Current turnover intention among nurse managers, directors, and executives.

BACKGROUND: Nursing leadership turnover can adversely affect nurse retention and thus quality of care. Little research has examined the way nurses at differing levels of leadership experience their workplace and voluntarily decide to leave. PURPOSE: Our study sought to explore and compare intent to leave and turnover experiences of acute care nurse managers, directors, and executives. METHODS: Data were collected via an online survey. Participants included nurse managers, directors, and executives from 47 states (n = 1880) working in acute care settings. FINDINGS: Over 50% of respondents intend to leave their current positions within the next 5 years with reasons for leaving differing by type of nurse leader. Retirement was a factor for slightly over 30% of those nurse leaders overall and almost 50% of nurse executives. DISCUSSION: Nurse managers, directors, and executives experience turnover and intent to leave differently. Most frequently, voluntary factors for leaving a position include job dissatisfaction and a desire for promotion and advancement.

Turnover Intention Among Nurses in Nurse Managers, Directors, and Executives: Developing a Tool for Measuring Environmental Factors.

BACKGROUND AND PURPOSE: Turnover among nurse managers, directors, and executives is associated with staff nurse retention and patient outcomes. The purpose of this article is to describe the development of an instrument to evaluate factors associated with intent to leave among these leaders within acute care facilities. METHODS: The Nurse Leader Environment Support Survey (NLESS) was developed and evaluated using exploratory factor analysis and reliability testing (Cronbach's α). Data was obtained as part of a large nationwide electronic survey (N = 1,903). RESULTS: Factors converged into three major themes (organizational culture, professional vulnerability, and workplace relationships) which were consistent across all three leadership groups. Factor subscales exhibited Cronbach's α > .7. CONCLUSIONS: The NLESS is a useful tool in comparing reasons for turnover among nursing leadership groups. Future refinement may prove useful in identifying and clarifying foundational causes of turnover.

Filler Migration and Granuloma Formation After Gluteal Augmentation with Free-silicone Injections.

Gluteal augmentation may be performed using a variety of techniques, including implant-based, autologous fat grafting, local flaps, impermanent filler injection, or, as in this case, by way of permanent filler injection with free-silicone. Of these, free-silicone injections carry one of the highest complication rates, specifically regarding migration of the filler material from the native injection site and induction of painful reactive soft tissue changes at the new filler location. A radiologist providing this diagnosis may assist the clinician, who often cannot obtain a history of illicit silicone injection for gluteal augmentation unless the suspicion is raised. Presented here is a case of painful filler migration to the knee with granuloma formation after free-silicone gluteal injection.

Imaging Manifestations of Creutzfeldt-Jakob Disease and Case Series.

Sporadic Creutzfeldt-Jakob disease (CJD) is the most common prion disease, resulting in rapid neurocognitive decline, and is universally lethal. CJD has a confounding clinical presentation with similarities which overlap with many other neurodegenerative disorders. Brain biopsy is the current gold standard; however, less-invasive initial screening tests are also utilized. These include brain magnetic resonance imaging (MRI), electroencephalography (EEG), and cerebrospinal fluid (CSF) laboratory studies. Five patients presented to our facility with varying levels of nonspecific cognitive impairment and movement disorders. CJD was initially suggested after review of each patient's brain MRI. The T2-weighted fluid attenuation inversion recovery and diffusion-weighted images in each case demonstrated varied classic patterns of signal abnormality involving the cortex, basal ganglia, thalami, and brainstem. EEG and CSF studies were confirmatory in three and four patients, respectively (EEG not performed in one patient). One death occurred two months after initial presentation, and the other four patients were transferred to hospice three, four, nine, and 20 months after initial presentation. Radiological evaluation is an invaluable component of the workup for nonspecific neurodegenerative disorders because brain MRI may suggest the initial diagnosis of CJD, as demonstrated in our presented cases. Familiarity with the spectrum of classic MRI findings suggestive of sporadic CJD can improve radiologists' role in early detection of the most common prion disease. Clinicians may benefit from understanding the utility of the newer CSF laboratory studies (Real-time quaking-induced conversion, T-tau, and 14-3-3 protein), which are far less invasive than the gold standard of brain biopsy. Early diagnosis can help save medical resources and guide clinicians to form appropriate plans of care with the patient and family.

CT and MR Imaging of the Postoperative Ankle and Foot.

A variety of surgical procedures exist for repair of both traumatic and degenerative osseous and soft-tissue pathologic conditions involving the foot and ankle. It is necessary for the radiologist to be familiar with these surgical procedures, so as to assess structural integrity, evaluate for complicating features, and avoid diagnostic pitfalls. Adequate interpretation of postoperative changes often requires access to surgical documentation to evaluate not only the surgery itself but the expected timeline for resolution of normal postoperative changes versus progressive disease. Appropriate use of surgical language in radiology reports is another important skill set to hone and is instrumental in providing a high-quality report to the referring surgeons. The pathophysiology of a myriad of surgical complaints, beginning from the Achilles tendon and concluding at the plantar plate, are presented, as are their common appearances at computed tomography and magnetic resonance imaging. Commonly encountered entities include Achilles tendon tear, spastic equinus, nonspastic equinus, talar dome osteochondral defect, tarsal tunnel syndrome, plantar fasciitis, pes planovalgus, pes cavovarus, peroneal tendinosis, lateral ligament complex pathology, Morton neuroma, plantar plate tear, and metatarsophalangeal joint instability. Computer-generated three-dimensional models are included with many of the procedures to provide a more global view of the surgical anatomy. Correlation with intraoperative photographs is made when available. When appropriate, discussion of postoperative complications, including entities such as infection and failure of graft integration, is presented, although a comprehensive review of postoperative complications is beyond the scope of this article. Notably absent from the current review are some common foot and ankle procedures including hallux valgus and hammertoe corrections, as these are more often evaluated radiographically than with cross-sectional imaging. ©RSNA, 2016.

Prosocial and antisocial children's perceptions of peers' motives for prosocial behaviours.

This study investigated whether peer-nominated prosocial and antisocial children have different perceptions of the motives underlying peers' prosocial actions. Eighty-seven children, aged 10-12 years old, completed peer-nomination measures of social behaviour. On the basis of numbers of social nominations received, a subsample of 51 children (32 who were peer-nominated as 'prosocial', and 18 who were peer-nominated as 'antisocial') then recorded their perceptions of peers' motives for prosocial behaviours. Expressed motives were categorized predominantly into three categories, coinciding with Turiel's (1978) 'moral', 'conventional', and 'personal domains'. Results indicate that children's social reputation is associated with the extent to which they perceive peers' prosocial motives as 'personal' or 'moral', with more prosocial children attributing moral motives, and more antisocial children attributing personal motives. Although traditionally Turiel's domain theory has been used to understand 'antisocial' children's behaviour, the current findings suggest that 'prosocial' children's behaviour may also be related to domains of judgment.

Preliminary results of combining low frequency low intensity ultrasound and liposomal drug delivery to treat tumors in rats.

Ultrasound is a convenient trigger for site-specific drug delivery in cancer therapy. Nano-sized liposomes formulated from soy phosphatidyl choline, cholesterol, 1,2-distearoyl-sn-glycero-3-phosphoethanolamine-N-[carboxy(polyethylene glycol)-2000] and alpha-tocopherol were loaded with Doxorubicin (Dox) using a pH gradient. The liposomal suspension was infused through the tail vein of BDIX rats possessing bilateral intradermal DHD/K12 tumors on their hind legs. Then 20-kHz ultrasound was applied to only one of the tumors for 15 minutes. This therapy was repeated weekly for 4 weeks. The results showed that in five of six rats, the tumors regressed to non-measurable size within 4 weeks. A paired comparison of the normalized size of the insonated and non-insonated tumors in the same rat indicated that the insonated tumors were smaller (p < 0.0001, n = 6 rats, 21 pairs). This observation has significant potential for non-invasive site-specific therapy of solid tumors.

Informational masking in young and elderly listeners for speech masked by simultaneous speech and noise.

Three experiments measured the effects of age on informational masking of speech by competing speech. The experiments were designed to minimize the energetic contributions of the competing speech so that informational masking could be measured with no large corrections for energetic masking. Experiment 1 used a "speech-in-speech-in-noise" design, in which the competing speech was presented in noise at a signal-to-noise ratio (SNR) of -4 dB. This ensured that the noise primarily contributed the energetic masking but the competing speech contributed the informational masking. Equal amounts of informational masking (3 dB) were observed for young and elderly listeners, although less was found for hearing-impaired listeners. Experiment 2 tested a range of SNRs in this design and showed that informational masking increased with SNR up to about an SNR of -4 dB, but decreased thereafter. Experiment 3 further reduced the energetic contribution of the competing speech by filtering it into different frequency bands from the target speech. The elderly listeners again showed approximately the same amount of informational masking (4-5 dB), although some elderly listeners had particular difficulty understanding these stimuli in any condition. On the whole, these results suggest that young and elderly listeners were equally susceptible to informational masking.

Physiologically-indexed and self-perceived affective empathy in Conduct-Disordered children high and low on Callous-Unemotional traits.

Heart rate (HR) was employed to compare vicarious affective arousal across three groups of children (aged 7.6 - 11, N = 95): Conduct Disordered (CD) elevated on Callous-Unemotional traits (CD/CU), CD low on CU traits (CD-only), and [Symbol: see text]typically-developing' controls, matched in age, gender and socioeconomic background. While watching an emotion evocative film, participants' HR was monitored. Immediately after viewing, self-reported vicarious responses were obtained. Participants also completed the Bryant Empathy Index. CD/CU children displayed lower magnitude of HR change than both CD-only and controls. Both CD groups reported fewer vicarious responses and scored lower than controls on the empathy index. These results support distinct deficits across CD subsets, suggestive of distinct mechanisms underlying their antisocial conduct.

Cognitive and affective perspective-taking in conduct-disordered children high and low on callous-unemotional traits.

BACKGROUND: Deficits in cognitive and/or affective perspective-taking have been implicated in Conduct-Disorder (CD), but empirical investigations produced equivocal results. Two factors may be implicated: (a) distinct deficits underlying the antisocial conduct of CD subgroups, (b) plausible disjunction between cognitive and affective perspective-taking with subgroups presenting either cognitive or affective-specific deficits. METHOD: This study employed a second-order false-belief paradigm in which the cognitive perspective-taking questions tapped the character's thoughts and the affective perspective-taking questions tapped the emotions generated by these thoughts. Affective and cognitive perspective-taking was compared across three groups of children: (a) CD elevated on Callous-Unemotional traits (CD-high-CU, n = 30), (b) CD low on CU traits (CD-low-CU, n = 42), and (c) a 'typically-developing' comparison group (n = 50), matched in age (7.5 - 10.8), gender and socioeconomic background. RESULTS: The results revealed deficits in CD-low-CU children for both affective and cognitive perspective-taking. In contrast CD-high-CU children showed relative competency in cognitive, but deficits in affective-perspective taking, a finding that suggests an affective-specific defect and a plausible dissociation of affective and cognitive perspective-taking in CD-high-CU children. CONCLUSION: Present findings indicate that deficits in cognitive perspective-taking that have long been implicated in CD appear to be characteristic of a subset of CD children. In contrast affective perspective-taking deficits characterise both CD subgroups, but these defects seem to be following diverse developmental paths that warrant further investigation.

Perceptions and correlates of peer-victimization and bullying.

BACKGROUND: The experiences of peer-victimization and bullying are often treated empirically as though they are conceptually indistinct. Both involve repeated aggression, but definitions of bullying additionally emphasize the importance of aggressor intent and imbalance of power between the aggressor and the victim (Olweus, 1978; Whitney & Smith, 1993). AIMS: The present study aimed to examine the extent to which peer-victimization and bullying are empirically similar. SAMPLE: The sample comprised 1,429 pupils (50.2% male) aged between 8 and 13 years attending mainstream Scottish schools. METHODS: Self-report questionnaire assessing peer-victimization and bullying, coping strategy use (WCCL: Hunter, 2000), situational appraisal and depressive symptomatology (Birleson, 1981). RESULTS: Almost one-third (30.7%) of pupils reported experiencing peer-victimization, and of these 38.1% (11.7% of whole sample) were categorized as victims of bullying. Victims of bullying perceived higher levels of threat and lower levels of perceived control. They also reported using more Wishful Thinking and Social Support coping strategies, but did not differ on Problem Focused coping. Bullied pupils also reported higher levels of depressive symptomatology. CONCLUSIONS: Peer-victimization and bullying appear to be qualitatively different experiences for children and adolescents, with bullying being the more serious phenomenon.

Help seeking amongst child and adolescent victims of peer-aggression and bullying: the influence of school-stage, gender, victimisation, appraisal, and emotion.

BACKGROUND: An important element of many anti-bullying programmes is encouraging victims to tell someone about their predicament. Research has already reported prevalence of telling, who/when children tell and efficacy of telling. However, seeking help can be viewed as a coping behaviour, and coping processes such as appraisal and emotion may be important predictors of whether pupils ask for help. AIMS: To examine the effects that background variables (gender, school-stage), victimisation (duration, frequency), appraisal (threat, challenge, control) and negative emotion have upon support seeking by child and adolescent victims of peer-aggression and bullying. To also examine how effective pupils perceive social support to be. SAMPLE: Participants were 830 children (49% male) aged 9-14 years. Three hundred and seventeen pupils were in Primary 6, 307 in Secondary 2 and 206 in Secondary 3. METHOD: A self-report bullying questionnaire was completed by the participants within their classes. Questionnaires included items relating to victimisation, appraisal, emotion, and coping strategy choice as well as demographic data. RESULTS: Hierarchical multiple regression analysis revealed that gender, challenge appraisals, and emotions were significant predictors of the degree to which child and adolescent victims of peer-aggression and bullying sought help (accounting for 15.8% of the variance): girls were more likely than boys to seek help, as were pupils with high challenge appraisals or those experiencing high levels of negative emotion. Also, girls were more likely than boys to view support as the best strategy for both stopping bullying and for helping them to feel better. CONCLUSION: Results suggest that pupils are more willing to seek help when they see the situation as one in which something can be achieved. Pupils also may be seeking support to get help coping with negative emotions, and this may need to be emphasized to teachers.