Novel halogenated flame retardants in Canadian human milk from the MIREC study (2008-2011).

Novel halogenated flame retardants (NHFRs) have been developed to replace those brominated flame retardants that have been restricted due to their persistence, bioaccumulation potential and toxicity, therefore, it is important to determine whether these replacement products are present at detectable concentrations in Canadians. NHFRs were measured in human milk samples (n = 541) collected from across Canada between 2008 and 2011, which is the first pan-Canadian dataset for these chemicals in human milk. Among the 15 measured NHFRs and eight methoxy-polybrominated diphenyl ethers (MeO-PBDEs), nine NHFRs and two MeO-PBDEs (6-MeO-PBDE 47 and 2-MeO-PBDE 68) were detected at a frequency of more than 9%. Despite benzene, 1,1'-(1,2-ethanediyl)bis [2,3,4,5,6-pentabromo-]/decabromodiphenylethane [DBDPE] being detected less frequently than the other observed NHFRs, its relative contribution to the sum of nine NHFRs was important when it was present. The maximum ΣNHFR concentration in Canadian human milk was 6930 pg g-1 lipid while the maximum ΣMeO-PBDEs was 1600 pg g-1 lipid. While most NHFR concentrations were significantly correlated with each other, no relationships between maternal age, parity or pre-pregnancy BMI were identified with ΣNHFR concentrations in the milk. In contrast, maternal age was significantly correlated with ΣMeO-PBDE concentrations (r = 0.237, p < 0.001). ΣNHFR concentrations were similarly not related to maternal education, although ΣMeO-PBDE concentrations were found to be higher in milk from women who had graduated from trade schools relative to the other education levels considered. NHFR detection frequency and concentrations observed in the Canadian human milk seem to align well with Europe.

Differences in mirex [dechlorane] and dechlorane plus [syn- and anti-] concentrations observed in Canadian human milk.

As part of the pan-Canadian Maternal-Infant Research on Environmental Chemicals (MIREC) study, human milk samples were collected between 2008 and 2011, and analyzed for mirex, an organochlorine insecticide and flame retardant, in addition to dechlorane plus (syn- and anti-DDC-CO), the flame retardant replacement for mirex. Mirex was analyzed separately, using a method for the analysis of existing organochlorine insecticides, while the presence of DDC-CO isomers was determined using a method developed for the detection of emerging flame retardants. Mirex was detected in all samples analyzed (n = 298), while syn- and anti-DDC-CO were present in 61.0% and 79.5% of the samples, respectively (n = 541). Mirex concentrations have declined in human milk since the 1990s. Since this is the first pan-Canadian dataset reporting DDC-CO concentrations in human milk, no temporal comparisons can be made. Maternal age was correlated with concentrations of both compounds although parity did not impact concentrations of either analyte. Given the presence of this relatively recently identified flame retardant (DDC-CO) in human milk from women across Canada, studies to identify dominant sources of this compound are critical. Despite low concentrations of environmental chemicals in human milk from Canadian women, Health Canada supports breastfeeding of infants because of the important health benefits to both the mothers and their infants.

Deciphering Redox State for a Metal-Rich World.

The Psyche mission's Oxidation-Reduction Working Group is focused on understanding, determining, and applying the redox state of (16) Psyche to understand the origin of a metal-rich world. The oxidation-reduction state of an asteroid, along with its temperature, parent body size, and composition, is a key parameter in determining the history of an asteroid. Determining the redox state from spacecraft data is most easily done by examining potential metal-oxide buffer pairs. The occurrence of Ni, Fe, C, Cr, P and Si, in that order, in the metal or sulfide phase of an asteroidal body indicates increasingly reduced conditions. Key observations by the Imager and Gamma-Ray and Neutron Spectrometer (GRNS) of Psyche can bracket the redox state using metal-oxide buffers. The presence of Fe,Ni metal can be confirmed by the ratios of Fe/O or Fe/Si and the concentration of Ni variability in metal across the asteroid can be determined by GRNS. The FeO concentration of silicates is complementary to the Ni concentration of metal and can be constrained using filters on the Imager. The presence of FeO in silicates from ground-based observations is one of the few measurements we already have of redox state, although available data permit a wide range of silicate compositions and mineralogies. The presence of C, P or Si concentrated in the metallic, Fe-rich portion of the asteroid, as measured by GRNS, or Ca-sulfide, determined by imaging, would indicate increasingly reducing conditions. Linkage to known types of meteorites, whether metal-rich chondrites, stony-irons or irons, expands the mineralogical, chemical and isotopic data not available from remote observations alone. Redox also controls both silicate and metal mineralogy, influencing differentiation, solidification, and subsolidus cooling, including the relative abundance of sulfur in the core and possible magnetic signatures. The redox state of Psyche, if a fully-differentiated metallic core, might constrain the location and timing of both the formation of Psyche and any oxidation it might have experienced.

Practice scholarship satisfaction and impact as perceived by DNP-prepared nurses.

BACKGROUND: Today's health systems are complex and are challenged to strive for high-quality care that leads to optimal health outcomes. Doctor of Nursing Practice (DNP)-prepared nurses have the necessary competencies to influence health systems and delivery, that lead to safe and effective practice, by implementing practice scholarship, the translation of science to transform health care delivery, and clinical inquiry to improve practice. PURPOSE: The purpose of this study was to determine DNP-prepared nurses' satisfaction with their frequency of engagement in practice scholarship, and the relationship between the satisfaction and perceived impact of practice scholarship. METHODS: In this cross-sectional study, DNP-prepared nurses (n = 309) were recruited from a U.S. national membership organization and were asked to complete an online survey. RESULTS: Usable data findings (n = 269) revealed that 81% of participants reported feeling very, or moderately, satisfied with time spent engaging in practice scholarship or clinical inquiry in the areas of quality improvement, translation of research, and evidence-based practice; however, 19% expressed minimal satisfaction or dissatisfaction. There was a significant, moderate positive correlation between impact and satisfaction with time spent engaging in practice scholarship. CONCLUSIONS: Unclear roles and the lack of objective data measurement of practice scholarship are hindering the ability of DNP-prepared nurses to work to the full extent of their education and scope of practice. IMPLICATIONS: Further studies to develop processes and tools to measure the value and impact of DNP-prepared nurses on quality and safety, health care policies, systems, and population health are recommended.

Entrustable Professional Activities in Clinical Education: A Practical Approach for Advanced Nursing Education.

BACKGROUND: Competency attainment is foremost in the ethos of this project that provides a practical guide to implementing entrustable professional activities (EPAs) as one approach to competency acquisition in the clinical education component of a health care program. EPAs are units of work that provide evidence of required competencies for the clinical education component of a program of study for educators, preceptors, and students. PROBLEM: The American Association of Colleges of Nursing has raised the importance of competency-based education and need for a practical approach to assess clinical competency challenges (eg, EPAs) in nursing education. APPROACH: The implementation of EPAs in the clinical component of advanced nursing education is detailed as an example in this article. Prioritizing a systematic approach, the Knowledge to Action framework, was chosen to guide the process. CONCLUSION: Nursing must act now to put in place a robust competency acquisition and validation system.

Impact of Practice Scholarship as Perceived by Nurses Holding a DNP Degree.

OBJECTIVE: The aim of this study was to explore the perceived impact of practice scholarship among DNP-prepared nurses and the relationship of impact to primary work role and years since graduation. BACKGROUND: Healthcare organizations continuously seek ways to improve health outcomes and reduce cost. Doctor of Nursing Practice-prepared nurses are educated with essential competencies to lead healthcare reform initiatives based on their practice scholarship contribution. METHODS: A cross-sectional design was used to administer a self-report online survey to a convenience sample of 306 DNP graduates currently in practice. RESULTS: The highest impact of practice scholarship was perceived on patients, populations, quality of care, and the profession. The impact on policy, cost, and cost savings was significantly lower. No significant difference was found on practice scholarship impact based on role or between years of experience since graduation. CONCLUSION: Doctor of Nursing Practice competencies support practice scholarship outcomes. Organizational resources are needed to support the impact of practice scholarship.

Practice scholarship engagement as reported by nurses holding a doctor of nursing practice degree.

BACKGROUND: Nearly 15 years after the introduction of the doctor of nursing practice (DNP) degree, stakeholders anticipate practice scholarship outcomes from graduates. PURPOSE: To examine the frequency of engagement in practice scholarship, the relationship between the knowledge gained in DNP programs and the frequency of engagement in practice scholarship and the relationship between engagement in practice scholarship, work role, and years since graduation with a DNP degree, as reported by practicing nurses. METHODOLOGY: This cross-sectional study recruited 306 practicing DNP graduates via a national organization and employed an electronic survey. Descriptive and inferential statistics, correlational analysis, and a one-way analysis of variance were conducted on demographics and outcome variables for 269 completed surveys. RESULTS: The practice scholarship activity reported most frequently was evaluation of current clinical evidence and least frequently was dissemination of policy papers. Reported knowledge gained from DNP programs and frequency of engagement in practice scholarship indicate a weak positive correlation. There was a significant difference in the direct care work role and practice scholarship engagement compared with other roles, and between those practicing greater than 10 years and those with less experience. CONCLUSIONS: Results highlight the underutilization of knowledge gained in DNP programs and engagement in practice scholarship. The study emphasizes the complexity of realizing practice scholarship outcomes of DNP-prepared nurses to influence patients, populations, systems, and policy as well as the advancement of the nursing profession. IMPLICATIONS: This is a call to action for DNP graduates, academia, practice, and the nursing profession to support and value practice scholarship.

Drivers for seeking the doctor of nursing practice degree and competencies acquired as reported by nurses in practice.

BACKGROUND: The American Association of Colleges of Nursing introduced the Doctor of Nursing Practice (DNP) degree in 2004. To date, few publications examine the competencies and impact of nurses with practice doctorates. PURPOSE: The purpose of this study was to examine reasons for seeking a DNP degree, assess knowledge and competencies acquired from DNP programs, and to inform stakeholders about the skills acquired by nurses with practice doctorates. METHODS: A cross-sectional design was used to administer a self-report survey to a convenience sample of DNP-prepared nurses in practice, recruited from a national membership organization. The electronic survey was designed using constructs developed from the literature, national organization position statements, and standards of doctoral nursing education. RESULTS: A total of 306 participants responded to the survey, 270 were used after data review. The majority of respondents did not seek a DNP degree because it was required for a job, to gain additional supervised practice, or to receive additional training with a specialty population. The majority strongly agreed that they gained competency in translating and synthesizing research evidence into practice, designing and implementing quality improvement, and identifying, measuring, and evaluating outcomes. CONCLUSIONS: Primary reasons for seeking a DNP degree were seeking knowledge, skills, competencies, confidence, and job opportunities. IMPLICATIONS FOR PRACTICE: Doctor of Nursing Practice-prepared nurses hold unique, advanced knowledge, competencies and skills to affect health care across multiple settings. Study results suggest that highly skilled DNP-prepared nurses are equipped to lead quality improvement, engage in practice scholarship, and improve clinical outcomes.

Traumatic brain injury epidemiology and rehabilitation in Ireland: a protocol paper.

Background: Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. In Ireland, a dearth of research means that we neither know the number of people affected by TBI, nor have the required data to improve neuro-rehabilitation services. This is a study protocol to examine the epidemiology and pathways through rehabilitation for a cohort of TBI survivors in the Republic of Ireland. Aims:  1. To document the epidemiological data of TBIs in Ireland. 2. To explore the pathway of TBI survivors through rehabilitation/health services. 3. To document the experiences of those providing care for TBI survivors in Ireland Methods: This is a quantitative cohort study. Existing routine datasets will be used to report epidemiological data. Participants with moderate or severe TBI will be recruited through two brain injury service providers, two acute hospitals that provide neurosurgical services, and the National Rehabilitation Hospital. Participants with TBI will be surveyed on two separate occasions, to explore their use of health and rehabilitation services. Those providing care or support to TBI survivors will be surveyed, on one occasion. Additionally, data from the medical records of TBI survivors will be extracted to capture key information about their TBI, such as mechanism of injury, severity, hospitalisation and follow-up. TBI survivors' use of health care will be followed prospectively for six months. Expected outcomes: The epidemiological data of TBI in Ireland will be documented. Data on survivors' experiences of how rehabilitation services are accessed, and any barriers encountered with rehabilitation/health services will be reported. The experiences of those providing care or support for TBI survivors will be captured. It is expected that the outcomes of the study will support advocacy efforts toward the redevelopment of neuro-rehabilitation services in the Republic of Ireland.

The practice doctorate approach to assessing advanced nursing practice in Ireland.

AIM: To describe the practice doctorate scholarly approach to assess advanced nursing practice in Ireland to address healthcare and nursing policy initiatives. BACKGROUND: A global team from Ireland and the United States collaborated with stakeholders, using a practice doctorate approach to identify geographic healthcare needs, the current state of the education and the evolving roles of advanced nursing practice. In Ireland, current policy initiatives call for expanding the capacity for advanced nurse practitioners to meet healthcare needs in community settings. SOURCES OF EVIDENCE: Further assessment data were required from stakeholders to inform graduate nursing education to prepare advanced practice nurses to fulfil increasingly complex healthcare needs. The practice doctorate approach included review of literature, current policy and assessment with interviews, dialogue and the development of working relationships with policymakers, academics and practitioners. DISCUSSION: The current state and future vision of graduate nursing education are evolving. A force field analysis identified promoting and restraining factors to the desired state of development of the primary care advanced practice role. Relationship building with stakeholders and sharing of expertise was key to engage academia and policymakers to address identified restraining forces. Short-term outcomes included development of collaborative relationships between practice, academia and policymakers, curricular development for the primary care nurse practitioner and intentionally shared dissemination to promote community graduate nursing education. IMPLICATIONS FOR NURSING PRACTICE: This innovative practice scholarship approach was used to assess and promote advanced nursing practice impact and promote the nursing profession globally. IMPLICATIONS FOR POLICY: Successful collaboration between two global partners was achieved to promote policy objectives for both nursing and health care, with the ultimate goal of improving health outcomes and population health.

The fall, recovery, classification, and initial characterization of the Hamburg, Michigan H4 chondrite.

The Hamburg meteorite fell on January 16, 2018, near Hamburg, Michigan, after a fireball event widely observed in the U.S. Midwest and in Ontario, Canada. Several fragments fell onto frozen surfaces of lakes and, thanks to weather radar data, were recovered days after the fall. The studied rock fragments show no or little signs of terrestrial weathering. Here, we present the initial results from an international consortium study to describe the fall, characterize the meteorite, and probe the collision history of Hamburg. About 1 kg of recovered meteorites was initially reported. Petrology, mineral chemistry, trace element and organic chemistry, and O and Cr isotopic compositions are characteristic of H4 chondrites. Cosmic ray exposure ages based on cosmogenic 3He, 21Ne, and 38Ar are ~12 Ma, and roughly agree with each other. Noble gas data as well as the cosmogenic 10Be concentration point to a small 40-60 cm diameter meteoroid. An 40Ar-39Ar age of 4532 ± 24 Ma indicates no major impact event occurring later in its evolutionary history, consistent with data of other H4 chondrites. Microanalyses of phosphates with LA-ICPMS give an average Pb-Pb age of 4549 ± 36 Ma. This is in good agreement with the average SIMS Pb-Pb phosphate age of 4535.3 ± 9.5 Ma and U-Pb Concordia age of 4535 ± 10 Ma. The weighted average age of 4541.6 ± 9.5 Ma reflects the metamorphic phosphate crystallization age after parent body formation in the early solar system.

Nursing in the Mercy Traditions: Engaging Students in the Life of Catherine McAuley.

The Institute of Medicine and the American Association of Colleges of Nursing advise that professional nursing education include development of a high level of cultural competency. A 10-day learning experience to Ireland for nursing students at the University of Detroit Mercy, an independent Catholic university, sponsored by the Sisters of Mercy and the Society of Jesus (Jesuit Fathers), helped them develop a philosophy of Mercy care and build cultural competence. Learning focused on the life of Catherine McAuley, Irish culture, spirituality, social justice, reflective thinking, and a value-centered professional education.

A method for the analysis of multiple novel halogenated flame retardants in cow's milk.

A method was developed for the extraction and analysis of cow's milk to measure 21 halogenated flame retardants (FRs), including individual isomers plus eight methoxy-polybrominated diphenyl ethers (MeO-PBDEs). Extraction was performed using homogenisation with acetone:hexane with size exclusion chromatography followed by adsorption chromatography clean-up. Analysis was undertaken using gas chromatography high-resolution mass spectrometry. The method was validated in fortified cow's milk with FRs and 2-methoxy-PBDE 68 at three levels (low [12.5-1250 pg g(-)(1)], mid [37.5-5000 pg g(-)(1)] and high [400-10 000 pg g(-)(1)]). Additional methoxy-PBDEs were tested at two fortification levels. Isotope dilution was used to correct for losses during sample preparation and average recoveries ranged from 58% (allyl 2,4,6-tribromophenyl ether [ATE]) to 121% (γ-tetrabromoethylcyclohexane (γ-TBECH)). Limits of detection ranged from 0.055 pg g(-)(1) (6-methoxy-PBDE 47) to 38.9 pg g(-)(1) (decabromodiphenylethane (DBDPE)). Matrix effects were overcome through the use of surrogate and performance standards. A single FR (1-bromomethyl-2,3,4,5,6-pentabromobenzene [PBBB]) and two methoxy-PBDEs were detected in commercially available cow's milk collected from local supermarkets in Ottawa, ON, Canada. Detection frequency was < 25% for these compounds and, where present, concentrations were low.

Social Support, Postpartum Depression, and Professional Assistance: A Survey of Mothers in the Midwestern United States.

Transition into motherhood is generally a joyful life event; for some women, however, it is marked by emotional turmoil. Lack of support can be associated with postpartum depression and can compromise both the mother and infant. A descriptive, cross-sectional study (N = 61) was conducted to explore the relationship between social support and postpartum depression and to determine whether mothers overwhelmed with childcare, or overwhelmed with life in general since becoming a mother, sought professional help. The results revealed that screening for depression alone may not be sufficient, that mothers are willing to contact a professional for help in the postpartum period, and that assessments after birth should include a broader assessment of life's difficulties rather than focusing on childcare responsibilities alone.