14.8% Quantum Efficient Gallium Phosphide Photocatalyst for Hydrogen Evolution.

Gallium phosphide is an established photoelectrode material for H2 or O2 evolution from water, but particle-based GaP photocatalysts for H2 evolution are very rare. To understand the reasons, we investigated the photocatalytic H2 evolution reaction (HER) of suspended n-type GaP particles with iodide, sulfite, ferricyanide, ferrous ion, and hydrosulfide as sacrificial electron donors, and using Pt, RhyCr2-yO3, and Ni2P HER cocatalysts. A record apparent quantum efficiency of 14.8% at 525 nm was achieved after removing gallium and oxide charge trapping states from the GaP surface, adding a Ni2P cocatalyst to reduce the proton reduction overpotential, lowering the Schottky-barrier at the GaP-cocatalyst interface, adjusting the polarity of the depletion layer at the GaP-liquid interface, and optimizing the electrochemical potential of the electron donor. The work not only showcases the main factors that control charge separation in suspended photocatalysts, but it also explains why most known HER photocatalysts in the literature are based on n-type and not p-type semiconductors.

Reproducibility of CRISPR-Cas9 methods for generation of conditional mouse alleles: a multi-center evaluation.

BACKGROUND: CRISPR-Cas9 gene-editing technology has facilitated the generation of knockout mice, providing an alternative to cumbersome and time-consuming traditional embryonic stem cell-based methods. An earlier study reported up to 16% efficiency in generating conditional knockout (cKO or floxed) alleles by microinjection of 2 single guide RNAs (sgRNA) and 2 single-stranded oligonucleotides as donors (referred herein as "two-donor floxing" method). RESULTS: We re-evaluate the two-donor method from a consortium of 20 laboratories across the world. The dataset constitutes 56 genetic loci, 17,887 zygotes, and 1718 live-born mice, of which only 15 (0.87%) mice contain cKO alleles. We subject the dataset to statistical analyses and a machine learning algorithm, which reveals that none of the factors analyzed was predictive for the success of this method. We test some of the newer methods that use one-donor DNA on 18 loci for which the two-donor approach failed to produce cKO alleles. We find that the one-donor methods are 10- to 20-fold more efficient than the two-donor approach. CONCLUSION: We propose that the two-donor method lacks efficiency because it relies on two simultaneous recombination events in cis, an outcome that is dwarfed by pervasive accompanying undesired editing events. The methods that use one-donor DNA are fairly efficient as they rely on only one recombination event, and the probability of correct insertion of the donor cassette without unanticipated mutational events is much higher. Therefore, one-donor methods offer higher efficiencies for the routine generation of cKO animal models.

The mitophagy receptor Bcl-2-like protein 13 stimulates adipogenesis by regulating mitochondrial oxidative phosphorylation and apoptosis in mice.

Metabolic programming of bone marrow stromal cells (BMSCs) could influence the function of progenitor osteoblasts or adipocytes and hence determine skeletal phenotypes. Adipocytes predominantly utilize oxidative phosphorylation, whereas osteoblasts use glycolysis to meet ATP demand. Here, we compared progenitor differentiation from the marrow of two inbred mouse strains, C3H/HeJ (C3H) and C57BL6J (B6). These strains differ in both skeletal mass and bone marrow adiposity. We hypothesized that genetic regulation of metabolic programs controls skeletal stem cell fate. Our experiments identified Bcl-2-like protein 13 (Bcl2l13), a mitochondrial mitophagy receptor, as being critical for adipogenic differentiation. We also found that Bcl2l13 is differentially expressed in the two mouse strains, with C3H adipocyte progenitor differentiation being accompanied by a >2-fold increase in Bcl2l13 levels relative to B6 marrow adipocytes. Bcl2l13 expression also increased during adipogenic differentiation in mouse ear mesenchymal stem cells (eMSCs) and the murine preadipocyte cell line 3T3-L1. The higher Bcl2l13 expression correlated with increased mitochondrial fusion and biogenesis. Importantly, Bcl2l13 knockdown significantly impaired adipocyte differentiation in both 3T3-L1 cells and eMSCs. Mechanistically, Bcl2l13 knockdown reprogrammed cells to rely more on glycolysis to meet ATP demand in the face of impaired oxidative phosphorylation. Bcl2l13 knockdown in eMSCs increased mitophagy. Moreover, Bcl2l13 prevented apoptosis during adipogenesis. Our findings indicate that the mitochondrial receptor Bcl2l13 promotes adipogenesis by increasing oxidative phosphorylation, suppressing apoptosis, and providing mitochondrial quality control through mitophagy. We conclude that genetic programming of metabolism may be important for lineage determination and cell function within the bone marrow.

Dissemination of scholarship across eight cohorts of doctor of nursing practice graduates.

AIMS AND OBJECTIVES: To evaluate the publication record across eight cohorts of post-master's Doctor of Nursing Practice graduates. BACKGROUND: Dissemination of findings from evidence-based practice is described in the American Association of the Colleges of Nursing, Doctor of Nursing Practice Essential III. Students in Doctor of Nursing Practice programmes are expected to generate deliverables (e.g., a manuscript) of evidence to improve practice or patient outcomes. DESIGN: A descriptive study was conducted to determine whether two key manuscripts (i.e., integrative review and an evidence-based quality improvement project) were disseminated in peer-reviewed journals, and if so, the length of time from graduation to publication. Co-authorship with faculty advisors and contributors was also examined. RESULTS: The number of evidence-based quality improvement publications outpaces the number of integrative reviews over this span of time. Time to publication from graduation has decreased in recent years. CONCLUSIONS: Expecting, rather than encouraging a publishable-ready manuscript as a course deliverable would further student's motivation to disseminate their scholarship. Focused attention on faculty co-authorship may help increase the number of successful student publications for both integrative reviews and evidence-based quality improvement projects and decrease the time from graduation for those publications. RELEVANCE TO CLINICAL PRACTICE: Dissemination of academic scholarly work is an expected outcome for Doctor of Nursing Practice graduates who impact clinical, operational and financial outcomes in complex healthcare delivery systems.

Improving Medication Adherence with Two-way Short Message Service Reminders in Sickle Cell Disease and Asthma. A feasibility randomized controlled trial.

INTRODUCTION: Sickle cell disease (SCD) is a childhood and adult disease that primarily affects African Americans, characterized by life threatening sequelae mitigated by medications. One-way and two-way short message service (SMS) medication reminders have differing efficacy in chronic diseases. There is limited literature about SMS medication reminders in SCD. OBJECTIVE: The goal of this study was to test the feasibility, defined by recruitment/acceptance, retention/attrition, and technology utilization, of two-way SMS medication reminders in individuals with SCD with and without asthma. MATERIALS AND METHODS: Participants were randomly allocated to standard care or reminders. Two-way SMS reminders were automated using Research Electronic Data Capture (REDCap) for hydroxyurea, fluticasone, budesonide and montelukast. Adherence was measured using the Morisky Medication Adherence Scale-8 (MMAS-8). Asthma control was assessed using the Childhood and Adult-Asthma Control Tests (ACT). Participants were enrolled 28 to 60 days with a common termination date. RESULTS: The recruitment rate was 95% (47/49) and 82.9% completed the study. Among the 47 study participants enrolled, 51.1% were male, 61.7% were adults, median age was 20 (range: 3 to 59), and 98% were African Americans. Of the 26 participants receiving messages, 20% responded on over 95% of the days and usage varied with an average response rate of 33%, ranging from 21% to 46%. Medication adherence scores improved significantly in the intervention group (3.42 before, 5.46 after; p=0.002), but not in the control group (3.90 before, 4.75 after; p=0.080). Childhood-ACT scores improved in the intervention group (19.20 before, 24.25 after). Adult-ACT scores within the intervention arm were unchanged (21.0 before, 22.0 after. ACT scores did not improve significantly. CONCLUSION: This study demonstrated the feasibility for two-way SMS medication reminders to improve medication adherence in a high-risk population where daily medication adherence is critical to health outcomes and quality of life.

Feasibility study of a nurse-led heart failure education program.

AIMS/OBJECTIVES: To assess the feasibility of a nurse-led heart failure (HF) education program using the Self-Care Heart Failure Index (SCHFI) instrument. BACKGROUND: HF is a frequent and burdensome condition requiring support with self-care management strategies and education. Translating best practice to health services is important in improving health outcomes. DESIGN: Longitudinal quasi-experimental design. METHODS: A convenience sample of (N = 41) patients with HF. We implemented a nurse-led education program with 30-day post-discharge home-based telephone follow-up. The SCHFI was used to measure self-care behaviors. 30-day readmission rates were assessed. RESULTS: A significant difference was found in scores for self-care maintenance (p ≤ .001) and self-care management (p ≤ .001) subscales, not self-care confidence. There was no statistically significant difference between 30-day HF readmission rates. CONCLUSIONS: Findings suggest that the nurse-led evidence-based HF education program improved self-care behaviors and decreased 30-day readmissions. There is a need for continued development of interventions focused on improving patient self-care confidence.

Associations among pain, depression, and functional limitation in low-income, home-dwelling older adults: An analysis of baseline data from CAPABLE.

A complex relationship exists between pain, depression, and functional limitation. These conditions, which substantially impact health care spending and quality of life, remain under-addressed in the current system of health care delivery, particularly among low-income and minority populations. This analysis uses baseline assessment data from CAPABLE, an ongoing randomized controlled trial (RCT), to examine associations between pain, depression, and functional limitation among a sample of low-income, community-dwelling elders with functional limitations. Linear regression revealed close associations between depression, pain, and activity of daily living (ADL) limitation. Mediation analyses indicated that depression fully mediated the relationship between pain intensity and functional limitation and partially mediated the relationship between pain interference and depression. Past research has shown that these conditions may be easily identified using validated assessment tools and effectively addressed through the introduction of interdisciplinary interventions. Several recommendations are presented for clinicians and health care organizations.

Development of The Johns Hopkins University School of Nursing Adult/Geriatric Primary Care Nurse Practitioner Program in HIV Prevention, Treatment, and Care.

In response to the call to create an AIDS Education and Training Center for Nurse Practitioner Education by the Health Resources and Services Administration, The Johns Hopkins University School of Nursing embarked on a transformative curriculum overhaul to integrate HIV prevention, treatment, and care into the Adult/Geriatric Nurse Practitioner Program. A six-step process outlined in the Curriculum Development for Medical Education was followed. A pilot cohort of Adult/Geriatric Nurse Practitioner students were enrolled, including 50% primary care setting and 50% HIV-focused primary care through a 12-month HIV continuity clinic experience. Through this pilot, substantive changes to the program were adopted. Programmatic outcomes were not compromised with the modification in clinical hours. The model of a 12-month HIV continuity clinical experience reduced the number of required preceptors. This model has important implications for the HIV workforce by demonstrating successful integration of HIV and primary care training for nurse practitioners.

Communication between office-based primary care providers and nurses working within patients' homes: an analysis of process data from CAPABLE.

AIMS AND OBJECTIVES: To examine themes of communication between office-based primary care providers and nurses working in private residences; to assess which methods of communication elicit fruitful responses to nurses' concerns. BACKGROUND: Lack of effective communication between home health care nurses and primary care providers contributes to clinical errors, inefficient care delivery and decreased patient safety. Few studies have described best practices related to frequency, methods and reasons for communication between community-based nurses and primary care providers. DESIGN: Secondary analysis of process data from 'Community Aging in Place: Advancing Better Living for Elders (CAPABLE)'. METHODS: Independent reviewers analysed nurse documentation of communication (phone calls, letters and client coaching) initiated for 70 patients and analysed 45 letters to primary care providers to identify common concerns and recommendations raised by CAPABLE nurses. RESULTS: Primary care providers responded to 86% of phone calls, 56% of letters and 50% of client coaching efforts. Primary care providers addressed 86% of concerns communicated by phone, 34% of concerns communicated by letter and 41% of client-raised concerns. Nurses' letters addressed five key concerns: medication safety, pain, change in activities of daily living, fall safety and mental health. In letters, CAPABLE nurses recommended 58 interventions: medication change; referral to a specialist; patient education; and further diagnostic evaluation. CONCLUSIONS: Effective communication between home-based nurses and primary care providers enhances care coordination and improves outcomes for home-dwelling elders. Various methods of contact show promise for addressing specific communication needs. RELEVANCE TO CLINICAL PRACTICE: Nurses practicing within patients' homes can improve care coordination by using phone calls to address minor matters and written letters for detailed communication. Future research should explore implementation of Situation, Background, Assessment and Recommendation in home care to promote safe and efficient communication. Nurses should empower patients to address concerns directly with providers through use of devices including health passports.

Evaluation of a Worksite Diabetes Education Program at a Large Urban Medical Center.

Evidence suggests that diabetes education can be delivered at the worksite to better support employees' diabetes self-management and improve productivity and health care costs. This study was conducted to address the feasibility of a diabetes worksite education program for employees at a large urban academic health care institution. The diabetes education program was delivered in the diabetes center at the institution, a resource that was previously underutilized by employees. Through collaboration with groups in the institution, 20 employees of diverse ethnicity participated in the worksite diabetes education program with positive outcomes: improved glycemic control measured (HbA1c), attainment of self-management goals, and satisfaction with the program. Work absences trended downward, but numbers of hospitalizations and emergency department visits were unchanged in the 3 months following education. Recommendations include replication of the study with more employee participation and program evaluation over a longer period of time to continue assessment of employees' educational needs.

Nutrition-based interventions to address metabolic syndrome in the Navajo: a systematic review.

AIMS AND OBJECTIVES: The objective of this systematic review is to identify nutrition-based interventions that may be effective for the prevention and treatment of metabolic syndrome in the Navajo. BACKGROUND: Metabolic syndrome, a major risk factor for cardiovascular disease, affects almost half of the Navajo population. The diet of the Navajo, heavy in fat and refined carbohydrates, has been identified as an important contributing factor to the high rates of metabolic syndrome in this population. DESIGN: A search was conducted on PubMed, EMBASE and CINAHL to identify studies published before October, 2013, involving nutrition-based interventions in adult populations similar to the Navajo targeting at least one measure of metabolic syndrome. METHODS: Data on efficacy and participation were gathered and synthesised qualitatively. RESULTS: Out of 19 studies included in this systematic review, 11 interventions were identified to be effective at improving at least one measure of metabolic syndrome. Level of exposure to the intervention, frequency of intervention activities, family and social support, cultural adaptation and case management were identified as factors that may improve the efficacy of an intervention. CONCLUSIONS: Multiple nutrition-based interventions have been found to be effective in populations similar to the Navajo. RELEVANCE TO CLINICAL PRACTICE: Development of a strategy to address metabolic syndrome in the Navajo may involve aspects from multiple interventions to increase efficacy and maximise participation.

A quality improvement intervention to address provider behaviour as it relates to utilisation of CA-MRSA guidelines.

AIMS AND OBJECTIVES: To evaluate the impact of a provider focused quality improvement educational intervention on appropriate prescribing for community associated methicillin-resistant Staphylococcus aureus infection. BACKGROUND: Patient, provider and health system factors contribute to appropriate antibiotic prescription. Achieving appropriate prescribing is critical in decreasing the burden of antibiotic resistance. Knowledge of appropriate prescribing for community associated methicillin-resistant Staphylococcus aureus infection is the first step in shifting prescriber behaviour to evidence-based recommendations. DESIGN: Quality Improvement Project. METHOD: Following a review of best practice guidelines and application of the Stetler Research Utilization model, a brief educational intervention was delivered using voice over PowerPoint. Items in the educational intervention included indications for screening, particularly focusing on the role of watch and wait after culturing for simple abscesses. The intervention was delivered in a for-profit, nonacademic, urgent care setting, and assessed prescribing providers' knowledge and practice. RESULTS: Out of 48 medical doctor, physician assistant and nurse practitioner providers, 18 (37·5%) participated; 12 of the 18 (67%) participants showed an increase in knowledge. Forty three per cent of prescribers' charts demonstrated improved practice through use of the guidelines. Out of 18 prescribers, 44% sent a total of 21 cultures for abscesses. There was no difference in practice behaviours between professional groups. CONCLUSIONS: In spite of the increase in knowledge scores, this improvement in knowledge did not translate in dramatic change in practice, although trends in a positive direction were noted. RELEVANCE TO CLINICAL PRACTICE: This quality improvement project underscores the complexity of changing prescriber behaviour and the need for ongoing interventions.

Hypertension education intervention with ugandan nurses working in hospital outpatient clinic: a pilot study.

Noncommunicable diseases (NCDs) pose a significant global burden in both developed and developing countries. It is estimated that, by 2025, 41.7% of males and 38.7% of females in Sub-Saharan Africa will develop high blood pressure (HBP). This is particularly true in Uganda with hypertensive prevalence rates estimated to range from 22.5% to 30.5%. Coupled with low levels of detection, treatment, and control, hypertension represents a Ugandan public health crisis. An innovative WHO-ISH education program culturally was adapted in a pilot study and focused on knowledge, skills, and attitudes (KSA) of nurses caring for hypertensive patients in an outpatient clinic. Pre-post intervention data was collected and analyzed in which significant improvements were noted on all the three outcome measures. This pilot study demonstrated that nurses' knowledge, skills, and attitudes could be significantly improved with a multimodal education program implemented in a low resource environment.

Genetic variation in the atrial natriuretic peptide transcription factor GATA4 modulates amygdala responsiveness in alcohol dependence.

BACKGROUND: Two genome-wide association studies recently showed alcohol dependence to be associated with a single-nucleotide polymorphism (rs13273672) located on a gene (GATA4) that encodes a transcription factor of atrial natriuretic peptide (ANP). A growing body of evidence suggests that ANP might be involved in the symptomology of alcohol dependence. This study examined whether reactivity to alcohol cues in the ANP target region amygdala, a key area implicated in addictive behavior, differs depending on the GATA4 genotype of a patient. We also investigated potential associations between these differences in amygdala activation and relapse behavior. METHODS: Eighty-one abstinent, alcohol-dependent patients completed a functional magnetic resonance imaging cue-reactivity task in a 3-Tesla scanner and provided blood samples for DNA extraction. RESULTS: The results showed significantly lower alcohol-cue-induced activations in G-allele carriers as compared with AA-homozygotes in the bilateral amygdala. A survival analysis revealed that a stronger alcohol-specific amygdala response predicted a lowered risk for relapse to heavy drinking in the AA-homozygotes, whereas this effect could not be observed in G-allele carriers. CONCLUSIONS: These results illuminate potential underlying mechanisms of the involvement of the GATA4 gene in the etiology of alcohol dependence via its influence on ANP and amygdala processing.

Effects of a graduate-level interprofessional education program on adult nurse practitioner student and internal medicine resident physician attitudes towards interprofessional care.

This article describes the development, implementation and evaluation of a longitudinal interprofessional education (IPE) experience for adult nurse practitioner students and internal medicine residents. This experience focused on providing care for complex community based patients during clinic and home visits, preceded by didactic learning that emphasized understanding one another's professional roles and education, teamwork and conflict management. Evaluation demonstrated significant improvements in attitudes and beliefs associated with professional role, respect among health professions' disciplines and conflict management. Results with regards to attitudes towards IPE and interprofessional practice, and valuing teamwork training were mixed. In particular, the curricular intervention did not change participants'self-reported skill in communication and did not affect attitudes and beliefs towards effects of interprofessional education on patient outcomes.

Taking charge of the challenge: factors to consider in taking your first nurse practitioner job.

PURPOSE: To describe factors that ensure a smooth transition from nurse practitioner (NP) student to independent NP during the first year of practice. DATA SOURCES: Two contrasting case examples, the authors' experiences, and selected professional literature. CONCLUSIONS: Key points to consider upon searching or taking a first NP job include patient, colleague, and clinic factors. Patient factors include mix of patient presentations, complexity of patient presentations, insurance status, and population. Colleague factors include mentorship, charting, mix of providers, and availability of providers. Perhaps most importantly, clinic factors include productivity expectations, practice mission, charting systems, on-call requirements, supervision of other staff, and teaching status. Together, these factors can largely determine whether an NP's days are satisfying or frustrating in a new job. IMPLICATIONS FOR PRACTICE: The transition from NP student to independent NP can be daunting. Although nursing schools and practice sites have responsibilities to ensure the transition is smooth, the new NP is ultimately responsible for the transition.

An evaluation framework for faculty practice.

Faculty practice is promoted in schools of nursing for the purposes of strengthening the clinical expertise of faculty, maintaining clinically relevant curricula, fostering student learning, and generating revenue. For clinical faculty, this practice often provides the foundation for academic scholarship. The integration of this scholarship into the traditional academic triad of education, research, and service has proved difficult. Pohl et al notes, "In promotion and tenure decisions, 68 percent of faculty reported that practice was weighted less than teaching and research in their institutions." There appears to be an inherent tension between the requirements for scholarly faculty practice and the academic missions of schools of nursing. The purpose of this article is to describe a framework for the evaluation of faculty practice at the Johns Hopkins University School Nursing (JHUSON) and the actions taken to align the scholarship of faculty practice with the academic research mission of the School.