Nurse Preceptor Burnout: Contributing Factors.

OBJECTIVE: The aim of this study was to assess nurse preceptor burnout and examine related factors. BACKGROUND: Nurse preceptors are essential to the provision of optimal hospital-based care. Preceptors guide and support nurses' transition from professional training to practice as well as movement within practice roles. METHODS: As a component of the DevelopYou database, nurse preceptors (N = 210) were surveyed electronically using the BHLex Preceptor Role Questionnaire. Data retrieved from this data set were analyzed. RESULTS: Twenty-eight percent (n = 60) of participants experienced burnout. Most (n = 203, 96.7%) enjoyed their role. Reasons for becoming a preceptor included a love for teaching, a desire to help others, and feelings of responsibility to the profession and the institution. Strategies to enable perceived value of the role focused on activities involving person-to-person interactions. CONCLUSIONS: On the basis of the results of this analysis, it is apparent that nurse preceptors want to feel valued and supported by administration and have opportunities to interact regularly with colleagues.

Trenches reduce crop foraging by elephants: Lessons from Kibale National Park, Uganda for elephant conservation in densely settled rural landscapes.

Crop loss to wildlife, particularly elephants, threatens livelihoods and support for conservation around many protected areas in Africa and Asia. Low-cost elephant barriers have been successfully deployed in savannas but seldom tested around isolated forest parks where the stakes are high for local farmers and isolated elephant populations. We measured the effectiveness of a series of ≥3 m deep trenches dug by farmers neighboring Kibale National Park, Uganda. We monitored trench quality and crop loss to elephants weekly for a year across 47 transects in four park-adjacent communities, and conducted controlled, before-and-after comparisons of verified damage. Elephants damaged or destroyed >4 ha of crops during 48 independent foraging events, the majority <220m from the forest boundary. The frequency of damage varied significantly between and within communities. The majority of trenches were not breached by elephants but five suffered ≥4 breaches. Elephant-breached trenches and their neighboring trenches were lower quality than those not breached in the same week (Wilcoxon test: p<0.001). Trenches were also more likely to be breached where people had planted more crops favored by elephants (Wilcoxon test: p = 0.014). Thus, trench quality and the draw of palatable crops both appeared to influence elephant damage. Although trenches may deter elephants, challenges include heavy labor and difficulties of digging in rocky and swampy areas. Trenches alone will not prevent conflict but this strategy holds promise for hot-spots of conflict at forest edges. Given the stakes for farmers and biodiversity, we call for systematic assessment of crop losses and offer recommendations on monitoring and analysis. Such data will allow for stronger inference about effectiveness before investment of effort and resources in interventions.

Diagnostic Dilemma in a Case of Necrotizing Pneumonia With Negative Transbronchial Biopsy.

A 33-year-old male with a past medical history of asthma presented to the Emergency room with a three-day history of right-sided chest pain, productive cough with dark brown sputum, and shortness of breath. He was found to have right lower lobe consolidation consistent with acute pneumonia, and areas of non-homogenous density within the consolidation, suspicious of necrotizing pneumonia. Computed tomography (CT) of the chest with IV contrast revealed a large, irregular thick-walled cavitary mass involving the right middle lobe with surrounding ground glass cavitation. An extensive workup was negative, including a transbronchial biopsy. The case explains how a causative organism was detected.

Preparing New Graduate Nurses for Patient Rescue: An Experimental Quantitative Study.

A patient deterioration educational program was offered to new graduate nurses. Pre and post self-confidence scores were compared, and competency performance was evaluated during a simulation. The results indicate that most of the participants successfully demonstrated simulation competencies, and there was a statistically significant improvement in self-confidence scores. Based on these findings, education on identifying and managing patient deterioration that includes a simulation experience may be beneficial.

The Baptist Health Lexington Nursing Orientation Progression Tool: A Methodological Study.

OBJECTIVE: The purpose of this study was to develop and test a tool to monitor a nursing orientee's progress to competence. BACKGROUND: The literature suggests that, during orientation, consistent documentation and communication among educators, preceptors, and nurse leaders facilitate a timely progression to independent practice for new nurses. METHODS: A 2-phase methodological study was conducted. Nurse educators clarified goals, identified essential competencies, and developed the Baptist Health Lexington Nursing Orientation Progression Tool (OPT). The tool was used to monitor orientees' progression through orientation. RESULTS: Content validity assessment of the OPT (content validity index = 0.98) demonstrated strong validity. Testing of the tool revealed 31 nurses completed orientation early, 12 completed orientation on time, and 18 nurses required extended orientation time. All requiring an extension were new graduates. CONCLUSION: The OPT guided preceptors to facilitate timely completion of orientation among newly hired nurses. Findings suggest that new graduates may need more assistance than experienced nurses.

PBX transcription factors drive pulmonary vascular adaptation to birth.

A critical event in the adaptation to extrauterine life is relaxation of the pulmonary vasculature at birth, allowing for a rapid increase in pulmonary blood flow that is essential for efficient gas exchange. Failure of this transition leads to pulmonary hypertension (PH), a major cause of newborn mortality associated with preterm birth, infection, hypoxia, and malformations including congenital diaphragmatic hernia (CDH). While individual vasoconstrictor and dilator genes have been identified, the coordination of their expression is not well understood. Here, we found that lung mesenchyme-specific deletion of CDH-implicated genes encoding pre-B cell leukemia transcription factors (Pbx) led to lethal PH in mice shortly after birth. Loss of Pbx genes resulted in the misexpression of both vasoconstrictors and vasodilators in multiple pathways that converge to increase phosphorylation of myosin in vascular smooth muscle (VSM) cells, causing persistent constriction. While targeting endothelin and angiotensin, which are upstream regulators that promote VSM contraction, was not effective, treatment with the Rho-kinase inhibitor Y-27632 reduced vessel constriction and PH in Pbx-mutant mice. These results demonstrate a lung-intrinsic, herniation-independent cause of PH in CDH. More broadly, our findings indicate that neonatal PH can result from perturbation of multiple pathways and suggest that targeting the downstream common effectors may be a more effective treatment for neonatal PH.

II. Evaluation of the impact of alternative light technology on male broiler chicken stress.

This study evaluates the impact of light-emitting diodes (LEDs), cold cathode fluorescent lamps (CCFLs), and incandescent lamps on broiler welfare in response to recent interest in the agriculture industry to transition to more energy-efficient lighting technologies. Male Ross 708 broilers (n=672) were raised to 6 wk age in 8 light-tight modified large colony houses under identical intermittent lighting conditions using 4 unique types of lamps, which were gradually dimmed throughout the study. Incandescent lamps served as the control; experimental technologies tested were a CCFL, and 2 different LED lamps. Each technology was tested in duplicate for each of the 4 trials (8 replications total per technology) conducted across the course of one year to account for seasonal variance. Birds were removed from each house at days 7, 14, 35, and 42 to be humanely euthanized and weighed for necropsy evaluation and comparison of body mass. Blood collection via cardiac puncture was performed to obtain heterophil to lymphocyte (H:L) ratios for evaluation of environmental stress. Birds raised under CCFLs had significantly lower body weights (2,871 g±53) than the control (3,000±33 g) by 42 d. Birds raised under CCFLs additionally had significantly higher H:L ratios (0.68±0.06) than the control (0.53±0.03), indicating that these birds may have been chronically stressed (P=0.03). There were not significant differences in the H:L ratio between LED technologies at α=0.05. A significant age and seasonal correlation in H:L ratios was observed across all technologies, along with significant differences among birds raised under the experimental technologies. This study indicates that variation in broiler body weight and stress may be attributed in part to lighting technologies implemented in broiler houses.

I. Evaluation of the impact of alternative light technology on male broiler chicken growth, feed conversion, and allometric characteristics.

This study evaluates the impact of light-emitting diode (LED), cold cathode fluorescent (CCFL), and incandescent lamps on broiler performance. Male Ross 708 broilers (n=672) were raised to 6 wk age in 8 black-out modified large colony houses, under identical intermittent lighting conditions using 4 unique types of lamps, which were gradually dimmed throughout the study. Incandescent lamps served as the control; experimental technologies tested included CCFL and 2 different LED lamps. Each technology was tested in duplicate for each of 4 trials (8 replications total per technology) conducted across the course of one year to account for seasonal variance. Live performance for each technology was evaluated using live broiler body weight (BW), weight gain, feed conversion, and mortality. Birds were removed from each house at 7, 14, 35, and 42 d to be humanely euthanized, weighed, and necropsied for allometric tissue sample analysis. Relative to the technologies tested, results indicate that birds raised under incandescent lamps had significantly higher BW by 42 d, compared to birds raised under CCFL lamps, which had poorer BW performance (P=0.03). Birds raised under both LED technologies grew to final BWs similar to those raised under incandescent light, with significant differences in neither feed conversion nor mortality.

A unique cutaneous presentation of Burkitt lymphoma.

Few reports of cutaneous Burkitt lymphoma exist in the literature. Here, the authors describe the case of a human immunodeficiency virus-positive individual with the rare diagnosis of cutaneous Burkitt lymphoma. Three weeks before the development of his cutaneous lesions, the patient experienced bilateral lower extremity paralysis, and an epidural mass was found. Bone marrow biopsy findings and serum protein electrophoresis seemed consistent with multiple myeloma. The visible appearance of the skin lesions raised concern for cutaneous involvement by myeloma; however, the skin biopsy showed morphological and immunohistochemical features of Burkitt lymphoma. In this case report, the authors discuss the histopathologic findings of the cutaneous lesions in consideration with the bone marrow biopsy findings.

Breast cancer survival in women of African descent living in the US and in the Caribbean: effect of place of birth.

In order to shed light on genetic and environmental factors contributing to breast cancer health disparities, anonymous data from the cancer registry in Brooklyn, NY and two countries in the Caribbean, have been analyzed and compared. De-identified data were obtained on 3,710 women from three cancer registries in Brooklyn (New York), Guyana, and Trinidad, all having been diagnosed with breast cancer between 1995 and 2007, with follow-up through to early 2009. There was a significant difference in breast cancer survival according to race, place of birth, and place of residence. Women of African origin had a significantly worse survival than White women. Women born in the Caribbean had significantly worse survival in comparison to their counterpart born in the US, independently from their ethnic background (adjusted hazard ratio: 1.6; 95% CI: 1.2-2.1). A significant lower breast cancer survival was observed in African Caribbean women living in the Caribbean (HR: 1.8; 95% CI: 1.6-2.1) versus African-Caribbean women born in the Caribbean and living in the US (HR: 1.3; 95% CI 1.1-1.7), versus African-descent women born and living in the US. This study suggests that biological, behavioral, environmental, and clinical factors play a significant role in the observed difference in breast cancer outcome in women of Afro Caribbean descent.

Understanding the risk factors for violence and criminality in women: the concurrent validity of the PCL-R and HCR-20.

This study explores the performance of 132 female maximum-security inmates on the Psychopathy Checklist-Revised (PCL-R) and the HCR-20 (Historical, Clinical, and Risk Management Scheme) to examine the concordance between these two risk assessment instruments, and to assess their potential usefulness in determining level of risk for violent behavior and other forms of criminality. The two instruments demonstrated consistent and highly significant correlations across total scores, factor scores, and subscale scores. When the two instruments were entered into a multiple regression analysis to predict violent and non-violent crime, the HCR-20 did not add to the variance explained by the PCL-R. These results confirm earlier research that suggests that there is little or no difference between these two risk assessment instruments in their relationship to community or institutional violence. Further, Receiver Operating Characteristics (ROC) analyses show that both instruments demonstrated an inverse ability to predict convictions for murder, a close to chance ability to predict violent crime, but a shared ability to predict property and minor crime. Broadly, these results suggest that psychopathic women are involved in chronic patterns of non-violent criminality, while women charged and convicted of murder generally do not have elevated scores on the PCL-R or HCR-20. The relevance of these findings to rehabilitation and treatment is discussed.