schools of nursing.

Nursing intervention intensity and focus: indicators of process for outcomes studies.

Outcomes research has become increasingly important in the current health care environment and for informatics research efforts. Recent efforts in automating clinical data for use in outcomes studies has focused attention on the need to represent the processes of care in the classic structure-process-outcome models of care. This paper reports on use of the Nursing Intervention Lexicon and Taxonomy for classifying interventions to characterize two process of care variables: intervention intensity and intervention focus. Study results demonstrate that these variables are descriptive and provide promise for describing processes of nursing care for describing clinical care.

Issues regarding aggregation of data in nursing systems research.

The unit of analysis at which variables are conceptualized and measured is an important consideration when conducting patient outcomes research. Outcomes research ranges from study of individual responses to nursing intervention to investigation of group level outcomes associated with the contexts and processes through which nursing care is delivered. Because many variables salient to the investigation of group level patient outcomes are not amenable to direct measurement, aggregation procedures are used to generate proxy measurement of organizational context or process variables. In this article, key conceptual and methodologic issues encountered when using data aggregation procedures are reviewed. Following this, estimation of aggregated data reliability is illustrated using data from a study conducted to investigate skilled nursing unit structures.

The conceptual validity of a taxonomy of nursing interventions.

The purpose of this paper is to report validity evidence for the nursing intervention taxonomy developed as part of the Nursing Intervention Lexicon and Taxonomy (NILT) Study. Using eclectic classification methods of library science, cognitive science, nursing science and computational linguistics, a taxonomy of nursing interventions consisting of seven categories was developed. These categories which incorporate care as a central concept are described and defined, and prototypical examples of each category are presented. Brinberg & McGrath's validity schema provides the framework within which evidence for validity as value, validity as correspondence and validity as generalizability were examined. Comparison of the NILT categories with previously published categorizations of nursing functions and interventions provides strong support for the validity of this classification. Additionally, comparison of the NILT categories with two internationally derived categorizations of nursing functions supports the robustness or generalizability of the NILT classification.