Sample records for advanced generalist practice

  1. Examining the practice of generalist expertise: a qualitative study identifying constraints and solutions

    PubMed Central

    Reeve, Joanne; Dowrick, Christopher F; Freeman, George K; Gunn, Jane; Mair, Frances; May, Carl; Mercer, Stewart; Palmer, Victoria; Howe, Amanda; Irving, Greg; Shiner, Alice; Watson, Jessica

    2013-01-01

    Objectives Provision of person-centred generalist care is a core component of quality primary care systems. The World Health Organisation believes that a lack of generalist primary care is contributing to inefficiency, ineffectiveness and inequity in healthcare. In UK primary care, General Practitioners (GPs) are the largest group of practising generalists. Yet GPs fulfil multiple roles and the pressures of delivering these roles along with wider contextual changes create real challenges to generalist practice. Our study aimed to explore GP perceptions of enablers and constraints for expert generalist care, in order to identify what is needed to ensure health systems are designed to support the generalist role. Design Qualitative study in General Practice. Setting UK primary care. Main outcome measures A qualitative study – interviews, surveys and focus groups with GPs and GP trainees. Data collection and analysis was informed by Normalisation Process Theory. Design and setting Qualitative study in General Practice. We conducted interviews, surveys and focus groups with GPs and GP trainees based mainly, but not exclusively, in the UK. Data collection and analysis were informed by Normalization Process Theory. Participants UK based GPs (interview and surveys); European GP trainees (focus groups). Results Our findings highlight key gaps in current training and service design which may limit development and implementation of expert generalist practice (EGP). These include the lack of a consistent and universal understanding of the distinct expertise of EGP, competing priorities inhibiting the delivery of EGP, lack of the consistent development of skills in interpretive practice and a lack of resources for monitoring EGP. Conclusions We describe four areas for change: Translating EGP, Priority setting for EGP, Trusting EGP and Identifying the impact of EGP. We outline proposals for work needed in each area to help enhance the expert generalist role. PMID:24475347

  2. 2013 Update in addiction medicine for the generalist.

    PubMed

    Gordon, Adam J; Bertholet, Nicolas; McNeely, Jennifer; Starrels, Joanna L; Tetrault, Jeanette M; Walley, Alexander Y

    2013-11-04

    Increasingly, patients with unhealthy alcohol and other drug use are being seen in primary care and other non-specialty addiction settings. Primary care providers are well positioned to screen, assess, and treat patients with alcohol and other drug use because this use, and substance use disorders, may contribute to a host of medical and mental health harms. We sought to identify and examine important recent advances in addiction medicine in the medical literature that have implications for the care of patients in primary care or other generalist settings. To accomplish this aim, we selected articles in the field of addiction medicine, critically appraised and summarized the manuscripts, and highlighted their implications for generalist practice. During an initial review, we identified articles through an electronic Medline search (limited to human studies and in English) using search terms for alcohol and other drugs of abuse published from January 2010 to January 2012. After this initial review, we searched for other literature in web-based or journal resources for potential articles of interest. From the list of articles identified in these initial reviews, each of the six authors independently selected articles for more intensive review and identified the ones they found to have a potential impact on generalist practice. The identified articles were then ranked by the number of authors who selected each article. Through a consensus process over 4 meetings, the authors reached agreement on the articles with implications for practice for generalist clinicians that warranted inclusion for discussion. The authors then grouped the articles into five categories: 1) screening and brief interventions in outpatient settings, 2) identification and management of substance use among inpatients, 3) medical complications of substance use, 4) use of pharmacotherapy for addiction treatment in primary care and its complications, and 5) integration of addiction treatment and

  3. Practice, clinical management, and financial arrangements of practicing generalists.

    PubMed

    Keating, Nancy L; Landon, Bruce E; Ayanian, John Z; Borbas, Catherine; Guadagnoli, Edward

    2004-05-01

    To describe the practice settings, financial arrangements, and management strategies experienced by generalist physicians and identify factors associated with reporting pressure to limit referrals, pressure to see more patients, and career dissatisfaction. Cross-sectional mail survey. Six hundred nineteen generalist physicians (62% response rate) caring for managed care patients in 3 Minnesota health plans during 1999. Twenty-six percent of physicians reported pressure to limit referrals. In adjusted analyses, female physicians and those who were board certified acted as gatekeepers for most of their patients, received incentives based on performance reports and quality profiles, and received direct income from capitation, and were more likely than others to report this pressure (all P <.05). Sixty-two percent reported pressure to see more patients. In adjusted analyses, this pressure was more frequent among physicians in practices owned by health systems, those using physician extenders, and among physicians paid by salary with performance adjustment or those receiving at least some capitation (all P <.05). One-quarter (24%) of physicians were dissatisfied with their career in medicine. In adjusted analyses, physicians reporting pressure to limit referrals (risk ratio, 1.12; 95% confidence interval, 1.01 to 1.19) and those reporting pressure to see more patients (risk ratio, 1.37; 95% confidence interval, 1.08 to 1.66) were more likely to be dissatisfied than other physicians. Pressures to limit referrals and to see more patients are common, particularly among physicians paid based on productivity or capitation, and they are associated with career dissatisfaction. Whether future changes in practice arrangements or compensation strategies can decrease such physician-reported pressures, and ultimately improve physician satisfaction, will be an important area for future study.

  4. The impact of workforce redesign policies on role boundaries in 'generalist' podiatry practice: expert views within the professional body.

    PubMed

    Stressing, Samantha J; Borthwick, Alan M

    2014-01-01

    Demographic changes and a predicted rise in the prevalence of chronic illness have led to a range of health policies in the UK (and elsewhere) focused on workforce flexibility and extended roles for the allied health professions. Whilst much academic attention has been paid to extended specialised roles for allied health professionals such as podiatrists, little work has addressed the likely impact of these policy changes on non-specialist, 'generalist' podiatry practice. This study aimed to explore expert professional views on the impact of role flexibility on generalist podiatry practice. Expert podiatry practitioners drawn from within the professional body, the Society of Chiropodists and Podiatrists/College of Podiatry were recruited to 3 focus groups and 4 individual semi structured interviews and the data subject to a thematic analysis. Three key themes emerged, reflecting concerns about the future of generalist podiatry practice in the NHS, a perceived likelihood that generalist care will move inexorably towards private sector provision, and a growth in support worker grades undermining the position of generalist practice in the mainstream health division of labour. Up skilling generalist practitioners was viewed as the strongest defence against marginalisation. An emphasis on enhanced and specialised roles in podiatry by NHS commissioners and profession alike may threaten the sustainability of generalist podiatry provision in the state funded NHS. Non-specialist general podiatry may increasingly become the province of the private sector.

  5. The expert-generalist: a contradiction whose time has come.

    PubMed

    Fins, Joseph J

    2015-08-01

    The author suggests the creation of expert-generalists to help provide the additional cost-effective access to care necessitated by increased insurance coverage under the Affordable Care Act. Expert-generalists, a concept drawn from an extant Canadian model, would be a cohort of primary care physicians who obtain additional training in a subspecialty area, which would widen their practice portfolio and bring enhanced infrastructure to primary care settings. Expanding the reach of primary care into the realm of more advanced subspecialty practice could be a way to enhance both access to and quality of care in a cost-effective fashion, in part because the educational framework for additional training already exists. Trainees could opt for an extra year of training after traditional residency or return to training after years in practice. Properly trained, an expert-generalist would benefit both the quality of the patient experience and the bottom line by expertly triaging patients to determine who will truly benefit from specialty consultations, decreasing specialists' engagement with cases that do not require their higher-tier care. The author considers the merits of this proposal, as well as potential objections and implementation challenges. It is suggested that this model be adopted incrementally, using demonstration projects that could assess the impact of an expert-generalist initiative on the physician workforce and on patients' access to quality primary and specialty care.

  6. Generalist solutions to complex problems: generating practice-based evidence - the example of managing multi-morbidity

    PubMed Central

    2013-01-01

    Background A growing proportion of people are living with long term conditions. The majority have more than one. Dealing with multi-morbidity is a complex problem for health systems: for those designing and implementing healthcare as well as for those providing the evidence informing practice. Yet the concept of multi-morbidity (the presence of >2 diseases) is a product of the design of health care systems which define health care need on the basis of disease status. So does the solution lie in an alternative model of healthcare? Discussion Strengthening generalist practice has been proposed as part of the solution to tackling multi-morbidity. Generalism is a professional philosophy of practice, deeply known to many practitioners, and described as expertise in whole person medicine. But generalism lacks the evidence base needed by policy makers and planners to support service redesign. The challenge is to fill this practice-research gap in order to critically explore if and when generalist care offers a robust alternative to management of this complex problem. We need practice-based evidence to fill this gap. By recognising generalist practice as a ‘complex intervention’ (intervening in a complex system), we outline an approach to evaluate impact using action-research principles. We highlight the implications for those who both commission and undertake research in order to tackle this problem. Summary Answers to the complex problem of multi-morbidity won’t come from doing more of the same. We need to change systems of care, and so the systems for generating evidence to support that care. This paper contributes to that work through outlining a process for generating practice-based evidence of generalist solutions to the complex problem of person-centred care for people with multi-morbidity. PMID:23919296

  7. Generalist solutions to complex problems: generating practice-based evidence--the example of managing multi-morbidity.

    PubMed

    Reeve, Joanne; Blakeman, Tom; Freeman, George K; Green, Larry A; James, Paul A; Lucassen, Peter; Martin, Carmel M; Sturmberg, Joachim P; van Weel, Chris

    2013-08-07

    A growing proportion of people are living with long term conditions. The majority have more than one. Dealing with multi-morbidity is a complex problem for health systems: for those designing and implementing healthcare as well as for those providing the evidence informing practice. Yet the concept of multi-morbidity (the presence of >2 diseases) is a product of the design of health care systems which define health care need on the basis of disease status. So does the solution lie in an alternative model of healthcare? Strengthening generalist practice has been proposed as part of the solution to tackling multi-morbidity. Generalism is a professional philosophy of practice, deeply known to many practitioners, and described as expertise in whole person medicine. But generalism lacks the evidence base needed by policy makers and planners to support service redesign. The challenge is to fill this practice-research gap in order to critically explore if and when generalist care offers a robust alternative to management of this complex problem. We need practice-based evidence to fill this gap. By recognising generalist practice as a 'complex intervention' (intervening in a complex system), we outline an approach to evaluate impact using action-research principles. We highlight the implications for those who both commission and undertake research in order to tackle this problem. Answers to the complex problem of multi-morbidity won't come from doing more of the same. We need to change systems of care, and so the systems for generating evidence to support that care. This paper contributes to that work through outlining a process for generating practice-based evidence of generalist solutions to the complex problem of person-centred care for people with multi-morbidity.

  8. Revising the Definition of the Generalist Physician.

    ERIC Educational Resources Information Center

    Altman, David F.

    1995-01-01

    Although generalist physicians have traditionally been defined by their specialties (family, internal, pediatric medicine), this approach may not recognize specific competencies and training needed. A new definition based on functional requirements of generalist practice and the central role of the generalist in comprehensive care is proposed.…

  9. Generalists to Specialists: Transformative Evidences and Impediments to Student-Centered Practices of Primary Music and Art Teachers in Singapore

    ERIC Educational Resources Information Center

    Costes-Onishi, Pamela; Caleon, Imelda

    2016-01-01

    This article fills in the knowledge gap in the student-centered practices of generalist music and art teachers to prepare 21st century learners. The study shows that generalists, after completing a specialist professional development program, struggle the most in connecting subject matter knowledge to pedagogical knowledge, specifically…

  10. Applying research to practice: generalist and specialist (visual ergonomics) consultancy.

    PubMed

    Long, Jennifer; Long, Airdrie

    2012-01-01

    Ergonomics is a holistic discipline encompassing a wide range of special interest groups. The role of an ergonomics consultant is to provide integrated solutions to improve comfort, safety and productivity. In Australia, there are two types of consultants--generalists and specialists. Both have training in ergonomics but specialist knowledge may be the result of previous education or work experience. This paper presents three projects illustrating generalist and specialist (visual ergonomics) consultancy: development of a vision screening protocol, solving visual discomfort in an office environment and solving postural discomfort in heavy industry. These case studies demonstrate how multiple ergonomics consultants may work together to solve ergonomics problems. It also describes some of the challenges for consultants, for those engaging their services and for the ergonomics profession, e.g. recognizing the boundaries of expertise, sharing information with business competitors, the costs-benefits of engaging multiple consultants and the risk of fragmentation of ergonomics knowledge and solutions. Since ergonomics problems are often multifaceted, ergonomics consultants should have a solid grounding in all domains of ergonomics, even if they ultimately only practice in one specialty or domain. This will benefit the profession and ensure that ergonomics remains a holistic discipline.

  11. Oncology Nurse Generalist Competencies: Oncology Nursing Society's Initiative to Establish Best Practice.

    PubMed

    Gaguski, Michele E; George, Kim; Bruce, Susan D; Brucker, Edie; Leija, Carol; LeFebvre, Kristine B; Mackey, Heather

    2017-12-01

    A project team was formulated to create evidence-based oncology nurse generalist competencies (ONGCs) to establish best practices in competency development, including high-risk tasks, critical thinking criteria, and measurement of key areas for oncology nurses.
. This article aims to describe the process and the development of ONGCs. 
. This article explains how the ONGCs were accomplished, and includes outcomes and suggestions for use in clinical practice. 
. Institutions can use the ONGCs to assess and develop competency programs, offer educational strategies to measure proficiency, and establish processes to foster a workplace committed to mentoring and teaching future oncology nurses.

  12. Medical nutrition therapy in adults with chronic kidney disease: integrating evidence and consensus into practice for the generalist registered dietitian nutritionist.

    PubMed

    Beto, Judith A; Ramirez, Wendy E; Bansal, Vinod K

    2014-07-01

    Chronic kidney disease is classified in stages 1 to 5 by the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative depending on the level of renal function by glomerular filtration rate and, more recently, using further categorization depending on the level of glomerular filtration rate and albuminuria by the Kidney Disease Improving Global Outcomes initiative. Registered dietitian nutritionists can be reimbursed for medical nutrition therapy in chronic kidney disease stages 3 to 4 for specific clients under Center for Medicare and Medicaid Services coverage. This predialysis medical nutrition therapy counseling has been shown to both potentially delay progression to stage 5 (renal replacement therapy) and decrease first-year mortality after initiation of hemodialysis. The Joint Standards Task Force of the American Dietetic Association (now the Academy of Nutrition and Dietetics), the Renal Nutrition Dietetic Practice Group, and the National Kidney Foundation Council on Renal Nutrition collaboratively published 2009 Standards of Practice and Standards of Professional Performance for generalist, specialty, and advanced practice registered dietitian nutritionists in nephrology care. The purpose of this article is to provide an update on current recommendations for screening, diagnosis, and treatment of adults with chronic kidney disease for application in clinical practice for the generalist registered dietitian nutritionist using the evidence-based library of the Academy of Nutrition and Dietetics, published clinical practice guidelines (ie, National Kidney Foundation Council on Renal Nutrition, Renal Nutrition Dietetic Practice Group, Kidney Disease Outcomes Quality Initiative, and Kidney Disease Improving Global Outcomes), the Nutrition Care Process model, and peer-reviewed literature. Copyright © 2014 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

  13. Best of Both Worlds: A Conceptual Model for Integrating an Aging Specialization within an Advanced Generalist MSW Program

    ERIC Educational Resources Information Center

    Dakin, Emily K.; Quijano, Louise M.; Bishop, Pamela S.; Sheafor, Bradford W.

    2015-01-01

    Must a master's of social work (MSW) program's orientation be either advanced generalist or some form of specialist? Or is there the possibility of a hybrid curriculum that provides enough breadth to prepare MSW graduates for a wide range of social work jobs, but that also addresses students' and community agencies' demands for student…

  14. Oncology Nurse Generalist Competencies: Oncology Nursing Society’s Initiative to Establish Best Practice

    PubMed

    Gaguski, Michele; George, Kim; Bruce, Susan; Brucker, Edie; Leija, Carol; LeFebvre, Kristine; Thompson Mackey, Heather

    2017-09-25

    A project team was formulated by the Oncology Nursing Society (ONS) to create evidence-based oncology nurse generalist (ONG) competencies to establish best practices in competency development, including high-risk tasks, critical thinking criteria, and measurement of key areas for oncology nurses. This article aims to describe the process and the development of ONG competencies. This article describes how the ONG competencies were accomplished, and includes outcomes and suggestions for use in clinical practice. Institutions can use the ONG competencies to assess and develop competency programs, offer unique educational strategies to measure and appraise proficiency, and establish processes to foster a workplace environment committed to mentoring and teaching future oncology nurses. 2017 Oncology Nursing Society

  15. Lower Rates of Promotion of Generalists in Academic Medicine: A Follow-up to the National Faculty Survey.

    PubMed

    Blazey-Martin, Deborah; Carr, Phyllis L; Terrin, Norma; Breeze, Janis L; Luk, Carolyn; Raj, Anita; Freund, Karen M

    2017-07-01

    Prior cross-sectional research has found that generalists have lower rates of academic advancement than specialists and basic science faculty. Our objective was to examine generalists relative to other medical faculty in advancement and academic productivity. In 2012, we conducted a follow-up survey (n = 607) of 1214 participants in the 1995 National Faculty Survey cohort and supplemented survey responses with publicly available data. Participants were randomly selected faculty from 24 US medical schools, oversampling for generalists, underrepresented minorities, and senior women. The primary outcomes were (1) promotion to full professor and (2) productivity, as indicated by mean number of peer-reviewed publications, and federal grant support in the prior 2 years. When comparing generalists with medical specialists, surgical specialists, and basic scientists on these outcomes, we adjusted for gender, race/ethnicity, effort distribution, parental and marital status, retention in academic career, and years in academia. When modeling promotion to full professor, we also adjusted for publications. In the intervening 17 years, generalists were least likely to have become full professors (53%) compared with medical specialists (67%), surgeons (66%), and basic scientists (78%, p < 0.0001). Generalists had a lower number of publications (mean = 44) than other faculty [medical specialists (56), surgeons (57), and basic scientists (83), p < 0.0001]. In the prior 2 years, generalists were as likely to receive federal grant funding (26%) as medical (21%) and surgical specialists (21%), but less likely than basic scientists (51%, p < 0.0001). In multivariable analyses, generalists were less likely to be promoted to full professor; however, there were no differences in promotion between groups when including publications as a covariate. Between 1995 and 2012, generalists were less likely to be promoted than other academic faculty; this difference in

  16. Information needs of generalists and specialists using online best-practice algorithms to answer clinical questions.

    PubMed

    Cook, David A; Sorensen, Kristi J; Linderbaum, Jane A; Pencille, Laurie J; Rhodes, Deborah J

    2017-07-01

    To better understand clinician information needs and learning opportunities by exploring the use of best-practice algorithms across different training levels and specialties. We developed interactive online algorithms (care process models [CPMs]) that integrate current guidelines, recent evidence, and local expertise to represent cross-disciplinary best practices for managing clinical problems. We reviewed CPM usage logs from January 2014 to June 2015 and compared usage across specialty and provider type. During the study period, 4009 clinicians (2014 physicians in practice, 1117 resident physicians, and 878 nurse practitioners/physician assistants [NP/PAs]) viewed 140 CPMs a total of 81 764 times. Usage varied from 1 to 809 views per person, and from 9 to 4615 views per CPM. Residents and NP/PAs viewed CPMs more often than practicing physicians. Among 2742 users with known specialties, generalists ( N  = 1397) used CPMs more often (mean 31.8, median 7 views) than specialists ( N  = 1345; mean 6.8, median 2; P  < .0001). The topics used by specialists largely aligned with topics within their specialties. The top 20% of available CPMs (28/140) collectively accounted for 61% of uses. In all, 2106 clinicians (52%) returned to the same CPM more than once (average 7.8 views per topic; median 4, maximum 195). Generalists revisited topics more often than specialists (mean 8.8 vs 5.1 views per topic; P  < .0001). CPM usage varied widely across topics, specialties, and individual clinicians. Frequently viewed and recurrently viewed topics might warrant special attention. Specialists usually view topics within their specialty and may have unique information needs. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  17. DNA barcodes affirm that 16 species of apparently generalist tropical parasitoid flies (Diptera, Tachinidae) are not all generalists

    PubMed Central

    Smith, M. Alex; Wood, D. Monty; Janzen, Daniel H.; Hallwachs, Winnie; Hebert, Paul D. N.

    2007-01-01

    Many species of tachinid flies are viewed as generalist parasitoids because what is apparently a single species of fly has been reared from many species of caterpillars. However, an ongoing inventory of the tachinid flies parasitizing thousands of species of caterpillars in Area de Conservación Guanacaste, northwestern Costa Rica, has encountered >400 species of specialist tachinids with only a few generalists. We DNA-barcoded 2,134 flies belonging to what appeared to be the 16 most generalist of the reared tachinid morphospecies and encountered 73 mitochondrial lineages separated by an average of 4% sequence divergence. These lineages are supported by collateral ecological information and, where tested, by independent nuclear markers (28S and ITS1), and we therefore view these lineages as provisional species. Each of the 16 apparently generalist species dissolved into one of four patterns: (i) a single generalist species, (ii) a pair of morphologically cryptic generalist species, (iii) a complex of specialist species plus a generalist, or (iv) a complex of specialists with no remaining generalist. In sum, there remained 9 generalist species among the 73 mitochondrial lineages we analyzed, demonstrating that a generalist lifestyle is possible for a tropical caterpillar parasitoid fly. These results reinforce the emerging suspicion that estimates of global species richness are likely underestimates for parasitoids (which may constitute as much as 20% of all animal life) and that the strategy of being a tropical generalist parasitic fly may be yet more unusual than has been envisioned for tachinids. PMID:17360352

  18. A Model of Teaching-Learning Transactions in Generalist-Specialist Consultations

    ERIC Educational Resources Information Center

    Shershneva, Marianna B.; Carnes, Molly; Bakken, Lori L.

    2006-01-01

    Introduction: A new paradigm in continuing medical education is characterized by emphasis on physicians' learning in practice. Consistent with this paradigm, our study examined a subset of clinical practice--generalist-specialist consultations--from an educational perspective. Methods: We applied the grounded-theory method with semistructured…

  19. The Scientific Basis of Generalist Medicine.

    ERIC Educational Resources Information Center

    Pruessner, Harold T.; And Others

    1992-01-01

    One reason medical students favor specialization over generalist medicine (primary care) is a perception of generalist medicine as nonrigorous. Chaos science, a new field, reveals an intellectual basis for generalist medicine. The history, strengths, and limits of reductionist thinking in medicine and aspects of chaos theory illuminate this…

  20. A specialist-generalist classification of the arable flora and its response to changes in agricultural practices

    PubMed Central

    2010-01-01

    developed in stable environments are valid in highly disturbed environments such as agro-ecosystems. The approach developed here to classify arable weeds according to the breadth of their ecological niche is robust and applicable to a wide range of organisms. It is also sensitive to disturbance regime and we show here that recent changes in agricultural practices, i.e. increased levels of disturbance have favoured the most generalist species, hence leading to biotic homogenisation in arable landscapes. PMID:20809982

  1. Reading and Generalist Genes

    ERIC Educational Resources Information Center

    Haworth, Claire M. A.; Meaburn, Emma L.; Harlaar, Nicole; Plomin, Robert

    2007-01-01

    Twin-study research suggests that many (but not all) of the same genes contribute to genetic influence on diverse learning abilities and disabilities, a hypothesis called "generalist genes". This generalist genes hypothesis was tested using a set of 10 DNA markers (single nucleotide polymorphisms [SNPs]) found to be associated with early reading…

  2. The METIS project for generalist ultrasonography.

    PubMed

    Bono, F; Campanini, A

    2007-12-01

    Reorganization of the community healthcare system and the growing presence of group practices in the field of general medicine have increased the demands placed on primary-care medicine, in terms of the skills required and the level of responsibility. Satisfying the need for rapid, effective primary-care solutions to the health problems of citizens is easier thanks to technological and medical advances that provide high level equipment at costs within the reach of general practitioners (GPs). In the near future, trained GPs equipped with appropriate diagnostic scanners will be able to handle up to 40% of the requests of ultrasound examinations of each primary-care group (each PCG includes approximately 15,000-20,000 citizens). The Italian Federation of General Practitioners (Federazione Italiana dei Medici di Medicina Generale - FIMMG) and its Scientific Society, METIS, have organized national courses for those GPs who wish to become generalist ultrasonographers, in a joint effort with the two most important Italian scientific societies of imaging, the Italian Society of Ultrasonology in Medicine and Biology and the Italian Society of Medical Radiology.

  3. Learning abilities and disabilities: generalist genes in early adolescence.

    PubMed

    Davis, Oliver S P; Haworth, Claire M A; Plomin, Robert

    2009-01-01

    The new view of cognitive neuropsychology that considers not just case studies of rare severe disorders but also common disorders, as well as normal variation and quantitative traits, is more amenable to recent advances in molecular genetics, such as genome-wide association studies, and advances in quantitative genetics, such as multivariate genetic analysis. A surprising finding emerging from multivariate quantitative genetic studies across diverse learning abilities is that most genetic influences are shared: they are "generalist", rather than "specialist". We exploited widespread access to inexpensive and fast Internet connections in the United Kingdom to assess over 5000 pairs of 12-year-old twins from the Twins Early Development Study (TEDS) on four distinct batteries: reading, mathematics, general cognitive ability (g) and, for the first time, language. Genetic correlations remain high among all of the measured abilities, with language as highly correlated genetically with g as reading and mathematics. Despite developmental upheaval, generalist genes remain important into early adolescence, suggesting optimal strategies for molecular genetic studies seeking to identify the genes of small effect that influence learning abilities and disabilities.

  4. Making Generalists Out of Specialists.

    ERIC Educational Resources Information Center

    Malinowski, Jon C.

    2001-01-01

    Most camps use specialists to run activities and cabin leaders to manage campers. However, a generalist model offers greater leadership development opportunities. To implement a more generalist paradigm, have camp leaders express their areas of skill and interest, pair up experienced and inexperienced staff, allow specialists to cover activities…

  5. Implementing Cooperative Learning in Australian Primary Schools: Generalist Teachers' Perspectives

    ERIC Educational Resources Information Center

    Hennessey, Angela; Dionigi, Rylee A.

    2013-01-01

    To implement cooperative learning successfully in practice, teachers require knowledge of cooperative learning, its features and terms, and how it functions in classrooms. This qualitative study examined 12 Australian generalist primary teachers', understandings of cooperative learning and perceived factors affecting its implementation. Using…

  6. Generalist Teachers' Self-Efficacy in Primary School Music Teaching

    ERIC Educational Resources Information Center

    de Vries, Peter

    2013-01-01

    This qualitative study focuses on the music teaching experiences of five Australian generalist primary school teachers in their third year of teaching. The aim was to identify these teachers' current practices in teaching music, in particular their self-efficacy in relation to teaching music. A narrative inquiry methodology was employed, drawing…

  7. Perceived Social-Ecological Barriers of Generalist Pre-Service Teachers towards Teaching Physical Education: Findings from the GET-PE Study

    ERIC Educational Resources Information Center

    Hyndman, Brendon P.

    2017-01-01

    Identifying and understanding the perceptions of pre-service teachers (PSTs) is vital to informing teaching practices. The purpose of the "Generalist Entry into Teaching Physical Education" (GET-PE) study was to investigate Australian generalist PSTs' perceptions of the barriers to teaching physical education (PE) classes. A…

  8. Distributions of Bacterial Generalists among the Guts of Birds ...

    EPA Pesticide Factsheets

    Complex distributions of bacterial taxa within diverse animal microbiomes have inspired ecological and biogeographical approaches to revealing the functions of taxa that may be most important for host health. Of particular interest are bacteria that find many diverse habitats suitable for growth and remain competitive amongst finely-tuned host specialists. While previous work has focused on identifying these specialists, here our aims were to 1) identify generalist taxa, 2) identify taxonomic clades with enriched generalist diversity, and 3) describe the distribution of the largest generalist groups among hosts. We analyzed existing bacterial rRNA tag-sequencing data (v6) available on VAMPs (vamps.mbl.edu) from the microbiomes of 12 host species (106 samples total) spanning birds, mammals, and fish for generalist taxa using the CLAM test. OTUs with approximately equal abundance and a minimum of 10 reads in two hosts were classified as generalists. Generalist OTUs (n=2,982) were found in all hosts tested. Bacterial families Alcaligenaceae and Burkholderiaceae were significantly enriched with generalists OTUs compared to other families. Bacterial families such as Bacteroidaceae and Lachnospiraceae significantly lacked generalists OTUs compared to other families. Enterobacteriaceae, Peptostreptococcaceae, and Erysipelotrichaceae more so than other bacterial families were widely distributed and abundant in birds, mammals, and fish suggesting that these taxa mainta

  9. Determinants of the generalist career intentions of 1995 graduating medical students.

    PubMed

    Kassebaum, D G; Szenas, P L; Schuchert, M K

    1996-02-01

    Using national databases of the Association of American Medical College, the authors employed logistic regression analysis to show the relative predictive influences of selected demographic, structural, attitudinal, and educational variables on the specialty careers choices of 1995 U.S. medical school graduates. Plans to pursue certification in family practice or an unspecified generalist career could be predicted with moderate success, while choices of general internal medicine and general pediatrics could not. The intentions of the 1995 graduates to pursue generalist specialty, were significantly associated with demographic factors such as female gender, older student age, and rural hometown; early interest in the generalist specialties; attitudes favoring helping people over seeking opportunities for leadership, intellectual challenge, or research; the presence of a department of family medicine in the medical school; and ambulatory care experiences in the third and fourth years. In the multiple-regression models used in this study, a number of factors widely touted as important to the cultivation of generalism were not significant predictors of generalist decisions; an institutional mission statement expressly addressing the cultivation of generalist careers; giving admission preferences to applicants who vowed an interest in generalism; public (versus private) school sponsorship; discrete organization units for general internal medical or general pediatrics; the proportion of institutional faculty in the general specialty of medicine and pediatrics; the level of educational debt; the students; clinical experiences in the first and second years of medical school. The authors acknowledge the danger of inferring causal relationships from analyses of this kind, and described how the power of previous associations--e.g., that between a required third-year clerkship in family medicine and graduates' family practice career choices--may be weakened when the

  10. 'eSimulation'. Part 2: Evaluation of an interactive multimedia mental health education program for generalist nurses.

    PubMed

    Lamont, Scott; Brunero, Scott

    2014-01-01

    This paper reports on an evaluation of an eSimulation mental health education program for generalist nurses; developed using the following five key attributes of simulation: (1) creating a hypothetical opportunity; (2) authentic representation; (3) active participation; (4) integration; (5) repetition, evaluation and reflection. Four themes emerged from a qualitative thematic analysis of semi-structured interview data involving fourteen generalist nurses. The following four themes: (1) authenticity; (2) participation; (3) clinical reasoning; (4) control of learning provide supporting evidence that these attributes are positioned within the learning resource. Participants found the scenarios within the resource realistic, engaging and relevant to their scope of practice. This type of learning resource may help in developing the knowledge, skills and confidence of generalist nurses in delivering safe and competent mental health care in the generalist setting, when access to specialist services and appropriate means of training are unavailable.

  11. Facilitating collaboration among academic generalist disciplines: a call to action.

    PubMed

    Kutner, Jean S; Westfall, John M; Morrison, Elizabeth H; Beach, Mary Catherine; Jacobs, Elizabeth A; Rosenblatt, Roger A

    2006-01-01

    To meet its population's health needs, the United States must have a coherent system to train and support primary care physicians. This goal can be achieved only though genuine collaboration between academic generalist disciplines. Academic general pediatrics, general internal medicine, and family medicine may be hampering this effort and their own futures by lack of collaboration. This essay addresses the necessity of collaboration among generalist physicians in research, medical education, clinical care, and advocacy. Academic generalists should collaborate by (1) making a clear decision to collaborate, (2) proactively discussing the flow of money, (3) rewarding collaboration, (4) initiating regular generalist meetings, (5) refusing to tolerate denigration of other generalist disciplines, (6) facilitating strategic planning for collaboration among generalist disciplines, and (7) learning from previous collaborative successes and failures. Collaboration among academic generalists will enhance opportunities for trainees, primary care research, and advocacy; conserve resources; and improve patient care.

  12. Comments on the AAMC policy statement recommending strategies for increasing the production of generalist physicians.

    PubMed

    Greer, D S; Bhak, K N; Zenker, B M

    1994-04-01

    The United States has a physician specialty imbalance, primarily a shortage of generalists (defined as family physicians, general internists, and general pediatricians) relative to other specialists. In recent years, the rising costs of health care, the expansion of managed care, and problems of access to care have accentuated the critical role that generalists must play in a cost-effective, accessible health care system. Despite numerous public and private initiatives designed to address the supply of generalist physicians, the ratio of generalists to specialists has been decreasing. Although the factors contributing to the shrinking proportion of generalists are many and are often outside the control of educators, there is evidence that medical schools can play a major role in influencing specialty choice. Recognizing the need to address the specialty imbalance in this country, the Association of American Medical Colleges (AAMC) appointed the Generalist Physician Task Force to develop a statement suggesting actions that the AAMC and its constituents could take to foster a greater representation of generalist physicians in the United States. The task force produced an Executive Summary, published as an AAMC policy statement in early 1993, that contained recommended strategies for medical schools, graduate medical education, and the practice environment. The authors of the present article critique these recommendations, provide a background and rationale for each of them, and give suggestions about how some of the recommendations might be implemented. While they are in general agreement with the AAMC policy statement, they feel the recommended strategies fall short of the need. They maintain that the AAMC statement represents an admirable but cautious approach to a daunting problem, and that the time is past when cautious approaches will suffice. The authors conclude with the hope that bolder initiatives will emerge from the new AAMC Office of Generalist Physician

  13. Generalist solutions to overprescribing: a joint challenge for clinical and academic primary care.

    PubMed

    Reeve, Joanne; Bancroft, Rebecca

    2014-01-01

    Polypharmacy is a phenomenon of modern health care that can offer benefits in terms of patient outcomes. Known risks associated with so-called inappropriate polypharmacy can be reduced through good medicine management and appropriate use of clinical guidelines. However, we now see a growing literature highlighting additional risks to individual well-being and social functioning not recognised within these existing frameworks - the burden of polypharmacy and a problem of overprescribing. We need a new approach to defining and understanding inappropriate polypharmacy from a person-centred perspective. This paper discusses practice-based work exploring the impact of introducing generalist needs assessment for elderly patients with multiple chronic morbidities. The work suggests that generalist care offers something 'different' to current chronic disease management models, but highlights the need for formal evaluation to determine whether it is 'better'. We call for new collaborative research between clinical and academic partners to address the question as to whether generalist care offers solutions to the problems of the burden of polypharmacy.

  14. Suicide risk assessment practices: a national survey of generalist drug and alcohol residential rehabilitation services.

    PubMed

    Ross, Joanne; Darke, Shane; Kelly, Erin; Hetherington, Kate

    2012-09-01

    Clients of drug and alcohol treatment services represent a high-risk group for attempted and completed suicide. The current study sought to examine suicide risk assessment practices in Australian generalist residential rehabilitation services. Semistructured interviews were conducted with managers of residential rehabilitation services and with volunteers from staff responsible for the case management/treatment of clients. Ninety per cent of services participated. In total, 64 managers and 142 staff were interviewed. One-third of services had no documented policy for the assessment and management of suicide risk, and one-quarter of staff had never received formal training in risk assessment. In more than one-third of agencies staff were not expected to use a structured suicide risk assessment tool when assessing a client's acute risk. To varying degrees agencies were gathering information about psychiatric comorbidity, but this information did not appear to be routinely integrated into the client's suicide risk assessment. The development of clearly documented polices, standardised assessment tools and the provision of annual training for all staff would help to address some of the gaps identified in current practice. © 2012 Australasian Professional Society on Alcohol and other Drugs.

  15. Advanced nursing practice.

    PubMed

    Carroll, Mark

    Mark Carroll examines the concept of advanced nursing practice and highlights a number of the difficulties in assessing and defining different levels of practice. Some of the differences and similarities between advanced practice in the US and UK are compared and contrasted. Issues of élitism and the lack of correlation between the needs of the healthcare system and professional self-interest prevent the advancement of specialist roles in the UK. The continuing focus of local trusts on the medicalisation of roles to meet the demands of the healthcare system appears to ignore the need for nursing to expand from within the profession.

  16. From pipelines to pathways: the Memorial experience in educating doctors for rural generalist practice.

    PubMed

    Rourke, James; Asghari, Shabnam; Hurley, Oliver; Ravalia, Mohamed; Jong, Michael; Parsons, Wanda; Duggan, Norah; Stringer, Katherine; O'Keefe, Danielle; Moffatt, Scott; Graham, Wendy; Sturge Sparkes, Carolyn; Hippe, Janelle; Harris Walsh, Kristin; McKay, Donald; Samarasena, Asoka

    2018-03-01

    This report describes the community context, concept and mission of The Faculty of Medicine at Memorial University of Newfoundland (Memorial), Canada, and its 'pathways to rural practice' approach, which includes influences at the pre-medical school, medical school experience, postgraduate residency training, and physician practice levels. Memorial's pathways to practice helped Memorial to fulfill its social accountability mandate to populate the province with highly skilled rural generalist practitioners. Programs/interventions/initiatives: The 'pathways to rural practice' include initiatives in four stages: (1) before admission to medical school; (2) during undergraduate medical training (medical degree (MD) program); (3) during postgraduate vocational residency training; and (4) after postgraduate vocational residency training. Memorial's Learners & Locations (L&L) database tracks students through these stages. The Aboriginal initiative - the MedQuest program and the admissions process that considers geographic or minority representation in terms of those selecting candidates and the candidates themselves - occurs before the student is admitted. Once a student starts Memorial's MD program, the student has ample opportunities to have rural-based experiences through pre-clerkship and clerkship, of which some take place exclusively outside of St. John's tertiary hospitals. Memorial's postgraduate (PG) Family Medicine (FM) residency (vocational) training program allows for deeper community integration and longer periods of training within the same community, which increases the likelihood of a physician choosing rural family medicine. After postgraduate training, rural physicians were given many opportunities for professional development as well as faculty development opportunities. Each of the programs and initiatives were assessed through geospatial rurality analysis of administrative data collected upon entry into and during the MD program and PG training (L

  17. The evolution of resource adaptation: how generalist and specialist consumers evolve.

    PubMed

    Ma, Junling; Levin, Simon A

    2006-07-01

    Why and how specialist and generalist strategies evolve are important questions in evolutionary ecology. In this paper, with the method of adaptive dynamics and evolutionary branching, we identify conditions that select for specialist and generalist strategies. Generally, generalist strategies evolve if there is a switching benefit; specialists evolve if there is a switching cost. If the switching cost is large, specialists always evolve. If the switching cost is small, even though the consumer will first evolve toward a generalist strategy, it will eventually branch into two specialists.

  18. Connecting intentional learning and cardiac specialty practice: The experiences of bachelor of science in nursing students.

    PubMed

    Rush, Kathy L; Wilson, Ryan; Costigan, Jeannine; Bannerman, Maggie; Donnelly, Sarah

    2016-09-01

    Internationally pre-registration education programs have ranged from entirely specialist to entirely generalist with varying degrees of specialty preparation in between. Students in generalist programs with specialty practice options may benefit from novel pedagogical approaches, such as intentional learning, to ease the transition from generalist to specialist practice. The purpose of this qualitative descriptive study was to understand undergraduate students' experiences of intentional learning in a 4-week consolidated cardiac specialty practicum. Eight students (7 females, 1 male) participated in a combination of weekly Blackboard discussions and an end-of-practicum focus group and completed a competency self-rating. Students had marred expectations about the integration of intentional learning in their specialty practice experience. They reflected advantages and disadvantages of both intentional and total patient care learning models but worked with their instructor to find the right balance that maximized learning. Students identified features that maximized intentional learning including open-ended questions, using learning versus workspaces, receiving feedback, and integrating peer interaction. Despite advancing their confidence and competence in specialty practice students remained anxious about their ability to assume the role of the graduate nurse in a years' time. Preparing a generalist nurse for the workforce needs to be balanced with meeting students' needs and increasing professional demands for specialty experiences in undergraduate nurse education programs. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. Emerging Lessons of the Interdisciplinary Generalist Curriculum (IGC) Project.

    ERIC Educational Resources Information Center

    Wartman, Steven A.; Davis, Ardis K.; Wilson, Modena E. H.; Kahn, Norman B., Jr.; Kahn, Ruth H.

    1998-01-01

    The interdisciplinary general-curriculum project was designed to develop innovative preclinical generalist curricula in ten medical and osteopathic schools and to encourage generalist careers. After two competitive cycles, much has been learned about interdisciplinary collaboration, recruitment and retention of community preceptors, faculty…

  20. A tale of two cultures: specialists and generalists sharing the load.

    PubMed

    Manca, Donna P; Breault, Lorraine; Wishart, Paul

    2011-05-01

    To understand what contributes to good collaborative physician working relationships through identifying the factors that affect working relationships between generalist physicians and specialists. Qualitative study using in-depth interviews. University and community hospital inpatient family practice settings in Edmonton, Alta. Eleven physicians from various specialties who graduated between 1977 and 2001. A grounded-theory approach, including constant comparison and creation of memorandums, helped to conceptualize the main concern and generated a framework for how the main concern was being resolved. A semistructured interview guide was developed and individual, in-depth interviews were audiotaped. Purposeful and theoretical sampling techniques were used. Three researchers participated in the analysis. The findings suggested that when generalist physicians perceived that work had been imposed on them by specialists without negotiation, they felt overwhelmed by the workload. Differing priorities determined whether physicians were left holding the bag or sharing the load. In a system that valued technology and specialized knowledge and skills, the specialists were better able to control resources, set boundaries, and influence learners. This precipitated a culture of protecting valuable specialty resources, increasing physician isolation, and generalists feeling that they were left holding the bag. In order to reverse this cycle, it was important for physicians to develop good working relationships based on accessibility to needed expertise and tests, with negotiated agreements on how to share resources; mutual empowerment, including negotiation of roles and responsibilities to develop flexible relationships with a clear understanding of roles; and concern for fairness by sharing the load. Medical systems that value technology and focused interests might lead to someone being left holding the bag, contributing to generalists feeling overwhelmed and isolated within

  1. Host specialist clownfishes are environmental niche generalists.

    PubMed

    Litsios, Glenn; Kostikova, Anna; Salamin, Nicolas

    2014-11-22

    Why generalist and specialist species coexist in nature is a question that has interested evolutionary biologists for a long time. While the coexistence of specialists and generalists exploiting resources on a single ecological dimension has been theoretically and empirically explored, biological systems with multiple resource dimensions (e.g. trophic, ecological) are less well understood. Yet, such systems may provide an alternative to the classical theory of stable evolutionary coexistence of generalist and specialist species on a single resource dimension. We explore such systems and the potential trade-offs between different resource dimensions in clownfishes. All species of this iconic clade are obligate mutualists with sea anemones yet show interspecific variation in anemone host specificity. Moreover, clownfishes developed variable environmental specialization across their distribution. In this study, we test for the existence of a relationship between host-specificity (number of anemones associated with a clownfish species) and environmental-specificity (expressed as the size of the ecological niche breadth across climatic gradients). We find a negative correlation between host range and environmental specificities in temperature, salinity and pH, probably indicating a trade-off between both types of specialization forcing species to specialize only in a single direction. Trade-offs in a multi-dimensional resource space could be a novel way of explaining the coexistence of generalist and specialists. © 2014 The Author(s) Published by the Royal Society. All rights reserved.

  2. Host specialist clownfishes are environmental niche generalists

    PubMed Central

    Litsios, Glenn; Kostikova, Anna; Salamin, Nicolas

    2014-01-01

    Why generalist and specialist species coexist in nature is a question that has interested evolutionary biologists for a long time. While the coexistence of specialists and generalists exploiting resources on a single ecological dimension has been theoretically and empirically explored, biological systems with multiple resource dimensions (e.g. trophic, ecological) are less well understood. Yet, such systems may provide an alternative to the classical theory of stable evolutionary coexistence of generalist and specialist species on a single resource dimension. We explore such systems and the potential trade-offs between different resource dimensions in clownfishes. All species of this iconic clade are obligate mutualists with sea anemones yet show interspecific variation in anemone host specificity. Moreover, clownfishes developed variable environmental specialization across their distribution. In this study, we test for the existence of a relationship between host-specificity (number of anemones associated with a clownfish species) and environmental-specificity (expressed as the size of the ecological niche breadth across climatic gradients). We find a negative correlation between host range and environmental specificities in temperature, salinity and pH, probably indicating a trade-off between both types of specialization forcing species to specialize only in a single direction. Trade-offs in a multi-dimensional resource space could be a novel way of explaining the coexistence of generalist and specialists. PMID:25274370

  3. Advanced practice nurses' scope of practice: a qualitative study of advanced clinical competencies.

    PubMed

    Nieminen, Anna-Lena; Mannevaara, Bodil; Fagerström, Lisbeth

    2011-12-01

    To describe and explore Advanced Practice Nurses' clinical competencies and how these are expressed in clinical practice. Discussion concerning advanced clinical practice has been ongoing in the USA since the 1960s and in the UK since the late 1980s. Approximately 24 countries, excluding the USA, have implemented the role of Advance Practice Nurse (APN). In the Nordic countries, especially Sweden and Finland, APNs have been introduced in some organizations but their competency domains have not yet been clearly defined. The study's theoretical framework emanates from Aristotle's three-dimensional view of knowledge that is epistêmê, technê, and phronesis. Between October 2005 and January 2006, focus group interviews of Clinical Nurse Specialists who provide expert functions in pediatric, internal medicine, and surgical units (n = 26) and APN students (n = 8) were conducted. The data material was analyzed using inductive content analysis. Grouped into five main themes, the study results indicate that APNs possess advanced level clinical competencies in: (A) assessment of patients' caring needs and nursing care activities, (B) the caring relationship, (C) multi-professional teamwork, (D) development of competence and nursing care, and (E) leadership in a learning and caring culture. Clinical competencies consist of advanced skills, which typify an expanding role that offers new possibilities for holistic patient care practice. APNs' scope of practice is characterized by responsibility and competence in making autonomous judgments based on expanded clinical competence. On an advanced level, clinical competence consists not merely of advanced skills for assessing and meeting the needs of patients but also the creation of safe and trustful relationships with patients and collaboration with colleagues. APNs can realize advanced skills in their actions through their manner of knowing, doing, and being. © 2011 The Authors. Scandinavian Journal of Caring Sciences © 2011

  4. Codon optimization underpins generalist parasitism in fungi

    PubMed Central

    Badet, Thomas; Peyraud, Remi; Mbengue, Malick; Navaud, Olivier; Derbyshire, Mark; Oliver, Richard P; Barbacci, Adelin; Raffaele, Sylvain

    2017-01-01

    The range of hosts that parasites can infect is a key determinant of the emergence and spread of disease. Yet, the impact of host range variation on the evolution of parasite genomes remains unknown. Here, we show that codon optimization underlies genome adaptation in broad host range parasites. We found that the longer proteins encoded by broad host range fungi likely increase natural selection on codon optimization in these species. Accordingly, codon optimization correlates with host range across the fungal kingdom. At the species level, biased patterns of synonymous substitutions underpin increased codon optimization in a generalist but not a specialist fungal pathogen. Virulence genes were consistently enriched in highly codon-optimized genes of generalist but not specialist species. We conclude that codon optimization is related to the capacity of parasites to colonize multiple hosts. Our results link genome evolution and translational regulation to the long-term persistence of generalist parasitism. DOI: http://dx.doi.org/10.7554/eLife.22472.001 PMID:28157073

  5. Impact of the Pharmacy Practice Model Initiative on Clinical Pharmacy Specialist Practice.

    PubMed

    Jacobi, Judith; Ray, Shaunta'; Danelich, Ilya; Dodds Ashley, Elizabeth; Eckel, Stephen; Guharoy, Roy; Militello, Michael; O'Donnell, Paul; Sam, Teena; Crist, Stephanie M; Smidt, Danielle

    2016-05-01

    This paper describes the goals of the American Society of Health-System Pharmacists' Pharmacy Practice Model Initiative (PPMI) and its recommendations for health-system pharmacy practice transformation to meet future patient care needs and elevate the role of pharmacists as patient care providers. PPMI envisions a future in which pharmacists have greater responsibility for medication-related outcomes and technicians assume greater responsibility for product-related activities. Although the PPMI recommendations have elevated the level of practice in many settings, they also potentially affect existing clinical pharmacists, in general, and clinical pharmacy specialists, in particular. Moreover, although more consistent patient care can be achieved with an expanded team of pharmacist providers, the role of clinical pharmacy specialists must not be diminished, especially in the care of complex patients and populations. Specialist practitioners with advanced training and credentials must be available to model and train pharmacists in generalist positions, residents, and students. Indeed, specialist practitioners are often the innovators and practice leaders. Negotiation between hospitals and pharmacy schools is needed to ensure a continuing role for academic clinical pharmacists and their contributions as educators and researchers. Lessons can be applied from disciplines such as nursing and medicine, which have developed new models of care involving effective collaboration between generalists and specialists. Several different pharmacy practice models have been described to meet the PPMI goals, based on available personnel and local goals. Studies measuring the impact of these new practice models are needed. © 2016 Pharmacotherapy Publications, Inc.

  6. Advancing nursing practice: redefining the theoretical and practical integration of knowledge.

    PubMed

    Christensen, Martin

    2011-03-01

    The aim of this paper is to offer an alternative knowing-how knowing-that framework of nursing knowledge, which in the past has been accepted as the provenance of advanced practice. The concept of advancing practice is central to the development of nursing practice and has been seen to take on many different forms depending on its use in context. To many it has become synonymous with the work of the advanced or expert practitioner; others have viewed it as a process of continuing professional development and skills acquisition. Moreover, it is becoming closely linked with practice development. However, there is much discussion as to what constitutes the knowledge necessary for advancing and advanced practice, and it has been suggested that theoretical and practical knowledge form the cornerstone of advanced knowledge. The design of this article takes a discursive approach as to the meaning and integration of knowledge within the context of advancing nursing practice. A thematic analysis of the current discourse relating to knowledge integration models in an advancing and advanced practice arena was used to identify concurrent themes relating to the knowing-how knowing-that framework which commonly used to classify the knowledge necessary for advanced nursing practice. There is a dichotomy as to what constitutes knowledge for advanced and advancing practice. Several authors have offered a variety of differing models, yet it is the application and integration of theoretical and practical knowledge that defines and develops the advancement of nursing practice. An alternative framework offered here may allow differences in the way that nursing knowledge important for advancing practice is perceived, developed and coordinated. What has inevitably been neglected is that there are various other variables which when transposed into the existing knowing-how knowing-that framework allows for advanced knowledge to be better defined. One of the more notable variables is

  7. Clinical practice: new challenges for the advanced practice nurse.

    PubMed

    Bartel, J C; Buturusis, B

    2000-12-01

    This report describes the challenges for advanced practice nurses (APNs) relative to supply and demand issues. The article also includes opportunities with the Balanced Budget Act, physician acceptance of Advanced Practice Nurses, and expanding practice opportunities. The challenges include the nursing shortage (both in nursing students and faculty), the aging of the nursing workforce, and a lag in nursing salaries; increased demand for nursing based on aging baby boomers, increasing patient acuity and technology, and new arenas for practice. The Balanced Budget Act of 1997 provided new opportunities for advanced practice nurses, including enhanced autonomy to provide services and bill independently of physicians. With these changes come new opportunities for advanced practice nurse entrepreneurs in the areas of independent practice, including opportunities to positively impact the health of families and communities in alignment with the Federal government's vision for "Healthy People 2010." As physician acceptance of advanced practice nurses continues to grow and in light of the changes in medical practice and education (residency reduction), opportunities to expand collaborative practice arrangements also exist. APNs are best suited to make the most of these changes. One example of an opportunity for independent practice, a Community Wellness Center, is developed as an entrepreneurial venture benefiting both the APN and the health of a community. Who better than registered nurses (RNs), especially those practicing at the advanced level, can ensure that these opportunities and challenges are addressed in an ethical manner and focused on the needs and health of the community?

  8. Of Specialists and Generalists.

    ERIC Educational Resources Information Center

    DeVore, Paul W.

    The issues involving the role and impact of specialists and generalists in society are critically examined in this paper. Currently held views on specialization are analyzed and challenged. Perspectives on this dilemma are developed in the following areas: (1) limitations of experts (casts doubt on the assumption that ordinary citizens are…

  9. HMO growth and the geographical redistribution of generalist and specialist physicians, 1987-1997.

    PubMed Central

    Escarce, J J; Polsky, D; Wozniak, G D; Kletke, P R

    2000-01-01

    OBJECTIVE: To assess the impact of the growth in HMO penetration in different metropolitan areas on the change in the number of generalists, specialists, and total physicians, and on the change in the proportion of physicians who are generalists. DATA SOURCES/STUDY SETTING: The American Medical Association Physician Masterfile, to obtain the number of patient care generalists and specialists in 1987 and in 1997 who were practicing in each of 316 metropolitan areas in the United States. Additional data for each metropolitan area were obtained from a variety of sources, and included HMO penetration in 1986 and 1996. STUDY DESIGN: We estimated multivariate regression models in which the change in the number of physicians between 1987 and 1997 was a function of HMO penetration in 1986, the change in HMO penetration between 1986 and 1996, population characteristics and physician fees in 1986, and the change in population characteristics and fees between 1986 and 1996. Each model was estimated using ordinary least squares (OLS) and two-stage least squares (TSLS). PRINCIPAL FINDINGS: HMO penetration did not affect the number of generalist physicians or hospital-based specialists, but faster HMO growth led to smaller increases in the numbers of medical/surgical specialists and total physicians. Faster HMO growth also led to larger increases in the proportion of physicians who were generalists. Our best estimate is that an increase in HMO penetration of .10 between 1986 and 1996 reduced the rate of increase in medical/surgical specialists by 10.3 percent and reduced the rate of increase in total physicians by 7.2 percent. CONCLUSIONS: The findings of this study support the notion that HMOs reduce the demand for physician services, particularly for specialists' services. The findings also imply that, during the past decade, there has been a redistribution of physicians-especially medical/surgical specialists-from metropolitan areas with high HMO penetration to low

  10. The Virginia Generalist Initiative: Lessons Learned in a Statewide Consortium.

    ERIC Educational Resources Information Center

    Morse, R. Michael; Plungas, Gay S.; Duke, Debra; Rollins, Lisa K.; Barnes, H. Verdain; Brinson, Betsy K.; Martindale, James R.; Marsland, David W.

    1999-01-01

    To increase supply of generalist physicians, three state-supported Virginia medical schools formed a partnership with governmental stakeholders in the Generalist Physician Initiative. Lessons learned concerning stakeholder participation in planning, shared philosophical commitment, support for risk-taking, attitudes toward change, and trust are…

  11. Competition promotes the evolution of host generalists in obligate parasites

    PubMed Central

    Johnson, Kevin P.; Malenke, Jael R.; Clayton, Dale H.

    2009-01-01

    Ecological theory traditionally predicts that interspecific competition selects for an increase in ecological specialization. Specialization, in turn, is often thought to be an evolutionary ‘dead end,’ with specialist lineages unlikely to evolve into generalist lineages. In host–parasite systems, this specialization can take the form of host specificity, with more specialized parasites using fewer hosts. We tested the hypothesis that specialists are evolutionarily more derived, and whether competition favours specialization, using the ectoparasitic feather lice of doves. Phylogenetic analyses revealed that complete host specificity is actually the ancestral condition, with generalists repeatedly evolving from specialist ancestors. These multiple origins of generalists are correlated with the presence of potentially competing species of the same genus. A competition experiment with captive doves and lice confirmed that congeneric species of lice do, in fact, have the potential to compete in ecological time. Taken together, these results suggest that interspecific competition can favour the evolution of host generalists, not specialists, over macroevolutionary time. PMID:19710056

  12. Macrophytes shape trophic niche variation among generalist fishes.

    PubMed

    Vejříková, Ivana; Eloranta, Antti P; Vejřík, Lukáš; Šmejkal, Marek; Čech, Martin; Sajdlová, Zuzana; Frouzová, Jaroslava; Kiljunen, Mikko; Peterka, Jiří

    2017-01-01

    Generalist species commonly have a fundamental role in ecosystems as they can integrate spatially distinct habitats and food-web compartments, as well as control the composition, abundance and behavior of organisms at different trophic levels. Generalist populations typically consist of specialized individuals, but the potential for and hence degree of individual niche variation can be largely determined by habitat complexity. We compared individual niche variation within three generalist fishes between two comparable lakes in the Czech Republic differing in macrophyte cover, i.e. macrophyte-rich Milada and macrophyte-poor Most. We tested the hypothesis that large individual niche variation among generalist fishes is facilitated by the presence of macrophytes, which provides niches and predation shelter for fish and their prey items. Based on results from stable nitrogen (δ15N) and carbon (δ13C) isotopic mixing models, perch (Perca fluviatilis L.) and rudd (Scardinius erythrophthalmus (L.)) showed larger individual variation (i.e., variance) in trophic position in Milada as compared to Most, whereas no significant between-lake differences were observed for roach (Rutilus rutilus (L.)). Contrary to our hypothesis, all the three species showed significantly lower individual variation in the relative reliance on littoral food resources in Milada than in Most. Rudd relied significantly more whereas perch and roach relied less on littoral food resources in Milada than in Most, likely due to prevalent herbivory by rudd and prevalent zooplanktivory by perch and roach in the macrophyte-rich Milada as compared to macrophyte-poor Most. Our study demonstrates how the succession of macrophyte vegetation, via its effects on the physical and biological complexity of the littoral zone and on the availability of small prey fish and zooplankton, can strongly influence individual niche variation among generalist fishes with different ontogenetic trajectories, and hence the overall

  13. Knowledge, attitudes, and practice behaviors of oncology advanced practice nurses regarding advanced care planning for patients with cancer.

    PubMed

    Zhou, Guiyun; Stoltzfus, Jill C; Houldin, Arlene D; Parks, Susan M; Swan, Beth Ann

    2010-11-01

    To establish initial reliability and validity of a Web-based survey focused on oncology advanced practice nurses' (APNs') knowledge, attitudes, and practice behaviors regarding advanced care planning, and to obtain preliminary understanding of APNs' knowledge, attitudes, and practice behaviors and perceived barriers to advanced care planning. Descriptive, cross-sectional, pilot survey study. The eastern United States. 300 oncology APNs. Guided by the Theory of Planned Behavior, a knowledge, attitudes, and practice behaviors survey was developed and reviewed for content validity. The survey was distributed to 300 APNs via e-mail and sent again to the 89 APNs who responded to the initial survey. Exploratory factor analysis was used to examine the construct validity and test-retest reliability of the survey's attitudinal and practice behavior portions. Respondents' demographics, knowledge, attitudes, practice behaviors, and perceived barriers to advanced care planning practice. Exploratory factor analysis yielded a five-factor solution from the survey's attitudes and practice behavior portions with internal consistency using Cronbach alpha. Respondents achieved an average of 67% correct answers in the 12-item knowledge section and scored positively in attitudes toward advanced care planning. Their practice behavior scores were marginally positive. The most common reported barriers were from patients' and families' as well as physicians' reluctance to discuss advanced care planning. The attitudinal and practice behaviors portions of the survey demonstrated preliminary construct validity and test-retest reliability. Regarding advanced care planning, respondents were moderately knowledgeable, but their advanced care planning practice was not routine. Validly assessing oncology APNs' knowledge, attitudes, and practice behaviors regarding advanced care planning will enable more tailored approaches to improve end-of-life care outcomes.

  14. From expert generalists to ambiguity masters: using ambiguity tolerance theory to redefine the practice of rural nurses.

    PubMed

    Knight, Kaye; Kenny, Amanda; Endacott, Ruth

    2016-06-01

    To redefine the practice of rural nurses and describe a model that conceptualises the capabilities and characteristics required in the rural environment. The way in which the practice of rural nurses has been conceptualised is problematic. Definitions of rural nursing have been identified primarily through the functional context of rural health service delivery. The expert generalist term has provided a foundation theory for rural nurses with understandings informed by the scope of practice needed to meet service delivery requirements. However, authors exploring intrinsic characteristics of rural nurses have challenged this definition, as it does not adequately address the deeper, intangible complexities of practice required in the rural context. Despite this discourse, an alternative way to articulate the distinctive nature of rural nursing practice has eluded authors in Australia and internationally. A theoretical paper based on primary research. The development of the model was informed by the findings of a study that explored the nursing practice of managing telephone presentations in rural health services in Victoria, Australia. The study involved policy review from State and Federal governments, nursing and medical professional bodies, and five rural health services; semi-structured interviews with eight Directors of Nursing, seven registered nurses and focus group interviews with eight registered nurses. An ambiguity tolerance model drawn from corporate global entrepreneurship theory was adapted to explain the findings of the study. The adapted model presents capabilities and characteristics used by nurses to successfully manage the ambiguity of providing care in the rural context. Redefining the practice of rural nurses, through an adapted theory of ambiguity tolerance, highlights nursing characteristics and capabilities required in the rural context. This perspective offers new ways of thinking about the work of rural nurses, rural nurse policy, education

  15. Programming the Generalist Volunteer: A Survey of Suggestions and Achievements.

    ERIC Educational Resources Information Center

    Petrides, George

    Peace Corps programing trends outlined in this manual indicate the need to balance the more personal and social aspects of volunteer service with purely technical job performance by developing the role of generalists, or AB liberal arts graduates. Topics covered in the manual are titled "A New Look at the Generalist,""A Look at the…

  16. The development of advanced nursing practice globally.

    PubMed

    Sheer, Barbara; Wong, Frances Kam Yuet

    2008-01-01

    To examine the development of advanced nursing practice globally. Data were collected from documentary resources available in the International Nurse Practitioners/Advanced Practice Nurse Network (INP/APNN) of the International Council of Nurses. The areas examined were guided by the "key informant survey on advanced nursing practice self-administered questionnaire." Two core members of the INP/APNN who have rich experience in global advanced nursing development analyzed the data.A total of 14 countries and three regions from five continents were included in the analyses. The development of advanced nursing practice in these areas is facilitated by a need for better access to care in a cost-containment era and the enhancement of nursing education to postgraduate level. The mechanism for regulation of practice is in place in some countries. Confirms the development of advanced practice in nursing is a global trend. APNs can improve global health with points to enhanced education in nursing and regulation of advanced practice.

  17. The Interdisciplinary Generalist Curriculum Project: A National Medical School Demonstration Project.

    ERIC Educational Resources Information Center

    Kahn, Norman B., Jr.; And Others

    1995-01-01

    The Interdisciplinary Generalist Curriculum Project was developed to encourage schools of medicine and colleges of osteopathic medicine to implement interdisciplinary generalist curricula in the preclinical years. Five sites were competitively established as demonstration projects, and rigorous attention to creating and maintaining an…

  18. Evolution of pollination niches in a generalist plant clade.

    PubMed

    Gómez, José María; Perfectti, Francisco; Abdelaziz, Mohamed; Lorite, Juan; Muñoz-Pajares, Antonio Jesús; Valverde, Javier

    2015-01-01

    It is widely assumed that floral diversification occurs by adaptive shifts between pollination niches. In contrast to specialized flowers, identifying pollination niches of generalist flowers is a challenge. Consequently, how generalist pollination niches evolve is largely unknown. We apply tools from network theory and comparative methods to investigate the evolution of pollination niches among generalist species belonging to the genus Erysimum. These species have similar flowers. We found that the studied species may be grouped in several multidimensional niches separated not by a shift of pollinators, but instead by quantitative variation in the relative abundance of pollinator functional groups. These pollination niches did not vary in generalization degree; we did not find any evolutionary trend toward specialization within the studied clade. Furthermore, the evolution of pollination niche fitted to a Brownian motion model without phylogenetic signal, and was characterized by frequent events of niche convergences and divergences. We presume that the evolution of Erysimum pollination niches has occurred mostly by recurrent shifts between slightly different generalized pollinator assemblages varying spatially as a mosaic and without any change in specialization degree. Most changes in pollination niches do not prompt floral divergence, a reason why adaptation to pollinators is uncommon in generalist plants. © 2014 The Authors. New Phytologist © 2014 New Phytologist Trust.

  19. Immune defence strategies of generalist and specialist insect herbivores

    PubMed Central

    Barthel, Andrea; Kopka, Isabell; Vogel, Heiko; Zipfel, Peter; Heckel, David G.; Groot, Astrid T.

    2014-01-01

    Ecological immunology examines the adaptive responses of animals to pathogens in relation to other environmental factors and explores the consequences of trade-offs between investment in immune function and other life-history traits. Among species of herbivorous insects, diet breadth may vary greatly, with generalists consuming a wide variety of plant families and specialists restricted to a few species. Generalists may thus be exposed to a wider range of pathogens exerting stronger selection on the innate immune system. To examine whether this produces an increase in the robustness of the immune response, we compared larvae of the generalist herbivore Heliothis virescens and the specialist Heliothis subflexa challenged by entomopathogenic and non-pathogenic bacteria. Heliothis virescens larvae showed lower mortality, a lower number of recoverable bacteria, lower proliferation of haemocytes and higher phagocytic activity. These results indicate a higher tolerance to entomopathogenic bacteria by the generalist, which is associated with a more efficient cell-mediated immune response by mechanisms that differ between these closely related species. Our findings provide novel insights into the consequences of diet breadth and related environmental factors, which may be significant in further studies to understand the ecological forces and investment trade-offs that shape the evolution of innate immunity. PMID:24943370

  20. Generalist genes and high cognitive abilities.

    PubMed

    Haworth, Claire M A; Dale, Philip S; Plomin, Robert

    2009-07-01

    The concept of generalist genes operating across diverse domains of cognitive abilities is now widely accepted. Much less is known about the etiology of the high extreme of performance. Is there more specialization at the high extreme? Using a representative sample of 4,000 12-year-old twin pairs from the UK Twins Early Development Study, we investigated the genetic and environmental overlap between web-based tests of general cognitive ability, reading, mathematics and language performance for the top 15% of the distribution using DF extremes analysis. Generalist genes are just as evident at the high extremes of performance as they are for the entire distribution of abilities and for cognitive disabilities. However, a smaller proportion of the phenotypic intercorrelations appears to be explained by genetic influences for high abilities.

  1. Generalist genes and high cognitive abilities

    PubMed Central

    Haworth, Claire M.A.; Dale, Philip S.; Plomin, Robert

    2014-01-01

    The concept of generalist genes operating across diverse domains of cognitive abilities is now widely accepted. Much less is known about the etiology of the high extreme of performance. Is there more specialization at the high extreme? Using a representative sample of 4000 12-year-old twin pairs from the UK Twins Early Development Study, we investigated the genetic and environmental overlap between web-based tests of general cognitive ability, reading, mathematics and language performance for the top 15% of the distribution using DF extremes analysis. Generalist genes are just as evident at the high extremes of performance as they are for the entire distribution of abilities and for cognitive disabilities. However, a smaller proportion of the phenotypic intercorrelations appears to be explained by genetic influences for high abilities. PMID:19377870

  2. A qualitative study of barriers to the implementation of a rheumatoid arthritis guideline among generalist and specialist physical therapists.

    PubMed

    van Bodegom-Vos, Leti; Verhoef, John; Dickmann, Margot; Kleijn, Marjon; van Vliet, Ingrid; Hurkmans, Emalie; van der Wees, Philip; Vliet Vlieland, Thea

    2012-10-01

    Although the increasing complexity and expansion of the body of knowledge in physical therapy have led to specialized practice areas to provide better patient care, the impact of specialization on guideline implementation has been scarcely studied. Objectives The objective of this study was to identify the similarities and differences in barriers to the implementation of a Dutch rheumatoid arthritis (RA) guideline by generalist and specialist physical therapists. Design This observational study consisted of 4 focus group interviews in which 24 physical therapists (13 generalist and 11 specialist physical therapists) participated. Physical therapists were asked to discuss barriers to the implementation of the RA guideline. Data were analyzed qualitatively using a directed approach to content analysis. Both the interviews and the interview analysis were informed by a previously developed conceptual framework. Besides a number of similarities (eg, lack of time), the present study showed important, although subtle, differences in barriers to the implementation of the RA guideline between generalist physical therapists and specialist physical therapists. Generalist physical therapists more frequently reported difficulties in interpreting the guideline (cognitive barriers) and had less favorable opinions about the guideline (affective barriers) than specialist physical therapists. Specialist physical therapists were hampered by external barriers that are outside the scope of generalist physical therapists, such as a lack of agreement about the roles and responsibilities of medical professionals involved in the care of the same patient. The identified differences in barriers to the implementation of the RA guideline indicated that the effectiveness of implementation strategies could be improved by tailoring them to the level of specialization of physical therapists. However, it is expected that tailoring implementation strategies to barriers that hamper both generalist

  3. Professional boundary work in the face of change to generalist working in community nursing in Scotland.

    PubMed

    Gray, Carol; Hogg, Rhona; Kennedy, Catriona

    2011-08-01

    The present study explored how community nurses and managers constituted changes towards generalist working. Following international trends moving from acute care towards community care, changes within community nursing in the United Kingdom have been subject to debate in recent years. Sociological insights into 'boundary work' in professional disciplines are informative for understandings about proposed new roles in community nursing. Recently, radical changes to the role of the community nurse from specialist disciplines to a generalist community health nurse model were proposed in Scotland and tested in four health boards. Focus group discussions were held with 27 community nurses and semi-structured interviews with three managers during January-March 2009 in a purposive sample from one health board. Discussions were audio-recorded and transcribed verbatim. Initial thematic analysis was used to highlight key themes from the data and later a discursive analysis focused on the rhetorical strategies used by participants. Four key themes were identified along with the rhetorical devices associated with these including: the undermining of the generalist model through the 'jack of all trades, master of none' metaphor through associations of loss of specialisms; how the re-establishment of specialist discipline boundaries occurred; how current roles were validated and how managers and nurses accounted for future changes to the profession. The qualitative study explored here has implications for discussions about future role change debates within community nursing as well as the specialist-generalist debate internationally. Managers and policy-makers involved in organizational changes are required to give greater credence to the perceived professional status of community nursing. © 2011 The Authors. Journal of Advanced Nursing © 2011 Blackwell Publishing Ltd.

  4. An efficacy trial of brief lifestyle intervention delivered by generalist community nurses (CN SNAP trial).

    PubMed

    Laws, Rachel A; Chan, Bibiana C; Williams, Anna M; Davies, Gawaine Powell; Jayasinghe, Upali W; Fanaian, Mahnaz; Harris, Mark F

    2010-02-23

    Lifestyle risk factors, in particular smoking, nutrition, alcohol consumption and physical inactivity (SNAP) are the main behavioural risk factors for chronic disease. Primary health care (PHC) has been shown to be an effective setting to address lifestyle risk factors at the individual level. However much of the focus of research to date has been in general practice. Relatively little attention has been paid to the role of nurses working in the PHC setting. Community health nurses are well placed to provide lifestyle intervention as they often see clients in their own homes over an extended period of time, providing the opportunity to offer intervention and enhance motivation through repeated contacts. The overall aim of this study is to evaluate the impact of a brief lifestyle intervention delivered by community nurses in routine practice on changes in clients' SNAP risk factors. The trial uses a quasi-experimental design involving four generalist community nursing services in NSW Australia. Services have been randomly allocated to an 'early intervention' group or 'late intervention' (comparison) group. 'Early intervention' sites are provided with training and support for nurses in identifying and offering brief lifestyle intervention for clients during routine consultations. 'Late intervention site' provide usual care and will be offered the study intervention following the final data collection point. A total of 720 generalist community nursing clients will be recruited at the time of referral from participating sites. Data collection consists of 1) telephone surveys with clients at baseline, three months and six months to examine change in SNAP risk factors and readiness to change 2) nurse survey at baseline, six and 12 months to examine changes in nurse confidence, attitudes and practices in the assessment and management of SNAP risk factors 3) semi-structured interviews/focus with nurses, managers and clients in 'early intervention' sites to explore the

  5. Organization and evaluation of generalist palliative care in a Danish hospital.

    PubMed

    Bergenholtz, Heidi; Hølge-Hazelton, Bibi; Jarlbaek, Lene

    2015-05-06

    Hospitals have a responsibility to ensure that palliative care is provided to all patients with life-threatening illnesses. Generalist palliative care should therefore be acknowledged and organized as a part of the clinical tasks. However, little is known about the organization and evaluation of generalist palliative care in hospitals. Therefore the aim of the study was to investigate the organization and evaluation of generalist palliative care in a large regional hospital by comparing results from existing evaluations. Results from three different data sets, all aiming to evaluate generalist palliative care, were compared retrospectively. The data-sets derived from; 1. a national accreditation of the hospital, 2. a national survey and 3. an internal self-evaluation performed in the hospital. The data were triangulated to investigate the organization and evaluation of palliative care in order to identify concordances and/or discrepancies. The triangulation indicated poor validity of the results from existing methods used to evaluate palliative care in hospitals. When the datasets were compared, several discrepancies occurred with regard to the organization and the performance of generalist palliative care. Five types of discrepancies were found in 35 out of 56 sections in the fulfilment of the national accreditation standard for palliative care. Responses from the hospital management and the department managements indicated that generalist palliative care was organized locally--if at all--within the various departments and with no overall structure or policy. This study demonstrates weaknesses in the existing evaluation methods for generalist palliative care and highlights the lack of an overall policy, organization and goals for the provision of palliative care in the hospital. More research is needed to focus on the organization of palliative care and to establish indicators for high quality palliative care provided by the hospital. The lack of valid indicators

  6. Views of newly-qualified GPs about their training and preparedness: lessons for extended generalist training.

    PubMed

    Sabey, Abigail; Hardy, Holly

    2015-04-01

    General practice is becoming increasingly complex due to an ageing population with multiple morbidities and the shift of services from secondary to primary care, yet GP training remains largely the same. Extended training is now recommended, initially proposed as a fourth GP specialty trainee year, but more recently as a broad-based 4-year specialty training programme. To explore the views of newly-qualified GPs about their training and preparedness for specific aspects of the GP's role. Qualitative study with newly-qualified GPs who qualified with Severn Deanery between 2007 and 2010. Semi-structured interviews with 18 GPs between November 2011 and April 2012. Gaining experience in a variety of primary care environments widens insight into patient populations as well as helping GPs develop adaptability and confidence, although this is not routinely part of GP training. However, alongside variety, having continuity with patients in practice remains important. Opportunities to be involved in the management of a practice or to take on substantial leadership roles also vary widely and this may limit preparedness and development of generalist skills. Extended training could help prepare GPs for the current challenges of general practice. It could ensure all trainees are exposed to a greater variety of primary care settings including those outside GP practice, as well as experience of business, finance, and leadership roles. Collectively, these changes have the potential to produce GPs with both generalist and enhanced skills, who are better prepared to work collaboratively across the organisational boundaries between primary, secondary, and community care. © British Journal of General Practice 2015.

  7. Can alien plants support generalist insect herbivores?

    Treesearch

    Douglas Tallamy; Meg Ballard; Vincent D' Amico

    2009-01-01

    Rearing experiments were conducted to address two questions relevant to understanding how generalist lepidopteran herbivores interact with alien plants. We reared 10 yellow-striped armyworms (Spodoptera ornithogalli),...

  8. Advanced practice nursing role delineation in acute and critical care: application of the strong model of advanced practice.

    PubMed

    Mick, D J; Ackerman, M H

    2000-01-01

    This purpose of this study was to differentiate between the roles of clinical nurse specialists and acute care nurse practitioners. Hypothesized blending of the clinical nurse specialist and acute care nurse practitioner roles is thought to result in an acute care clinician who integrates the clinical skills of the nurse practitioner with the systems knowledge, educational commitment, and leadership ability of the clinical nurse specialist. Ideally, this role blending would facilitate excellence in both direct and indirect patient care. The Strong Model of Advanced Practice, which incorporates practice domains of direct comprehensive care, support of systems, education, research, and publication and professional leadership, was tested to search for practical evidence of role blending. This descriptive, exploratory, pilot study included subjects (N = 18) solicited from an academic medical center and from an Internet advanced practice listserv. Questionnaires included self-ranking of expertise in practice domains, as well as valuing of role-related tasks. Content validity was judged by an expert panel of advanced practice nurses. Analyses of descriptive statistics revealed that clinical nurse specialists, who had more experience both as registered nurses and in the advanced practice nurse role, self-ranked their expertise higher in all practice domains. Acute care nurse practitioners placed higher importance on tasks related to direct comprehensive care, including conducting histories and physicals, diagnosing, and performing diagnostic procedures, whereas clinical nurse specialists assigned greater importance to tasks related to education, research, and leadership. Levels of self-assessed clinical expertise as well as valuing of role-related tasks differed among this sample of clinical nurse specialists and acute care nurse practitioners. Groundwork has been laid for continuing exploration into differentiation in advanced practice nursing roles. As the clinical

  9. The APA and the Rise of Pediatric Generalist Network Research

    PubMed Central

    Wasserman, Richard; Serwint, Janet R.; Kuppermann, Nathan; Srivastava, Rajendu; Dreyer, Benard

    2010-01-01

    The Academic Pediatric Association (APA – formerly the Ambulatory Pediatric Association) first encouraged multi-institutional collaborative research among its members over thirty years ago. Individual APA members went on subsequently to figure prominently in establishing formal research networks. These enduring collaborations have been established to conduct investigations in a variety of generalist contexts. At present, four generalist networks – Pediatric Research in Office Settings (PROS), the Pediatric Emergency Care Applied Network (PECARN), the COntinuity Research NETwork (CORNET), and Pediatric Research in Inpatient Settings (PRIS) – have a track record of extensive achievement in generating new knowledge aimed at improving the health and health care of children. This review details the history, accomplishments, and future directions of these networks and summarizes the common themes, strengths, challenges and opportunities inherent in pediatric generalist network research. PMID:21282083

  10. Differing Experiences with Pre-Exposure Prophylaxis in Boston Among Lesbian, Gay, Bisexual, and Transgender Specialists and Generalists in Primary Care: Implications for Scale-Up.

    PubMed

    Krakower, Douglas S; Ware, Norma C; Maloney, Kevin M; Wilson, Ira B; Wong, John B; Mayer, Kenneth H

    2017-07-01

    The Centers for Disease Control and Prevention estimates that one in four sexually active men who have sex with men (MSM) could decrease their HIV risk by using HIV pre-exposure prophylaxis (PrEP). Because many MSM access healthcare from primary care providers (PCPs), these clinicians could play an important role in providing access to PrEP. Semistructured qualitative interviews were conducted with 31 PCPs in Boston, MA, to explore how they approach decisions about prescribing PrEP to MSM and their experiences with PrEP provision. Purposive sampling included 12 PCPs from an urban community health center specializing in the care of lesbian, gay, bisexual, and transgender persons ("LGBT specialists") and 19 PCPs from a general academic medical center ("generalists"). Analyses utilized an inductive approach to identify emergent themes. Both groups of PCPs approached prescribing decisions about PrEP as a process of informed decision-making with patients. Providers would defer to patients' preferences if they were unsure about the appropriateness of PrEP. LGBT specialists and generalists were at vastly different stages of adopting PrEP into practice. For LGBT specialists, PrEP was a disruptive innovation that rapidly became normative in practice. Generalists had limited experience with PrEP; however, they desired succinct decision-support tools to help them achieve proficiency, because they considered preventive medicine to be central to their professional role. As generalists vastly outnumber LGBT specialists in the United States, interventions to support PrEP provision by generalists could accelerate the scale-up of PrEP for MSM nationally, which could in turn decrease HIV incidence for this priority population.

  11. Concepts of advanced practice: what does it mean?

    PubMed

    Pearson, Helen

    'Advanced practice nursing' may be a familiar concept, but a definition of advanced practice, its scope and its responsibilities, remains elusive. This article discusses the origins of advanced practice, and its practical meaning for nurses working in the NHS today.

  12. Evaluation of pharmacy generalists performing antimicrobial stewardship services.

    PubMed

    Carreno, Joseph J; Kenney, Rachel M; Bloome, Mary; McDonnell, Jane; Rodriguez, Jennifer; Weinmann, Allison; Kilgore, Paul E; Davis, Susan L

    2015-08-01

    Improvements in medication use achieved by pharmacy generalists using a care bundle approach to antimicrobial stewardship are reported. A six-month prospective, repeated-treatment, quasi-experimental study involving three month-long intervention periods and three month-long control periods was conducted in the setting of an existing antimicrobial stewardship program at a large hospital. The intervention involved prospective audit and feedback conducted by pharmacy generalists who were trained in an antimicrobial stewardship care bundle approach. During control months, a pharmacy generalist who was not trained in antimicrobial stewardship rounded with the multidisciplinary team and provided standard-of-care pharmacy services. The primary endpoint was compliance with a care bundle of four antimicrobial stewardship metrics: documentation of indication for therapy in the medical record, selection of empirical therapy according to institutional guidelines, documented performance of indicated culture testing, and deescalation of therapy when indicated. Two-hundred eighty-six patients were enrolled in the study: 124 in the intervention group and 162 in the control group. The cumulative rate of full compliance with all care bundle components during the six-month study was significantly greater during intervention months than during control months (68.5% versus 45.7%, p < 0.001). After adjusting for infection type, antimicrobial stewardship provided by an intervention-group pharmacist was associated with improved care bundle compliance (adjusted odds ratio, 2.70; p < 0.001). No significant differences in patient outcomes during intervention and control months were detected. Pharmacy generalists trained to comply with a systematic care bundle approach enhanced the quality of antimicrobial management. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  13. Education of advanced practice nurses in Canada.

    PubMed

    Martin-Misener, Ruth; Bryant-Lukosius, Denise; Harbman, Patricia; Donald, Faith; Kaasalainen, Sharon; Carter, Nancy; Kilpatrick, Kelley; DiCenso, Alba

    2010-12-01

    In Canada, education programs for the clinical nurse specialist (CNS) and nurse practitioner (NP) roles began 40 years ago. NP programs are offered in almost all provinces. Education for the CNS role has occurred through graduate nursing programs generically defined as providing preparation for advanced nursing practice. For this paper, we drew on pertinent sections of a scoping review of the literature and key informant interviews conducted for a decision support synthesis on advanced practice nursing to describe the following: (1) history of advanced practice nursing education in Canada, (2) current status of advanced practice nursing education in Canada, (3) curriculum issues, (4) interprofessional education, (5) resources for education and (6) continuing education. Although national frameworks defining advanced nursing practice and NP competencies provide some direction for education programs, Canada does not have countrywide standards of education for either the NP or CNS role. Inconsistency in the educational requirements for primary healthcare NPs continues to cause significant problems and interferes with inter-jurisdictional licensing portability. For both CNSs and NPs, there can be a mismatch between a generalized education and specialized practice. The value of interprofessional education in facilitating effective teamwork is emphasized. Recommendations for future directions for advanced practice nursing education are offered.

  14. Outsourcing Physical Education in Primary Schools: Evaluating the Impact of Externally Provided Programmes on Generalist Teachers

    ERIC Educational Resources Information Center

    Whipp, Peter R.; Hutton, Heidi; Grove, J. Robert; Jackson, Ben

    2011-01-01

    In place of generalist delivery, externally provided physical activity programmes (EPPAPs) are potentially an effective method for offering primary school students specialist physical education (PE) instruction, as well as providing training for generalist classroom teachers. In the present study, a group of generalist teachers were interviewed…

  15. Learning Abilities and Disabilities: Generalist Genes, Specialist Environments.

    PubMed

    Kovas, Yulia; Plomin, Robert

    2007-10-01

    Twin studies comparing identical and fraternal twins consistently show substantial genetic influence on individual differences in learning abilities such as reading and mathematics, as well as in other cognitive abilities such as spatial ability and memory. Multivariate genetic research has shown that the same set of genes is largely responsible for genetic influence on these diverse cognitive areas. We call these "generalist genes." What differentiates these abilities is largely the environment, especially nonshared environments that make children growing up in the same family different from one another. These multivariate genetic findings of generalist genes and specialist environments have far-reaching implications for diagnosis and treatment of learning disabilities and for understanding the brain mechanisms that mediate these effects.

  16. Competency frameworks for advanced practice nursing: a literature review.

    PubMed

    Sastre-Fullana, P; De Pedro-Gómez, J E; Bennasar-Veny, M; Serrano-Gallardo, P; Morales-Asencio, J M

    2014-12-01

    This paper describes a literature review that identified common traits in advanced practice nursing that are specific to competency development worldwide. There is a lack of international agreement on the definition of advanced practice nursing and its core competencies. Despite the lack of consensus, there is an ongoing process worldwide to establish and outline the standards and competencies for advanced practice nursing roles. International agencies, such as the International Council of Nurses, have provided general definitions for advanced practice nursing. Additionally, a set of competency standards for this aim has been developed. A literature review and a directed search of institutional websites were performed to identify specific developments in advanced practice nursing competencies and standards of practice. To determine a competency map specific to international advanced practice nursing, key documents were analysed using a qualitative approach based on content analysis to identify common traits among documents and countries. The review process identified 119 relevant journal articles related to advanced practice nursing competencies. Additionally, 97 documents from grey literature that were related to advanced practice nursing competency mapping were identified. From the text analysis, 17 worldwide transversal competency domains emerged. Despite the variety of patterns in international advanced practice nursing development, essential competency domains can be found in most national frameworks for the role development of international advanced practice nursing. These 17 core competencies can be used to further develop instruments that assess the perceived competency of advanced practice nurses. The results of this review can help policy developers and researchers develop instruments to compare advanced practice nursing services in various contexts and to examine their association with related outcomes. © 2014 International Council of Nurses.

  17. Can alien plants support generalist insect herbivores?

    Treesearch

    Douglas W. Tallamy; Meg Ballard; Vincent D' Amico

    2010-01-01

    Simple rearing experiments were conducted to address two questions relevant to understanding how generalist lepidopteran herbivores interact with alien plants. Yellow-striped armyworm (Spodoptera ornithogalli), luna moth (Actias luna), bagworm (Thyridopteryx ephemeraeformis) and white-marked tussock moth (

  18. An Advanced Pharmacy Practice Framework for Australia

    PubMed Central

    Jackson, Shane; Martin, Grant; Bergin, Jennifer; Clark, Bronwyn; Stupans, Ieva; Yeates, Gilbert; Nissen, Lisa; Marty, Stephen; Gysslink, Paul; Matthews, Andrew; Kirsa, Sue; Deans, Kerry; Sorimachi, Kay

    2015-01-01

    The need to develop An Advanced Pharmacy Practice Framework for Australia (the “APPF”) was identified during the 2010 review of the competency standards for Australian pharmacists. The Advanced Pharmacy Practice Framework Steering Committee, a collaborative profession-wide committee comprised of representatives of ten pharmacy organisations, examined and adapted existing advanced practice frameworks, all of which were found to have been based on the Competency Development and Evaluation Group (CoDEG) Advanced and Consultant Level Framework (the “CoDEG Framework”) from the United Kingdom. Its competency standards were also found to align well with the Domains of the National Competency Standards Framework for Pharmacists in Australia (the “National Framework”). Adaptation of the CoDEG Framework created an APPF that is complementary to the National Framework, sufficiently flexible to customise for recognising advanced practice in any area of professional practice and has been approved by the boards/councils of all participating organisations. The primary purpose of the APPF is to assist the development of the profession to meet the changing health care needs of the community. However, it is also a valuable tool for assuring members of the public of the competence of an advanced practice pharmacist and the quality and safety of the services they deliver. PMID:28975900

  19. Generalist palliative care in hospital - Cultural and organisational interactions. Results of a mixed-methods study.

    PubMed

    Bergenholtz, Heidi; Jarlbaek, Lene; Hølge-Hazelton, Bibi

    2016-06-01

    It can be challenging to provide generalist palliative care in hospitals, owing to difficulties in integrating disease-oriented treatment with palliative care and the influences of cultural and organisational conditions. However, knowledge on the interactions that occur is sparse. To investigate the interactions between organisation and culture as conditions for integrated palliative care in hospital and, if possible, to suggest workable solutions for the provision of generalist palliative care. A convergent parallel mixed-methods design was chosen using two independent studies: a quantitative study, in which three independent datasets were triangulated to study the organisation and evaluation of generalist palliative care, and a qualitative, ethnographic study exploring the culture of generalist palliative nursing care in medical departments. A Danish regional hospital with 29 department managements and one hospital management. Two overall themes emerged: (1) 'generalist palliative care as a priority at the hospital', suggesting contrasting issues regarding prioritisation of palliative care at different organisational levels, and (2) 'knowledge and use of generalist palliative care clinical guideline', suggesting that the guideline had not reached all levels of the organisation. Contrasting issues in the hospital's provision of generalist palliative care at different organisational levels seem to hamper the interactions between organisation and culture - interactions that appear to be necessary for the provision of integrated palliative care in the hospital. The implementation of palliative care is also hindered by the main focus being on disease-oriented treatment, which is reflected at all the organisational levels. © The Author(s) 2015.

  20. Response of pest control by generalist predators to local-scale plant diversity: a meta-analysis.

    PubMed

    Dassou, Anicet Gbèblonoudo; Tixier, Philippe

    2016-02-01

    Disentangling the effects of plant diversity on the control of herbivores is important for understanding agricultural sustainability. Recent studies have investigated the relationships between plant diversity and arthropod communities at the landscape scale, but few have done so at the local scale. We conducted a meta-analysis of 32 papers containing 175 independent measures of the relationship between plant diversity and arthropod communities. We found that generalist predators had a strong positive response to plant diversity, that is, their abundance increased as plant diversity increased. Herbivores, in contrast, had an overall weak and negative response to plant diversity. However, specialist and generalist herbivores differed in their response to plant diversity, that is, the response was negative for specialists and not significant for generalists. While the effects of scale remain unclear, the response to plant diversity tended to increase for specialist herbivores, but decrease for generalist herbivores as the scale increased. There was no clear effect of scale on the response of generalist predators to plant diversity. Our results suggest that the response of herbivores to plant diversity at the local scale is a balance between habitat and trophic effects that vary according to arthropod specialization and habitat type. Synthesis and applications. Positive effects of plant diversity on generalist predators confirm that, at the local scale, plant diversification of agroecosystems is a credible and promising option for increasing pest regulation. Results from our meta-analysis suggest that natural control in plant-diversified systems is more likely to occur for specialist than for generalist herbivores. In terms of pest management, our results indicate that small-scale plant diversification (via the planting of cover crops or intercrops and reduced weed management) is likely to increase the control of specialist herbivores by generalist predators.

  1. Modelling invasion for a habitat generalist and a specialist plant species

    USGS Publications Warehouse

    Evangelista, P.H.; Kumar, S.; Stohlgren, T.J.; Jarnevich, C.S.; Crall, A.W.; Norman, J. B.; Barnett, D.T.

    2008-01-01

    Predicting suitable habitat and the potential distribution of invasive species is a high priority for resource managers and systems ecologists. Most models are designed to identify habitat characteristics that define the ecological niche of a species with little consideration to individual species' traits. We tested five commonly used modelling methods on two invasive plant species, the habitat generalist Bromus tectorum and habitat specialist Tamarix chinensis, to compare model performances, evaluate predictability, and relate results to distribution traits associated with each species. Most of the tested models performed similarly for each species; however, the generalist species proved to be more difficult to predict than the specialist species. The highest area under the receiver-operating characteristic curve values with independent validation data sets of B. tectorum and T. chinensis was 0.503 and 0.885, respectively. Similarly, a confusion matrix for B. tectorum had the highest overall accuracy of 55%, while the overall accuracy for T. chinensis was 85%. Models for the generalist species had varying performances, poor evaluations, and inconsistent results. This may be a result of a generalist's capability to persist in a wide range of environmental conditions that are not easily defined by the data, independent variables or model design. Models for the specialist species had consistently strong performances, high evaluations, and similar results among different model applications. This is likely a consequence of the specialist's requirement for explicit environmental resources and ecological barriers that are easily defined by predictive models. Although defining new invaders as generalist or specialist species can be challenging, model performances and evaluations may provide valuable information on a species' potential invasiveness.

  2. Learning Abilities and Disabilities: Generalist Genes, Specialist Environments

    PubMed Central

    Kovas, Yulia; Plomin, Robert

    2007-01-01

    Twin studies comparing identical and fraternal twins consistently show substantial genetic influence on individual differences in learning abilities such as reading and mathematics, as well as in other cognitive abilities such as spatial ability and memory. Multivariate genetic research has shown that the same set of genes is largely responsible for genetic influence on these diverse cognitive areas. We call these “generalist genes.” What differentiates these abilities is largely the environment, especially nonshared environments that make children growing up in the same family different from one another. These multivariate genetic findings of generalist genes and specialist environments have far-reaching implications for diagnosis and treatment of learning disabilities and for understanding the brain mechanisms that mediate these effects. PMID:20351764

  3. Factors affecting host range in a generalist seed pathogen of semi-arid shrublands

    Treesearch

    Julie Beckstead; Susan E. Meyer; Kurt O. Reinhart; Kellene M. Bergen; Sandra R. Holden; Heather F. Boekweg

    2014-01-01

    Generalist pathogens can exhibit differential success on different hosts, resulting in complex host range patterns. Several factors operate to reduce realized host range relative to potential host range, particularly under field conditions. We explored factors influencing host range of the naturally occurring generalist ascomycete grass seed pathogen Pyrenophora...

  4. Measuring inequalities in the demographical and geographical distribution of physicians in China: Generalist versus specialist.

    PubMed

    Wu, Jingxian

    2018-05-20

    The equitable distribution of both generalist and specialist physicians is vital in establishing a fair and efficient health care system. The presents study aims at comparatively measuring the demographical and geographical distribution of generalist and specialist physicians in China from 2012 to 2016. The data were obtained from China Health and Family Planning Statistics and China Statistical Yearbooks 2013 to 2017. Descriptive statistical methods were used to address the quantity and density of physicians, and Gini coefficient was adopted as inequality indicator to trace their distribution inequalities. The quantity and density of total physicians, generalist, and specialist physicians increased during the last 5 years. The demographic distribution inequalities of total physicians, generalist, and specialist physicians are decent with Gini coefficients of approximately 0.3, whereas the corresponding geographical distribution inequalities are severe with Gini coefficients higher than 0.6. Compared with generalist physicians, specialist physicians not only had a higher geographical and geographical density but also maintained a more equitable distribution. The present study compares the distribution inequalities between generalist and specialist physicians in China for the first time. Despite the rapid increase in quantity and density of these physicians, the whole nation faces a severe shortage and maldistribution of generalist physicians. The increase in the number of physicians has not necessarily eliminated the geographical distribution inequalities. The government should consider all influencing factors when allocating health workers and continue promoting the development of primary health care to alleviate these inequalities in physician distribution. Copyright © 2018 John Wiley & Sons, Ltd.

  5. Comparison of the capture efficiency, prey processing, and nutrient extraction in a generalist and a specialist spider predator.

    PubMed

    García, Luis Fernando; Viera, Carmen; Pekár, Stano

    2018-04-02

    Predators are traditionally classified as generalists and specialists based on the presence of adaptations that increase efficiency of prey capture and consumption and selection of particular prey types. Nevertheless, empirical evidence comparing foraging efficiency between generalist and specialist carnivores is scarce. We compared the prey-capture and feeding efficiency in a generalist and a specialist (araneophagous) spider predator. By using two related species, the generalist Harpactea rubicunda (Dysderidae) and the specialist Nops cf. variabilis (Caponiidae), we evaluated their fundamental trophic niche by studying the acceptance of different prey. Then, we compared their predatory behavior, efficiency in capturing prey of varying sizes, feeding efficiency, and nutrient extraction. Nops accepted only spiders as prey, while Harpactea accepted all offered prey, confirming that Nops is stenophagous, while Harpactea is euryphagous. Further, Nops displayed more specialized (stereotyped) capture behavior than Harpactea, suggesting that Nops is a specialist, while Harpactea is a generalist. The specialist immobilized prey faster, overcame much larger prey, and gained more mass (due to feeding on larger prey) than the generalist. Both the specialist and the generalist spider extracted more proteins than lipids, but the extraction of macronutrients in the specialist was achieved mainly by consuming the prosoma of the focal prey. We show that the specialist has more efficient foraging strategy than the generalist.

  6. Influences of Plant Traits on Immune Responses of Specialist and Generalist Herbivores

    PubMed Central

    Lampert, Evan

    2012-01-01

    Specialist and generalist insect herbivore species often differ in how they respond to host plant traits, particularly defensive traits, and these responses can include weakened or strengthened immune responses to pathogens and parasites. Accurate methods to measure immune response in the presence and absence of pathogens and parasites are necessary to determine whether susceptibility to these natural enemies is reduced or increased by host plant traits. Plant chemical traits are particularly important in that host plant metabolites may function as antioxidants beneficial to the immune response, or interfere with the immune response of both specialist and generalist herbivores. Specialist herbivores that are adapted to process and sometimes accumulate specific plant compounds may experience high metabolic demands that may decrease immune response, whereas the metabolic demands of generalist species differ due to more broad-substrate enzyme systems. However, the direct deleterious effects of plant compounds on generalist herbivores may weaken their immune responses. Further research in this area is important given that the ecological relevance of plant traits to herbivore immune responses is equally important in natural systems and agroecosystems, due to potential incompatibility of some host plant species and cultivars with biological control agents of herbivorous pests. PMID:26466545

  7. How Glucosinolates Affect Generalist Lepidopteran Larvae: Growth, Development and Glucosinolate Metabolism

    PubMed Central

    Jeschke, Verena; Kearney, Emily E.; Schramm, Katharina; Kunert, Grit; Shekhov, Anton; Gershenzon, Jonathan; Vassão, Daniel G.

    2017-01-01

    Multiple lepidopteran larvae feed successfully on plants containing glucosinolates despite the diverse array of toxic and deterrent breakdown products, such as isothiocyanates (ITCs), formed upon plant damage. While much is known about how specialist lepidopterans metabolize and tolerate glucosinolates, there is little information about the metabolic fate of these plant defense compounds in specialized herbivores. Employing 13C- and 14C-labeled 4-methylsulfinylbutyl glucosinolate (glucoraphanin), we identified and quantified the major detoxification products of glucosinolates and ITCs in selected specialized and generalist larvae. While specialists prevented glucosinolate hydrolysis or diverted hydrolysis to form nitriles, hydrolysis in generalists proceeded to toxic ITCs, of which a portion were conjugated to glutathione. However, a large amount of ITCs remained unmodified, which may have led to the observed negative effects on growth and development. The performance of two generalist-feeding caterpillars, Spodoptera littoralis (African cotton leafworm) and Mamestra brassicae (cabbage moth) on Arabidopsis thaliana Col-0 and various glucosinolate-deficient mutants was investigated from hatching until pupation. We found that glucosinolates negatively affected larval growth and development, but not survival, with aliphatic glucosinolates having stronger effects than indolic glucosinolates, and the combination of the two glucosinolate types being even more detrimental to growth and development. Curiously, last instar larvae grew better on wild type than on non-glucosinolate-containing plant lines, but this could not be attributed to a change in detoxification rate or feeding behavior. Glucosinolates thus appear to be effective defenses against generalist lepidopteran herbivores at least during most stages of larval development. Nevertheless, the reversal of negative effects in the oldest instar is intriguing, and further investigation of this phenomenon may shed light

  8. Generalist Pre-Service Teacher Education, Self-Efficacy and Arts Education: An Impossible Expectation?

    ERIC Educational Resources Information Center

    Collins, Anita

    2016-01-01

    Generalist teacher educators in Australia are struggling with an impossible expectation in the area of arts education. This is due to a cascading trio of systemic issues. Firstly generalist teachers are entering their teacher education courses with variable and often minimal personal arts training. Secondly they are ill supported to improve their…

  9. Partners in research: building academic-practice partnerships to educate and mentor advanced practice nurses.

    PubMed

    Harbman, Patricia; Bryant-Lukosius, Denise; Martin-Misener, Ruth; Carter, Nancy; Covell, Christine L; Donald, Faith; Gibbins, Sharyn; Kilpatrick, Kelley; McKinlay, James; Rawson, Krista; Sherifali, Diana; Tranmer, Joan; Valaitis, Ruta

    2017-04-01

    Clinical practice is the primary focus of advanced practice nursing (APN) roles. However, with unprecedented needs for health care reform and quality improvement (QI), health care administrators are seeking new ways to utilize all dimensions of APN expertise, especially related to research and evidence-based practice. International studies reveal research as the most underdeveloped and underutilized aspect of these roles. To improve patient care by strengthening the capacity of advanced practice nurses to integrate research and evidence-based practice activities into their day-to-day practice. An academic-practice partnership was created among hospital-based advanced practice nurses, nurse administrators, and APN researchers to create an innovative approach to educate and mentor advanced practice nurses in conducting point-of-care research, QI, or evidence-based practice projects to improve patient, provider, and/or system outcomes. A practice-based research course was delivered to 2 cohorts of advanced practice nurses using a range of teaching strategies including 1-to-1 academic mentorship. All participants completed self-report surveys before and after course delivery. Through participation in this initiative, advanced practice nurses enhanced their knowledge, skills, and confidence in the design, implementation, and/or evaluation of research, QI, and evidence-based practice activities. Evaluation of this initiative provides evidence of the acceptability and feasibility of academic-practice partnerships to educate and mentor point-of-care providers on how to lead, implement, and integrate research, QI and evidence-based activities into their practices. © 2016 John Wiley & Sons, Ltd.

  10. Use of novel pollen species by specialist and generalist solitary bees (Hymenoptera: Megachilidae).

    PubMed

    Williams, Neal M

    2003-01-01

    If trade-offs between flexibility to use a range of host species and efficiency on a limited set underlie the evolution of diet breadth, one resulting prediction is that specialists ought to be more restricted than generalists in their ability to use novel resource species. I used foraging tests and feeding trials to compare the ability of a generalist and a specialist solitary mason bee species to collect and develop on two pollen species that are not normally used in natural populations (novel pollens). Osmia lignaria (Hymenoptera: Megachilidae) is a generalist pollen feeder; O. californica, is more specialized. Adults of the specialist were more limited in use of novel hosts, but only in some contexts. Both bee species refused to collect one novel pollen. The specialist accepted a second novel pollen only when it was presented along with its normal pollen, whereas the generalist collected novel pollen whether presented alone or with normal pollen. Surprisingly, larvae of the specialist were more flexible than were generalists. The specialist grew well on mixtures of normal and novel pollen species, in some cases better than on its normal host alone. Larvae of the generalist grew more poorly on all diets containing novel pollens than on their normal host. Data on these two species of bees suggest that specialization by itself need not reduce flexibility on novel hosts. The findings also provide information about mechanisms of specialization in bees. Similar to some folivores, specific cues of the pollen host and the bee's interpretation of these contribute, along with foraging economics, to pollen choice by adults. The ability of the larvae to cope with specific components of one pollen species need not interfere with its ability to use others.

  11. Effect of urbanisation on habitat generalists: starlings not so flexible?

    NASA Astrophysics Data System (ADS)

    Mennechez, Gwénaëlle; Clergeau, Philippe

    2006-09-01

    The small variability of habitat generalist abundances in relation to landscape changes has been related to their behavioural flexibility. We hypothesise that successful generalists, such as the starling, compensate for feeding resource difficulties (poor quality of food, accessibility) in habitats such as urban ecosystems and that its behavioural flexibility allows for similar breeding performance in rural and urban areas. Along an urbanisation gradient we compared simultaneously (1) success factors such as the abundance of breeding starlings, their breeding performance and the fitness of nestlings, and (2) possible flexibility quantified through the rate of parental food-provisioning, and the composition and the amount of food delivered to nestlings. Abundance of breeding starlings are similar throughout the urbanisation gradient, but urbanisation profoundly and negatively affects reproductive parameters of starlings. Differences in the amount of food delivered to nestlings by parents (less food in town centre), and the small masses of nestlings reared in the urban sectors support the idea that urban nestlings received insufficient food loads. Despite modifications to their diurnal food-provisioning rhythm and the incorporation of some human food refuse into their diet, starling parents have a significantly reduced production of young in the urban centre sector. We rebut the idea that the "generalist" starling is able to breed successfully anywhere: other more "specialist" species succeed in producing their young by innovating more in terms of diet resources. We suggest defining successful birds with respect to colonisation or invasion process through behavioural innovation rather than an ambiguous habitat generalist definition.

  12. Contrasting effects of specialist and generalist herbivores on resistance evolution in invasive plants.

    PubMed

    Zhang, Zhijie; Pan, Xiaoyun; Blumenthal, Dana; van Kleunen, Mark; Liu, Mu; Li, Bo

    2018-04-01

    Invasive alien plants are likely to be released from specialist herbivores and at the same time encounter biotic resistance from resident generalist herbivores in their new ranges. The Shifting Defense hypothesis predicts that this will result in evolution of decreased defense against specialist herbivores and increased defense against generalist herbivores. To test this, we performed a comprehensive meta-analysis of 61 common garden studies that provide data on resistance and/or tolerance for both introduced and native populations of 32 invasive plant species. We demonstrate that introduced populations, relative to native populations, decreased their resistance against specialists, and increased their resistance against generalists. These differences were significant when resistance was measured in terms of damage caused by the herbivore, but not in terms of performance of the herbivore. Furthermore, we found the first evidence that the magnitude of resistance differences between introduced and native populations depended significantly on herbivore origin (i.e., whether the test herbivore was collected from the native or non-native range of the invasive plant). Finally, tolerance to generalists was found to be higher in introduced populations, while neither tolerance to specialists nor that to simulated herbivory differed between introduced and native plant populations. We conclude that enemy release from specialist herbivores and biotic resistance from generalist herbivores have contrasting effects on resistance evolution in invasive plants. Our results thus provide strong support for the Shifting Defense hypothesis. © 2018 by the Ecological Society of America.

  13. How Musical Are Primary Generalist Student Teachers?

    ERIC Educational Resources Information Center

    Henley, Jennie

    2017-01-01

    Current inclusive pedagogical thinking advocates that learning should begin with what the learner can already do. As children bring rich musical experiences with them into school, primary generalist student teachers also bring rich experiences of music and music-making into their initial teacher education programmes. Yet debate still continues as…

  14. Biotic resistance via granivory: Establishment by invasive, naturalized, and native asters reflects generalist preference

    Treesearch

    Dean E. Pearson; Ragan M. Callaway; John L. Maron

    2011-01-01

    Escape from specialist natural enemies is frequently invoked to explain exotic plant invasions, but little attention has been paid to how generalist consumers in the recipient range may influence invasion. We examined how seed preferences of the widespread generalist granivore Peromyscus maniculatus related to recruitment of the strongly invasive exotic Centaurea...

  15. Pharmacists' self-perceptions in relation to the 'Advanced Pharmacy Practice Framework'.

    PubMed

    Ali, A S; Fejzic, J; Grant, G D; Nissen, L M

    2016-01-01

    The Australian Pharmacy Practice Framework was developed by the Advanced Pharmacy Practice Steering Committee and endorsed by the Pharmacy Board of Australia in October 2012. The Steering Committee conducted a study that found practice portfolios to be the preferred method to assess and credential Advanced Pharmacy Practitioner, which is currently being piloted by the Australian Pharmacy Council. Credentialing is predicted to open to all pharmacists practising in Australia by November 2015. To explore how Australian pharmacists self-perceived being advanced in practice and how they related their level of practice to the Australian Advanced Pharmacy Practice Framework. This was an explorative, cross-sectional study with mixed methods analysis. Advanced Pharmacy Practice Framework, a review of the recent explorative study on Advanced Practice conducted by the Advanced Pharmacy Practice Framework Steering Committee and semi-structured interviews (n = 10) were utilized to create, refine and pilot the questionnaire. The questionnaire was advertised across pharmacy-organizational websites via a purposive sampling method. The target population were pharmacists currently registered in Australia. Seventy-two participants responded to the questionnaire. The participants were mostly female (56.9%) and in the 30-40 age group (26.4%). The pharmacists self-perceived their levels of practice as either entry, transition, consolidation or advanced, with the majority selecting the consolidation level (38.9%). Although nearly half (43.1%) of the participants had not seen the Framework beforehand, they defined Advanced Pharmacy Practice similarly to the definition outlined in the Framework, but also added specialization as a requirement. Pharmacists explained why they were practising at their level of practice, stating that not having more years of practice, lacking experience, or postgraduate/post-registration qualifications, and more involvement and recognition in practice were the

  16. Specific foraging kairomones used by a generalist parasitoid.

    PubMed

    Steidle, Johannes L M; Steppuhn, Anke; Ruther, Joachim

    2003-01-01

    In general, it is assumed that generalist natural enemies do not innately use specific cues for the location of their host or prey species. This hypothesis was tested using naïve females of the generalist parasitoid Lariophagus distinguendus Förster and two of its hosts, larvae of the lesser grain borer Rhyzopertha dominica (F.) and of the granary weevil Sitophilus granarius L., feeding in wheat grains. In a four-chamber olfactometer, female parasitoids were attracted to volatiles emanating from the feces of both host species. Chemical analysis of the volatiles from the feces of R. dominica revealed the presence of dominicalure 1 and 2, the species specific aggregation pheromones of R. dominica. The main compounds in the volatiles from feces of S. granarius were identified as chemicals related to mites that are associated with hosts of L. distinguendus. Because these mites are not specific for S. granarius but also co-occur with other hosts, the mite chemicals have to be considered as general cues. In bioassays, synthetic dominicalure was attractive to naïve L. distinguendus, explaining the attraction of feces volatiles from R. dominica. Synthetic mite chemicals and sitophilate, the aggregation pheromone of S. granarius, had no effect on naïve parasitoids. It remains to be determined which innate chemical cues from feces of S. granarius are used by L. distinguendus. In contrast to our initial hypothesis, the generalist L. distinguendus is innately using specific cues for foraging. Two ideas are provided to explain this result.

  17. Beyond competencies: using a capability framework in developing practice standards for advanced practice nursing.

    PubMed

    O'Connell, Jane; Gardner, Glenn; Coyer, Fiona

    2014-12-01

    This paper presents a discussion on the application of a capability framework for advanced practice nursing standards/competencies. There is acceptance that competencies are useful and necessary for definition and education of practice-based professions. Competencies have been described as appropriate for practice in stable environments with familiar problems. Increasingly competencies are being designed for use in the health sector for advanced practice such as the nurse practitioner role. Nurse practitioners work in environments and roles that are dynamic and unpredictable necessitating attributes and skills to practice at advanced and extended levels in both familiar and unfamiliar clinical situations. Capability has been described as the combination of skills, knowledge, values and self-esteem which enables individuals to manage change, be flexible and move beyond competency. A discussion paper exploring 'capability' as a framework for advanced nursing practice standards. Data were sourced from electronic databases as described in the background section. As advanced practice nursing becomes more established and formalized, novel ways of teaching and assessing the practice of experienced clinicians beyond competency are imperative for the changing context of health services. Leading researchers into capability in health care state that traditional education and training in health disciplines concentrates mainly on developing competence. To ensure that healthcare delivery keeps pace with increasing demand and a continuously changing context there is a need to embrace capability as a framework for advanced practice and education. © 2014 John Wiley & Sons Ltd.

  18. A Continuum of Specialists and Generalists in Empirical Communities

    PubMed Central

    Poisot, Timothée; Kéfi, Sonia; Morand, Serge; Stanko, Michal; Marquet, Pablo A.; Hochberg, Michael E.

    2015-01-01

    Understanding the persistence of specialists and generalists within ecological communities is a topical research question, with far-reaching consequences for the maintenance of functional diversity. Although theoretical studies indicate that restricted conditions may be necessary to achieve co-occurrence of specialists and generalists, analyses of larger empirical (and species-rich) communities reveal the pervasiveness of coexistence. In this paper, we analyze 175 ecological bipartite networks of three interaction types (animal hosts–parasite, plant–herbivore and plant–pollinator), and measure the extent to which these communities are composed of species with different levels of specificity in their biotic interactions. We find a continuum from specialism to generalism. Furthermore, we demonstrate that diversity tends to be greatest in networks with intermediate connectance, and argue this is because of physical constraints in the filling of networks. PMID:25992798

  19. Delineating advanced practice nursing in New Zealand: a national survey.

    PubMed

    Carryer, J; Wilkinson, J; Towers, A; Gardner, G

    2018-03-01

    A variety of advanced practice nursing roles and titles have proliferated in response to the changing demands of a population characterized by increasing age and chronic illness. Whilst similarly identified as advanced practice roles, they do not share a common practice profile, educational requirements or legislative direction. The lack of clarity limits comparative research that can inform policy and health service planning. To identify advanced practice roles within nursing titles employed in New Zealand and practice differences between advanced practice and other roles. Replicating recent Australian research, 3255 registered nurses/nurse practitioners in New Zealand completed the amended Advanced Practice Delineation survey tool. The mean domain scores of the predominant advanced practice position were compared with those of other positions. Differences between groups were explored using one-way ANOVA and post hoc between group comparisons. Four nursing position bands were identified: nurse practitioner, clinical nurse specialist, domain-specific and registered nurse. Significant differences between the bands were found on many domain scores. The nurse practitioner and clinical nurse specialist bands had the most similar practice profiles, nurse practitioners being more involved in direct care and professional leadership. Similar to the position of clinical nurse consultant in Australia, those practicing as clinical nurse specialists were deemed to reflect the threshold for advanced practice nursing. The results identified different practice patterns for the identified bands and distinguish the advanced practice nursing roles. By replicating the Australian study of Gardener et al. (2016), this NZ paper extends the international data available to support more evidence-based nursing workforce planning and policy development. © 2017 International Council of Nurses.

  20. Evolution of pollination niches and floral divergence in the generalist plant Erysimum mediohispanicum

    PubMed Central

    Gómez, J. M.; Muñoz-Pajares, A. J.; Abdelaziz, M.; Lorite, J.; Perfectti, F.

    2014-01-01

    Background and Aims How generalist plants diverge in response to pollinator selection without becoming specialized is still unknown. This study explores this question, focusing on the evolution of the pollination system in the pollination generalist Erysimum mediohispanicum (Brassicaceae). Methods Pollinator assemblages were surveyed from 2001 to 2010 in 48 geo-referenced populations covering the entire geographic distribution of E. mediohispanicum. Bipartite modularity, a complex network tool, was used to find the pollination niche of each population. Evolution of the pollination niches and the correlated evolution of floral traits and pollination niches were explored using within-species comparative analyses. Key Results Despite being generalists, the E. mediohispanicum populations studied can be classified into five pollination niches. The boundaries between niches were not sharp, the niches differing among them in the relative frequencies of the floral visitor functional groups. The absence of spatial autocorrelation and phylogenetic signal indicates that the niches were distributed in a phylogeographic mosaic. The ancestral E. mediohispanicum populations presumably belonged to the niche defined by a high number of beetle and ant visits. A correlated evolution was found between pollination niches and some floral traits, suggesting the existence of generalist pollination ecotypes. Conclusions It is conjectured that the geographic variation in pollination niches has contributed to the observed floral divergence in E. mediohispanicum. The process mediating this floral divergence presumably has been adaptive wandering, but the adaptation to the local pollinator faunas has been not universal. The outcome is a landscape where a few populations locally adapted to their pollination environment (generalist pollination ecotypes) coexist with many populations where this local adaptation has failed and where the plant phenotype is not primarily shaped by pollinators. PMID

  1. Predator interference effects on biological control: The "paradox" of the generalist predator revisited

    NASA Astrophysics Data System (ADS)

    Parshad, Rana D.; Bhowmick, Suman; Quansah, Emmanuel; Basheer, Aladeen; Upadhyay, Ranjit Kumar

    2016-10-01

    An interesting conundrum in biological control questions the efficiency of generalist predators as biological control agents. Theory suggests, generalist predators are poor agents for biological control, primarily due to mutual interference. However field evidence shows they are actually quite effective in regulating pest densities. In this work we provide a plausible answer to this paradox. We analyze a three species model, where a generalist top predator is introduced into an ecosystem as a biological control, to check the population of a middle predator, that in turn is depredating on a prey species. We show that the inclusion of predator interference alone, can cause the solution of the top predator equation to blow-up in finite time, while there is global existence in the no interference case. This result shows that interference could actually cause a population explosion of the top predator, enabling it to control the target species, thus corroborating recent field evidence. Our results might also partially explain the population explosion of certain species, introduced originally for biological control purposes, such as the cane toad (Bufo marinus) in Australia, which now functions as a generalist top predator. We also show both Turing instability and spatio-temporal chaos in the model. Lastly we investigate time delay effects.

  2. Is non-host pollen suitable for generalist bumblebees?

    PubMed

    Vanderplanck, Maryse; Decleves, Sylvain; Roger, Nathalie; Decroo, Corentin; Caulier, Guillaume; Glauser, Gaetan; Gerbaux, Pascal; Lognay, Georges; Richel, Aurore; Escaravage, Nathalie; Michez, Denis

    2018-04-01

    Current evidence suggests that pollen is both chemically and structurally protected. Despite increasing interest in studying bee-flower networks, the constraints for bee development related to pollen nutritional content, toxicity and digestibility as well as their role in the shaping of bee-flower interactions have been poorly studied. In this study we combined bioassays of the generalist bee Bombus terrestris on pollen of Cirsium, Trifolium, Salix, and Cistus genera with an assessment of nutritional content, toxicity, and digestibility of pollen. Microcolonies showed significant differences in their development, non-host pollen of Cirsium being the most unfavorable. This pollen was characterized by the presence of quite rare δ7-sterols and a low digestibility. Cirsium consumption seemed increase syrup collection, which is probably related to a detoxification mixing behavior. These results strongly suggest that pollen traits may act as drivers of plant selection by bees and partly explain why Asteraceae pollen is rare in bee generalist diet. © 2016 Institute of Zoology, Chinese Academy of Sciences.

  3. Twenty-year trends in the Ohio generalist physician workforce.

    PubMed

    Williams, P T

    1998-12-01

    Many factors contribute to the variations seen in physician workforce projections, including assumptions about attrition, new physician entry, and geographic requirements. Our study offers data for bench-marking future research into this complex issue. At 5-year intervals starting in 1975, data were collected for each Ohio county by local physician census takers. Total Ohio family physician rates per population did not increase appreciably during the 20-year period. A decrease in the number of allopathic family physicians was balanced by an increase in the number of osteopathic family physicians, many of whom were graduates of the state's first osteopathic medical school, which graduated its first class in 1980. Rates of general internists and general pediatricians increased. In 1975, the percentage of physicians older than 59 years was higher for family physicians than for general internists and general pediatricians. By 1995, this disparity in age distribution had greatly decreased. Rural family physician rates per 100,000 population decreased, and urban rates increased, while both urban and rural rates increased for general internists and general pediatricians. Variations in accounting for clinical time used for non-generalist clinical and nonclinical activities may explain a large part of the difference between generalist head count and full-time equivalency (FTE) study results; together these activities can be said to make up a "fourth compartment" contributing to improper specialty designation. The decrease in the percentage of family physicians older than 59 years indicates that the future supply of practicing family physicians is not in jeopardy. The rural family physician workforce is decreasing, while the general internist and general pediatrician rural workforce is increasing, but the total rural workforce is still well below the urban workforce. Neither component of the rural workforce appears to have stabilized.

  4. Advanced marketing: how to protect and advance your practice.

    PubMed

    Lexa, Frank James

    2007-02-01

    Radiology practices in the United States are facing mounting competitive challenges in many metropolitan areas. This competition is multifaceted and includes other traditional diagnostic imagers. However, the most severe pressures are from new entrants, such as primary and specialty physicians outside of radiology. The business science of marketing provides a set of solutions to help you fight back against this onslaught. In particular, advanced marketing techniques offer compelling strengths for raising awareness of the unique nature of our specialty among both the lay population and primary referrers. Applications of advanced marketing can be used to simultaneously hold and expand your turf. Relying on smarts rather than dollars, they also help overcome the fears that many radiology practices have about the high costs of traditional broadcasting.

  5. Generalist feeding strategies in Arctic freshwater fish: A mechanism for dealing with extreme environments

    USGS Publications Warehouse

    Laske, Sarah M.; Rosenberger, Amanda E.; Wipfli, Mark S.; Zimmerman, Christian E.

    2018-01-01

    Generalist feeding strategies are favoured in stressful or variable environments where flexibility in ecological traits is beneficial. Species that feed across multiple habitat types and trophic levels may impart stability on food webs through the use of readily available, alternative energy pools. In lakes, generalist fish species may take advantage of spatially and temporally variable prey by consuming both benthic and pelagic prey to meet their energy demands. Using stomach content and stable isotope analyses, we examined the feeding habits of fish species in Alaska's Arctic Coastal Plain (ACP) lakes to determine the prevalence of generalist feeding strategies as a mechanism for persistence in extreme environments (e.g. low productivity, extreme cold and short growing season). Generalist and flexible feeding strategies were evident in five common fish species. Fish fed on benthic and pelagic (or nektonic) prey and across trophic levels. Three species were clearly omnivorous, feeding on fish and their shared invertebrate prey. Dietary differences based on stomach content analysis often exceeded 70%, and overlap in dietary niches based on shared isotopic space varied from zero to 40%. Metrics of community‐wide trophic structure varied with the number and identity of species involved and on the dietary overlap and niche size of individual fishes. Accumulation of energy from shared carbon sources by Arctic fishes creates redundancy in food webs, increasing likely resistance to perturbations or stochastic events. Therefore, the generalist and omnivorous feeding strategies employed by ACP fish may maintain energy flow and food web stability in extreme environments.

  6. Analysis instruments for the performance of Advanced Practice Nursing.

    PubMed

    Sevilla-Guerra, Sonia; Zabalegui, Adelaida

    2017-11-29

    Advanced Practice Nursing has been a reality in the international context for several decades and recently new nursing profiles have been developed in Spain as well that follow this model. The consolidation of these advanced practice roles has also led to of the creation of tools that attempt to define and evaluate their functions. This study aims to identify and explore the existing instruments that enable the domains of Advanced Practice Nursing to be defined. A review of existing international questionnaires and instruments was undertaken, including an analysis of the design process, the domains/dimensions defined, the main results and an exploration of clinimetric properties. Seven studies were analysed but not all proved to be valid, stable or reliable tools. One included tool was able to differentiate between the functions of the general nurse and the advanced practice nurse by the level of activities undertaken within the five domains described. These tools are necessary to evaluate the scope of advanced practice in new nursing roles that correspond to other international models of competencies and practice domains. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  7. Jumping through "Loops": A Reflective Study on Preparing Generalist Pre-Service Teachers to Teach Music

    ERIC Educational Resources Information Center

    Heyworth, John

    2011-01-01

    Generalist classroom teachers are being given more responsibility for music education in their schools. How confident and competent are they to do this? I find myself in a position where I am expected to train pre-service generalist teachers to be able to facilitate music in their future classrooms within one unit of music study over a four year…

  8. Factors supporting good partnership working between generalist and specialist palliative care services: a systematic review.

    PubMed

    Gardiner, Clare; Gott, Merryn; Ingleton, Christine

    2012-05-01

    The care that most people receive at the end of their lives is provided not by specialist palliative care professionals but by generalists such as GPs, district nurses and others who have not undertaken specialist training in palliative care. A key focus of recent UK policy is improving partnership working across the spectrum of palliative care provision. However there is little evidence to suggest factors which support collaborative working between specialist and generalist palliative care providers. To explore factors that support partnership working between specialist and generalist palliative care providers. Systematic review. A systematic review of studies relating to partnership working between specialist and generalist palliative care providers was undertaken. Six electronic databases were searched for papers published up until January 2011. Of the 159 articles initially identified, 22 papers met the criteria for inclusion. Factors supporting good partnership working included: good communication between providers; clear definition of roles and responsibilities; opportunities for shared learning and education; appropriate and timely access to specialist palliative care services; and coordinated care. Multiple examples exist of good partnership working between specialist and generalist providers; however, there is little consistency regarding how models of collaborative working are developed, and which models are most effective. Little is known about the direct impact of collaborative working on patient outcomes. Further research is required to gain the direct perspectives of health professionals and patients regarding collaborative working in palliative care, and to develop appropriate and cost-effective models for partnership working.

  9. Clinical Experience in Advanced Practice Nursing: A Canadian Perspective.

    ERIC Educational Resources Information Center

    Donnelly, Glenn

    2003-01-01

    The role of advanced practice (AP) nurses must be clearly articulated and defined and not overshadowed by medical functions. Consensus on their educational preparation and explication of the nature of expertise in advanced practice are needed if AP nurses are to realize the full scope of their practice. (Contains 35 references.) (SK)

  10. A constructivist grounded theory of generalist health professionals and their mental health work.

    PubMed

    Brunero, Scott; Ramjan, Lucie M; Salamonson, Yenna; Nicholls, Daniel

    2018-05-30

    Generalist health professionals, often without formal mental health training, provide treatment and care to people with serious mental illness who present with physical health problems in general hospital settings. This article will present findings from a constructivist grounded theory study of the work delivered by generalist health staff to consumers with mental illness on the general medical/surgical wards of two metropolitan hospitals in Sydney, Australia. The results analysed included three participant observations, two focus groups, and 21 interviews and hospital policy and protocol documents. A substantive theory of mental health work in general hospital settings is illustrated which conceptualizes the following categories: (i) the experience: conflicting realities and ideals; (ii) The Context: facilitating social distancing; and (iii) the social processes: invisibility affecting confidence. The categories are understood through the theoretical lens of symbolic interactionism with the theory providing insights into how the generalist health professionals understand their sense of self or identity. © 2018 Australian College of Mental Health Nurses Inc.

  11. Will generalist physician supply meet demands of an increasing and aging population?

    PubMed

    Colwill, Jack M; Cultice, James M; Kruse, Robin L

    2008-01-01

    We predict that population growth and aging will increase family physicians' and general internists' workloads by 29 percent between 2005 and 2025. We expect a 13 percent increased workload for care of children by pediatricians and family physicians. However, the supply of generalists for adult care, adjusted for age and sex, will increase 7 percent, or only 2 percent if the number of graduates continues to decline through 2008. We expect deficits of 35,000-44,000 adult care generalists, although the supply for care of children should be adequate. These forces threaten the nation's foundation of primary care for adults.

  12. Diet of generalist predators reflects effects of cropping period and farming system on extra- and intraguild prey.

    PubMed

    Roubinet, Eve; Birkhofer, Klaus; Malsher, Gerard; Staudacher, Karin; Ekbom, Barbara; Traugott, Michael; Jonsson, Mattias

    2017-06-01

    The suppression of agricultural pests by natural enemies, including generalist arthropod predators, is an economically important regulating ecosystem service. Besides pests, generalist predators may also consume non-pest extraguild and intraguild prey, which can affect their impact on pest populations. This may either reduce the impact of generalist predators on pest populations, because they are diverted from pest predation, or increase it, as it helps them survive periods of low pest availability. However, the availability of pest prey and alternative, non-pest prey can vary over the crop growing season and between farming systems, potentially affecting predator-prey interactions and the levels of biological control. We have limited information about how farming systems and environmental variation over the crop growing season influence predator diets. This limits our ability to predict the importance of generalist predators as natural enemies of agricultural pests. Here we utilize molecular gut content analyses to assess detection frequencies of extra- and intraguild prey DNA in generalist predator communities in replicated organically and conventionally managed cereal fields at two key periods of the cropping season for aphid biological control. This is done in order to understand how farming system, crop season, prey availability and predator community composition determine the composition of predator diets. Aphid pests and decomposers (springtails) were equally important prey for generalist predators early in the growing season. Later in the season, the importance of aphid prey increased with increasing aphid densities while springtail predation rates were positively correlated to abundance of this prey at both early and late crop growth stages. Intraguild predation was unidirectional: carabids fed on spiders, whereas spiders rarely fed on carabids. Carabids had higher detection frequencies for the two most common spider families in organically compared to

  13. State legislative strategies to improve the supply and distribution of generalist physicians, 1985 to 1992.

    PubMed Central

    Rivo, M L; Henderson, T M; Jackson, D M

    1995-01-01

    State laws enacted between 1985 and 1992 were reviewed to examine state involvement in influencing the supply and distribution of generalist physicians. Forty-seven states enacted 238 relevant laws during this period. In 1991 and 1992, 36 states enacted 98 laws, as compared with 1985 and 1986, when 8 states enacted 12 laws. Legislation addressed planning and oversight; financial incentives to institutions, students, and residents; and strategies to enhance the practice environment. A new strategy is to link funding to measureable outcomes, such as the career choices of a state medical school's graduates. Few states devoted resources to evaluate their efforts. PMID:7892929

  14. Value of wireless personal digital assistants for practice: perceptions of advanced practice nurses.

    PubMed

    Garrett, Bernard; Klein, Gerri

    2008-08-01

    The aims were to explore advanced practice nurses' perceptions on wireless Personal Digital Assistant technologies, to establish the type and range of tools that would be useful to support their practice and to identify any requirements and limitations that may impact the implementation of wireless Personal Digital Assistants in practice. The wireless Personal Digital Assistant is becoming established as a hand-held computing tool for healthcare professionals. The reflections of advanced practice nurses' about the value of wireless Personal Digital Assistants and its potential to contribute to improved patient care has not been investigated. A qualitative interpretivist design was used to explore advanced practice nurses' perceptions on the value of wireless Personal Digital Assistant technologies to support their practice. The data were collected using survey questionnaires and individual and focus group interviews with nurse practitioners, clinical nurse specialists and information technology managers based in British Columbia, Canada. An open-coding content analysis was performed using qualitative data analysis software. Wireless Personal Digital Assistant's use supports the principles of pervasivity and is a technology rapidly being adopted by advanced practice nurses. Some nurses indicated a reluctance to integrate wireless Personal Digital Assistant technologies into their practices because of the cost and the short technological life cycle of these devices. Many of the barriers which precluded the use of wireless networks within facilities are being removed. Nurses demonstrated a complex understanding of wireless Personal Digital Assistant technologies and gave good rationales for its integration in their practice. Nurses identified improved client care as the major benefit of this technology in practice and the type and range of tools they identified included clinical reference tools such as drug and diagnostic/laboratory reference applications and wireless

  15. The eco-evolutionary responses of a generalist consumer to resource competition.

    PubMed

    Abrams, Peter A

    2012-10-01

    This article explores the combined evolutionary and ecological responses of resource uptake abilities in a generalist consumer to exploitative competition for one resource using a simple 2-resource model. It compares the sizes of ecologically and evolutionarily caused changes in population densities in cases where the original consumer has a strong or a weak trade-off in its abilities to consume the two resources. The analysis also compares the responses of the original species to competition when the competitor's population size is or is not limited by the shared resource. Although divergence in resource use traits in the resident generalist consumer is expected under all scenarios when resources are substitutable, the changes in population densities of the resources and resident consumer frequently differ between scenarios. The population of the original consumer often decreases as a result of its own adaptive divergence, and this decrease is often much greater than the initial ecological decrease. If the evolving consumer has a strong trade-off, the overlapped resource increases in equilibrium population density in response to being consumed by a generalist competitor. Some of these predictions differ qualitatively in alternative scenarios involving sustained variation in population densities or nutritionally essential resources. © 2012 The Author(s). Evolution© 2012 The Society for the Study of Evolution.

  16. Chemical and behavioral integration of army ant-associated rove beetles - a comparison between specialists and generalists.

    PubMed

    von Beeren, Christoph; Brückner, Adrian; Maruyama, Munetoshi; Burke, Griffin; Wieschollek, Jana; Kronauer, Daniel J C

    2018-01-01

    Host-symbiont interactions are embedded in ecological communities and range from unspecific to highly specific relationships. Army ants and their arthropod guests represent a fascinating example of species-rich host-symbiont associations where host specificity ranges across the entire generalist - specialist continuum. In the present study, we compared the behavioral and chemical integration mechanisms of two extremes of the generalist - specialist continuum: generalist ant-predators in the genus Tetradonia (Staphylinidae: Aleocharinae: Athetini), and specialist ant-mimics in the genera Ecitomorpha and Ecitophya (Staphylinidae: Aleocharinae: Ecitocharini). Similar to a previous study of Tetradonia beetles, we combined DNA barcoding with morphological studies to define species boundaries in ant-mimicking beetles. This approach found four ant-mimicking species at our study site at La Selva Biological Station in Costa Rica. Community sampling of Eciton army ant parasites revealed that ant-mimicking beetles were perfect host specialists, each beetle species being associated with a single Eciton species. These specialists were seamlessly integrated into the host colony, while generalists avoided physical contact to host ants in behavioral assays. Analysis of the ants' nestmate recognition cues, i.e. cuticular hydrocarbons (CHCs), showed close similarity in CHC composition and CHC concentration between specialists and Eciton burchellii foreli host ants. On the contrary, the chemical profiles of generalists matched host profiles less well, indicating that high accuracy in chemical host resemblance is only accomplished by socially integrated species. Considering the interplay between behavior, morphology, and cuticular chemistry, specialists but not generalists have cracked the ants' social code with respect to various sensory modalities. Our results support the long-standing idea that the evolution of host-specialization in parasites is a trade-off between the range of

  17. Ethanol confers differential protection against generalist and specialist parasitoids of Drosophila melanogaster.

    PubMed

    Lynch, Zachary R; Schlenke, Todd A; Morran, Levi T; de Roode, Jacobus C

    2017-01-01

    As parasites coevolve with their hosts, they can evolve counter-defenses that render host immune responses ineffective. These counter-defenses are more likely to evolve in specialist parasites than generalist parasites; the latter face variable selection pressures between the different hosts they infect. Natural populations of the fruit fly Drosophila melanogaster are commonly threatened by endoparasitoid wasps in the genus Leptopilina, including the specialist L. boulardi and the generalist L. heterotoma, and both wasp species can incapacitate the cellular immune response of D. melanogaster larvae. Given that ethanol tolerance is high in D. melanogaster and stronger in the specialist wasp than the generalist, we tested whether fly larvae could use ethanol as an anti-parasite defense and whether its effectiveness would differ against the two wasp species. We found that fly larvae benefited from eating ethanol-containing food during exposure to L. heterotoma; we observed a two-fold decrease in parasitization intensity and a 24-fold increase in fly survival to adulthood. Although host ethanol consumption did not affect L. boulardi parasitization rates or intensities, it led to a modest increase in fly survival. Thus, ethanol conferred stronger protection against the generalist wasp than the specialist. We tested whether fly larvae can self-medicate by seeking ethanol-containing food after being attacked by wasps, but found no support for this hypothesis. We also allowed female flies to choose between control and ethanol-containing oviposition sites in the presence vs. absence of wasps and generally found significant preferences for ethanol regardless of wasp presence. Overall, our results suggest that D. melanogaster larvae obtain protection from certain parasitoid wasp species through their mothers' innate oviposition preferences for ethanol-containing food sources.

  18. Epigenetics: An Emerging Framework for Advanced Practice Psychiatric Nursing.

    PubMed

    DeSocio, Janiece E

    2016-07-01

    The aims of this paper are to synthesize and report research findings from neuroscience and epigenetics that contribute to an emerging explanatory framework for advanced practice psychiatric nursing. Discoveries in neuroscience and epigenetics reveal synergistic mechanisms that support the integration of psychotherapy, psychopharmacology, and psychoeducation in practice. Advanced practice psychiatric nurses will benefit from an expanded knowledge base in neuroscience and epigenetics that informs and explains the scientific rationale for our integrated practice. © 2015 Wiley Periodicals, Inc.

  19. Tennessee advanced practice nurse compensation survey results 2006-2007.

    PubMed

    Arnold, Kimberly

    2007-01-01

    In 2006, representatives from Middle Tennessee Advanced Practice Nurses (MTAPN), Greater Memphis Area Advanced Practice Nurses (GMAAPN), and Northeast Tennessee Nurse Practitioners Association (NETNPA) decided to poll APNs in Tennessee to compare data with the most recent results from the Advance for Nurse Practitioners national NP survey. Every other year, Advance for Nurse Practitioners publishes salary survey results from their survey. Most recently, in January 2006, an average nationwide salary for all APNs was reported at $74,812, with Tennessee's average at $71,068.

  20. Impact of generalist care managers on patients with diabetes.

    PubMed

    Dorr, David A; Wilcox, Adam; Donnelly, Steven M; Burns, Laurie; Clayton, Paul D

    2005-10-01

    To determine how the addition of generalist care managers and collaborative information technology to an ambulatory team affects the care of patients with diabetes. Multiple ambulatory clinics within Intermountain Health Care (IHC), a large integrated delivery network. A retrospective cohort study comparing diabetic patients treated by generalist care managers with matched controls was completed. Exposure patients had one or more contacts with a care manager; controls were matched on utilization, demographics, testing, and baseline glucose control. Using role-specific information technology to support their efforts, care managers assessed patients' readiness for change, followed guidelines, and educated and motivated patients. Patient data collected as part of an electronic patient record were combined with care manager-created databases to assess timely testing of glycosylated hemoglobin (HbA1c) and low-density lipoprotein (LDL) levels and changes in LDL and HbA1c levels. In a multivariable model, the odds of being overdue for testing for HbA1c decreased by 21 percent in the exposure group (n=1,185) versus the control group (n=4,740). The odds of being tested when overdue for HbA1c or LDL increased by 49 and 26 percent, respectively, and the odds of HbA1c <7.0 percent also increased by 19 percent in the exposure group. The average HbA1c levels decreased more in the exposure group than in the controls. The effect on LDL was not significant. Generalist care managers using computer-supported diabetes management helped increase adherence to guidelines for testing and control of HbA1c levels, leading to improved health status of patients with diabetes.

  1. Experimental evolution for generalists and specialists reveals multivariate genetic constraints on thermal reaction norms.

    PubMed

    Berger, D; Walters, R J; Blanckenhorn, W U

    2014-09-01

    Theory predicts the emergence of generalists in variable environments and antagonistic pleiotropy to favour specialists in constant environments, but empirical data seldom support such generalist-specialist trade-offs. We selected for generalists and specialists in the dung fly Sepsis punctum (Diptera: Sepsidae) under conditions that we predicted would reveal antagonistic pleiotropy and multivariate trade-offs underlying thermal reaction norms for juvenile development. We performed replicated laboratory evolution using four treatments: adaptation at a hot (31 °C) or a cold (15 °C) temperature, or under regimes fluctuating between these temperatures, either within or between generations. After 20 generations, we assessed parental effects and genetic responses of thermal reaction norms for three correlated life-history traits: size at maturity, juvenile growth rate and juvenile survival. We find evidence for antagonistic pleiotropy for performance at hot and cold temperatures, and a temperature-mediated trade-off between juvenile survival and size at maturity, suggesting that trade-offs associated with environmental tolerance can arise via intensified evolutionary compromises between genetically correlated traits. However, despite this antagonistic pleiotropy, we found no support for the evolution of increased thermal tolerance breadth at the expense of reduced maximal performance, suggesting low genetic variance in the generalist-specialist dimension. © 2014 The Authors. Journal of Evolutionary Biology © 2014 European Society For Evolutionary Biology.

  2. Training Advanced Practice Palliative Care Nurses.

    ERIC Educational Resources Information Center

    Sherman, Deborah Witt

    1999-01-01

    Describes the role and responsibilities of advanced-practice nurses in palliative care and nursing's initiative in promoting high-quality care through the educational preparation of these nurses. (JOW)

  3. An Australian investigation of emotional work, emotional well-being and professional practice: an emancipatory inquiry.

    PubMed

    Rose, Jayln; Glass, Nel

    2010-05-01

    This study set out to explore the relationship between emotional work, emotional well-being and professional practice of generalist community health nurses who provided palliative care to clients living at home. Research suggests that palliative care practice is emotionally demanding and at times challenging. Whilst nurses find their palliative practice a source of job satisfaction the associated stresses can impact on nurses emotional well-being. A qualitative emancipatory methodology informed this study. Semi-structured interviews/storytelling and reflective journaling were the two methods applied. Sixteen community health nurses including the researcher participated. Thematic analysis of the data was undertaken. The concept of emotional well-being is associated with nurses' feelings of being balanced or out of balance. There is a pervasive interconnectedness between emotional work, emotional well-being and professional practice that is influenced by factors such as organisational and workplace issues; communication with health professionals, professional boundaries; education and professional development. Three major interwoven themes emerged highlighting that palliative care provision was demanding and rewarding, yet dependent on the nurse's comfortability within practice. Self-care is also important to the generalist nurses and strategies to enhance well-being include healthy lifestyle choices, debriefing, self-validation, assertiveness and emotional support. Emotional well-being is complex and multifaceted. The value of emotional well-being to professional practice is important. Palliative care provision is associated with demands, rewards and comfortability. It is essential that attention be given to the experiences of generalist community health nurses who engage in palliative care provision. As the demand for community palliative care increases, the issues that limit and enhance the emotional well-being of generalist palliative care nurses' become critical

  4. Dynamics of a intraguild predation model with generalist or specialist predator.

    PubMed

    Kang, Yun; Wedekin, Lauren

    2013-11-01

    Intraguild predation (IGP) is a combination of competition and predation which is the most basic system in food webs that contains three species where two species that are involved in a predator/prey relationship are also competing for a shared resource or prey. We formulate two intraguild predation (IGP: resource, IG prey and IG predator) models: one has generalist predator while the other one has specialist predator. Both models have Holling-Type I functional response between resource-IG prey and resource-IG predator; Holling-Type III functional response between IG prey and IG predator. We provide sufficient conditions of the persistence and extinction of all possible scenarios for these two models, which give us a complete picture on their global dynamics. In addition, we show that both IGP models can have multiple interior equilibria under certain parameters range. These analytical results indicate that IGP model with generalist predator has "top down" regulation by comparing to IGP model with specialist predator. Our analysis and numerical simulations suggest that: (1) Both IGP models can have multiple attractors with complicated dynamical patterns; (2) Only IGP model with specialist predator can have both boundary attractor and interior attractor, i.e., whether the system has the extinction of one species or the coexistence of three species depending on initial conditions; (3) IGP model with generalist predator is prone to have coexistence of three species.

  5. Ethanol confers differential protection against generalist and specialist parasitoids of Drosophila melanogaster

    PubMed Central

    Schlenke, Todd A.; Morran, Levi T.; de Roode, Jacobus C.

    2017-01-01

    As parasites coevolve with their hosts, they can evolve counter-defenses that render host immune responses ineffective. These counter-defenses are more likely to evolve in specialist parasites than generalist parasites; the latter face variable selection pressures between the different hosts they infect. Natural populations of the fruit fly Drosophila melanogaster are commonly threatened by endoparasitoid wasps in the genus Leptopilina, including the specialist L. boulardi and the generalist L. heterotoma, and both wasp species can incapacitate the cellular immune response of D. melanogaster larvae. Given that ethanol tolerance is high in D. melanogaster and stronger in the specialist wasp than the generalist, we tested whether fly larvae could use ethanol as an anti-parasite defense and whether its effectiveness would differ against the two wasp species. We found that fly larvae benefited from eating ethanol-containing food during exposure to L. heterotoma; we observed a two-fold decrease in parasitization intensity and a 24-fold increase in fly survival to adulthood. Although host ethanol consumption did not affect L. boulardi parasitization rates or intensities, it led to a modest increase in fly survival. Thus, ethanol conferred stronger protection against the generalist wasp than the specialist. We tested whether fly larvae can self-medicate by seeking ethanol-containing food after being attacked by wasps, but found no support for this hypothesis. We also allowed female flies to choose between control and ethanol-containing oviposition sites in the presence vs. absence of wasps and generally found significant preferences for ethanol regardless of wasp presence. Overall, our results suggest that D. melanogaster larvae obtain protection from certain parasitoid wasp species through their mothers’ innate oviposition preferences for ethanol-containing food sources. PMID:28700600

  6. Frequency, efficiency, and physical characteristics of predation by generalist predators of brown marmorated stink bug (Hemiptera: Pentatomidae) eggs

    USDA-ARS?s Scientific Manuscript database

    The native generalist predator community of Halyomorpha halys, an invasive species in the United States and Europe, remains poorly studied. The aims of the current study were to determine which generalist predators that are commonly found in mid-Atlantic orchards and vegetable crops are capable of ...

  7. Organizing a Community Advanced Pharmacy Practice Experience

    PubMed Central

    Koenigsfeld, Carrie Foust; Tice, Angela L

    2006-01-01

    Setting up a community advanced pharmacy practice experience can be an overwhelming task for many pharmacy preceptors. This article provides guidance to pharmacist preceptors in developing a complete and effective community advanced pharmacy practice experience (APPE). When preparing for the APPE, initial discussions with the college or school of pharmacy are key. Benefits, training, and requirements should be addressed. Site preparation, including staff education, will assist in the development process. The preceptor should plan orientation day activities and determine appropriate evaluation and feedback methods. With thorough preparation, the APPE will be rewarding for both the student and the pharmacy site. PMID:17136163

  8. Organizing a community advanced pharmacy practice experience.

    PubMed

    Koenigsfeld, Carrie Foust; Tice, Angela L

    2006-02-15

    Setting up a community advanced pharmacy practice experience can be an overwhelming task for many pharmacy preceptors. This article provides guidance to pharmacist preceptors in developing a complete and effective community advanced pharmacy practice experience (APPE). When preparing for the APPE, initial discussions with the college or school of pharmacy are key. Benefits, training, and requirements should be addressed. Site preparation, including staff education, will assist in the development process. The preceptor should plan orientation day activities and determine appropriate evaluation and feedback methods. With thorough preparation, the APPE will be rewarding for both the student and the pharmacy site.

  9. Specialist Individuals, Generalist Populations, and Gentoo Penguin Foraging Ecology Across the Scotia Arc During a Time of Rapid Environmental Change

    NASA Astrophysics Data System (ADS)

    Herman, R.; Polito, M. J.

    2016-02-01

    Populations of Gentoo penguins (Pygoscelis papua), have increased in the Scotia arc in the last four decades, while sister species such as Chinstrap (P. antarctics) and Adélie penguins (P. adeliae) have experienced substantial declines in numbers. Previous dietary analyses suggest Gentoo penguins have a generalist foraging niche, which may help buffer them from recent climate-driven declines in key prey species, such as Antarctic krill (Euphausia superba). Ecological theory indicates that generalist populations fall under two different categories: Type A generalist populations exhibit large variation within individuals, and little variation between individuals, where Type B generalist populations are comprised of individual specialists, with large variation between individuals. It is important to identify which type of generalist population Gentoo penguins fall under, as these strategies impart differing ecological and evolutionary ramifications under times of environmental change. We conducted stable isotope analysis using tail feathers from Gentoo penguins at four breeding sites across the Scotia arc, including the Falkland Islands, South Georgia, the South Shetland Islands, and the Western Antarctic Peninsula, to assess individual variation in winter diets and determine the type of generalist strategies that Gentoo penguins utilize. Preliminary analysis indicates the presence of individual specialization within the four geographically distinct breeding colonies, suggesting that individual resilience to further shifts in food availability may vary within Gentoo penguin populations.

  10. Effects of generalist herbivory on resistance and resource allocation by the invasive plant, Phytolacca americana.

    PubMed

    Huang, Wei; Ding, Jianqing

    2016-04-01

    Successful invasions by exotic plants are often attributed to a loss of co-evolved specialists and a re-allocation of resources from defense to growth and reproduction. However, invasive plants are rarely completely released from insect herbivory because they are frequently attacked by generalists in their introduced ranges. The novel generalist community may also affect the invasive plant's defensive strategies and resource allocation. Here, we tested this hypothesis using American pokeweed (Phytolacca americana L.), a species that has become invasive in China, which is native to North America. We examined resistance, tolerance, growth and reproduction of plant populations from both China and the USA when plants were exposed to natural generalist herbivores in China. We found that leaf damage was greater for invasive populations than for native populations, indicating that plants from invasive ranges had lower resistance to herbivory than those from native ranges. A regression of the percentage of leaf damage against mass showed that there was no significant difference in tolerance between invasive and native populations, even though the shoot, root, fruit and total mass were larger for invasive populations than for native populations. These results suggest that generalist herbivores are important drivers mediating the defensive strategies and resource allocation of the invasive American pokeweed. © 2015 Institute of Zoology, Chinese Academy of Sciences.

  11. Musical Knowledge, Musical Identity, and the Generalist Teacher: Vicki's Story.

    ERIC Educational Resources Information Center

    Russell, Joan

    1996-01-01

    Utilizes excerpts from an undergraduate elementary education student's journal to examine generalist teachers' attitudes towards musical competency and the necessary qualifications for teachers. Traces one teacher's recognition of her own musicality and the corresponding influence on her feelings of competency to teach this subject in an…

  12. Generalist genes’ and mathematics in 7-year-old twins

    PubMed Central

    Kovas, Y.; Harlaar, N.; Petrill, S. A.; Plomin, R.

    2009-01-01

    Mathematics performance at 7 years as assessed by teachers using UK national curriculum criteria has been found to be highly heritable. For almost 3000 pairs of 7-year-old same-sex twins, we used multivariate genetic analysis to investigate the extent to which these genetic effects on mathematics performance overlap with genetic effects on reading and general intelligence (g) as predicted by the ‘generalist genes’ hypothesis. We found substantial genetic overlap between mathematics and reading (genetic correlation=0.74) and between mathematics and g (0.67). These findings support the ‘generalist genes’ hypothesis that most of the genes that contribute to individual differences in mathematics are the same genes that affect reading and g. Nonetheless, the genetic correlations are less than unity and about a third of the genetic variance on mathematics is independent of reading and g, suggesting that there are also some genes whose effects are specific to mathematics. PMID:19319204

  13. Earlier nesting by generalist predatory bird is associated with human responses to climate change.

    PubMed

    Smith, Shawn H; Steenhof, Karen; McClure, Christopher J W; Heath, Julie A

    2017-01-01

    Warming temperatures cause temporal changes in growing seasons and prey abundance that drive earlier breeding by birds, especially dietary specialists within homogeneous habitat. Less is known about how generalists respond to climate-associated shifts in growing seasons or prey phenology, which may occur at different rates across land cover types. We studied whether breeding phenology of a generalist predator, the American kestrel (Falco sparverius), was associated with shifts in growing seasons and, presumably, prey abundance, in a mosaic of non-irrigated shrub/grasslands and irrigated crops/pastures. We examined the relationship between remotely-sensed normalized difference vegetation index (NDVI) and abundance of small mammals that, with insects, constitute approximately 93% of kestrel diet biomass. We used NDVI to estimate the start of the growing season (SoGS) in irrigated and non-irrigated lands from 1992 to 2015 and tested whether either estimate of annual SoGS predicted the timing of kestrel nesting. Finally, we examined relationships among irrigated SoGS, weather and crop planting. NDVI was a useful proxy for kestrel prey because it predicted small mammal abundance and past studies showed that NDVI predicts insect abundance. NDVI-estimated SoGS advanced significantly in irrigated lands (β = -1·09 ± 0·30 SE) but not in non-irrigated lands (β = -0·57 ± 0·53). Average date of kestrel nesting advanced 15 days in the past 24 years and was positively associated with the SoGS in irrigated lands, but not the SoGS in non-irrigated lands. Advanced SoGS in irrigated lands was related to earlier planting of crops after relatively warm winters, which were more common in recent years. Despite different patterns of SoGS change between land cover types, kestrel nesting phenology shifted with earlier prey availability in irrigated lands. Kestrels may preferentially track prey in irrigated lands over non-irrigated lands because of higher quality prey on

  14. Sugar preferences and digestive efficiency of the village weaver: a generalist avian pollinator of African plants.

    PubMed

    Odendaal, T C; Brown, M; Downs, C T; Johnson, S D

    2010-07-15

    Recent research has shown that nectar properties of flowers pollinated by generalist avian nectarivores differ markedly from those of flowers pollinated by specialist avian nectarivores. In particular, flowers pollinated by generalist avian nectarivores tend to have very dilute nectar dominated by hexose sugars. To establish whether pollinator-mediated selection can explain these traits, we tested nectar sugar preferences and digestive capabilities of the village weaver (Ploceus cucullatus), a common generalist passerine nectarivore in South Africa. When offered pairwise choices of equicaloric hexose and sucrose solutions, village weavers preferred hexose solutions at 5% and 10% sucrose equivalents (SE) but did not show significant preference for either type of sugar when higher concentrations were offered (15%, 20% and 25% SE). Birds were less efficient at absorbing sucrose than hexose sugars, as revealed by high-performance liquid chromatography (HPLC) analysis of excreta sugar content. This was true at both concentrations tested (8.22% and 25%), although apparent sucrose assimilation rates were still relatively high (89.6+/-2.9% at low concentrations and 93.6+/-1.7% at high concentrations). Transit times indicated that sucrose also passes through the digestive tract faster than hexose sugars, particularly when consumed at high concentrations. This may limit the rate at which sucrose can be hydrolyzed before absorption. These results indicate that hexose preferences in generalist avian nectarivores may help explain the low sucrose content in flowers pollinated by these birds. Moreover, the preference for hexose sugars in weavers was most evident at the low concentrations (ca. 9% sugar by mass) that are typical of nectar in flowers pollinated by generalist avian nectarivores.

  15. Trends and quality of care in outpatient visits to generalist and specialist physicians delivering primary care in the United States, 1997-2010.

    PubMed

    Edwards, Samuel T; Mafi, John N; Landon, Bruce E

    2014-06-01

    Although many specialists serve as primary care physicians (PCPs), the type of patients they serve, the range of services they provide, and the quality of care they deliver is uncertain. To describe trends in patient, physician, and visit characteristics, and compare visit-based quality for visits to generalists and specialists self-identified as PCPs. Cross-sectional study and time trend analysis. Nationally representative sample of visits to office-based physicians from the National Ambulatory Medical Care Survey, 1997-2010. Proportions of primary care visits to generalist and specialists, patient characteristics, principal diagnoses, and quality. Among 84,041 visits to self-identified PCPs representing an estimated 4.0 billion visits, 91.5 % were to generalists, 5.9 % were to medical specialists and 2.6 % were to obstetrician/gynecologists. The proportion of PCP visits to generalists increased from 88.4 % in 1997 to 92.4 % in 2010, but decreased for medical specialists from 8.0 % to 4.8 %, p = 0.04). The proportion of medical specialist visits in which the physician self-identified as the patient's PCP decreased from 30.6 % in 1997 to 9.8 % in 2010 (p < 0.01). Medical specialist PCPs take care of older patients (mean age 61 years), and dedicate most of their visits to chronic disease management (51.0 %), while generalist PCPs see younger patients (mean age 55.4 years) most commonly for new problems (40.5 %). Obstetrician/gynecologists self-identified as PCPs see younger patients (mean age 38.3 p < 0.01), primarily for preventive care (54.0 %, p < 0.01). Quality of care for cardiovascular disease was better in visits to cardiologists than in visits to generalists, but was similar or better in visits to generalists compared to visits to other medical specialists. Medical specialists are less frequently serving as PCPs for their patients over time. Generalist, medical specialist, and obstetrician/gynecologist PCPs serve different primary care roles

  16. How can a competency framework for advanced practice support care?

    PubMed

    Stanford, Pamela Elizabeth

    2016-11-10

    Aim To explore whether perception of nurse practitioners in relation to whether a competency framework for advanced practice can support their work. Method A qualitative cross-sectional design was used, embedded in an interpretative paradigm of research. A non-probability sample of eight experienced nurse practitioners took part in focus groups and answered questionnaires. A mixture of phenomenological and grounded theory approaches were used to collect the data. Findings Four major themes were identified: competency frameworks can identify individual strengths and weaknesses, they can be used to set clear goals and targets, they can improve how practice is organised, and they have the potential to limit practice in terms of narrowing boundaries. The study also found competency frameworks could provide an structure to guide the development and evaluation of educational programmes. Conclusion Competency frameworks can be used so to target the development of new advanced nurse practitioners. They can address workforce development and governance by ensuring nurse practitioners have the competencies to provide safe, autonomous practice. Competency frameworks have been shown to ensure consistency in clinical practice skills underpinned with nurse practitioners' theoretical knowledge. They provide a clear development structure for career development and advanced practice. However, internationally, there is still a lack of definition of advanced practice and its core competencies.

  17. Food-limitation in a generalist predator.

    PubMed

    Rutz, Christian; Bijlsma, Rob G

    2006-08-22

    Investigating food-limitation in generalist predators is difficult, because they can switch to alternative prey, when one of their staple prey becomes scarce. Apart from data on the dynamics of the predator population, a robust study requires: (i) a documentation of the predator's entire prey base; and (ii) an experimental or natural situation, where profitable dietary shifts are impossible, because several preferred prey species decline simultaneously. Here, we provide a detailed description of how food-supply has limited a generalist avian top predator, the northern goshawk Accipiter gentilis. In our study area, populations of several principal goshawk prey species crashed simultaneously during 1975-2000, whereas other extrinsic factors remained essentially unchanged. The breeding and non-breeding segments of the local goshawk population declined markedly, associated with a significant increase in nest failures. Brood size of successful pairs remained unaffected by changes in prey availability. Breeding recruitment ceased at a time when potential replacement birds ('floaters') were still present, providing a rare empirical demonstration of an 'acceptance threshold' in raptor territory choice. To investigate how goshawk diet changed in response to varying food-supplies, we make novel use of an analytical tool from biodiversity research-'abundance-biomass-comparison curves' (ABC curves). With increasing levels of food-stress, the dominance of principal prey species in the diet decreased, and the number of small-bodied prey species increased, as did intra-guild predation. Our finding that breeder and non-breeder segments declined in concert is unexpected. Our results carry the management implication that, in food-limited raptor populations, externally induced breeder mortality can rapidly depress population size, as losses are no longer buffered when floaters reject breeding opportunities.

  18. Neonatal nurse practitioners: identity as advanced practice nurses.

    PubMed

    Beal, J A; Maguire, D; Carr, R

    1996-06-01

    To define how neonatal nurse practitioners (NNPs) perceive their identity as advanced practice nurses. Non-experimental descriptive and correlational survey. Nationwide random sample drawn from NNPs certified by the National Certification Corporation. Two hundred fifty-eight neonatal nurse practitioners practicing in neonatal intensive-care units across the United States. Neonatal Nurse Practitioners indicated on a visual analogue scale at which point their philosophy of practice fell on a continuum from nursing to medicine and specified on a 5-point bipolar Likert scale how various role socialization factors influenced their identity. The NNPs predominantly were certificate-prepared and aligned themselves with a medical philosophy. Those NNPs who were master's-prepared (p < .01), precepted by another NNP (p < .05), espoused a philosophy of nursing (p < .001), belonged to a professional nursing organization (p < .05), and had an NNP role model (p < .001) were more likely to have a strong nursing identity (95% confidence interval). The issues of role differentiation, socialization, and identity of advanced practice nurses in tertiary care need further exploration. These data support the American Nurses' Association mandate of graduate nursing education for advanced nurse practitioners.

  19. Profile of advanced nursing practice in Spain: A cross-sectional study.

    PubMed

    Sevilla Guerra, Sonia; Miranda Salmerón, Josep; Zabalegui, Adelaida

    2018-03-01

    In this study, we described the profile of advanced nursing practice in Spain. A cross-sectional study design was used to explore the extent and patterns of advanced nursing practice activity within the domains of expert care planning, integrated care, interprofessional collaboration, education, research, evidence-based practice, and professional leadership. Data were collected in 2015/2016. Purposive sampling yielded a sample of 165 specialist and expert nurses employed by a dual tertiary and community hospital in an urban setting. The study included specialist and expert nurses who had a higher practice profile than registered general nurses. The performance of activities according to age, current position, years of experience, nursing grade, and education was compared. Practice domains were more strongly influenced by the predictors of nursing position and professional career ladder. Age and experience predictors were found to be weak predictors of advanced practice domains. This study offers essential information of the nursing workforce, and clarifies both the advanced nursing practice profile and nomenclature in the context of study. © 2017 John Wiley & Sons Australia, Ltd.

  20. Establishing philanthropic funds for advanced practice scholarships.

    PubMed

    Neumann, T

    1997-01-01

    Because of decreased tuition assistance at some hospitals, experienced nurses interested in advanced roles may quit rather than stay and expand their roles. This author describes how a hospital based philanthropic community group has helped provide scholarships for nurses interested in advanced practice and how to set up a similar scholarship program that will retain these experienced and motivated nurses.

  1. Findings from non-participant observational data concerning health promoting nursing practice in the acute hospital setting focusing on generalist nurses.

    PubMed

    Casey, Dympna

    2007-03-01

    This paper reports on the non-participant observational findings from a study, which examined hospital-based nurses' health promoting nursing practice in an acute setting. Nurses are considered to have a key role in health promotion. However, the development of the role of the generalist hospital-based nurse in health promotion has been slow and is not well-understood. The conceptual framework used was based on the Ottawa Charter (WHO 1986). A single qualitative embedded case study, employing data source and methodological triangulation was used. A framework for identifying nurse's use of health promotion methods was developed and used to collect non-participant observations on a purposive sample of eight nurses working on an acute hospital ward. Following the observations a semi structured one-to-one interview was conducted with each observed nurse. One randomly selected patient that the observed nurse had cared for during the observations was also interviewed. Qualitative data analysis based on the work of Miles and Huberman was employed. Two categories were identified 'health promotion strategies and content' and 'patient participation'. The findings indicated that, overall, the strategies used by nurses to promote health were prescriptive and individualistic. The main strategy observed was information giving and the content was 'preparatory information'. Predominantly, nurses practised traditional health education. Overall, patient participation was limited to minor personal aspects of care as nurses focused on the routine and getting the tasks completed. There was no evidence of a ward culture which valued health promotion. Ward managers are key in creating a culture for health promotion. A review of the methods of organizing nursing care is warranted. Nursing programmes must highlight health promotion as integral to practice and emphasis the socio-political dimensions of health promotion.

  2. Work participation of patients with musculoskeletal disorders: is this addressed in physical therapy practice?

    PubMed

    Oswald, Wiebke; Hutting, Nathan; Engels, Josephine A; Bart Staal, J; Nijhuis-van der Sanden, Maria W G; Heerkens, Yvonne F

    2017-01-01

    Musculoskeletal disorders are the main complaints for visiting a physical therapist (PT) in primary health care; they have a negative effect on an individual's quality of life and result in a major cost to society. Qualitative research has shown that physical therapists (PTs) treating patients with these disorders experience barriers in the integration of occupational factors within their practice, and also revealed a lack of cooperation between PTs and (other) occupational healthcare providers. The aim of this study is to quantitatively investigate how generalist PTs in the Netherlands, who treat patients with musculoskeletal disorders, currently integrate occupational factors within their practice, and to identify their opinions and needs with regard to enhancing the integration of the patient's work within physical therapy practice. A cross-sectional survey was conducted among generalist PTs who treat working-age (18-67 years) patients with musculoskeletal disorders. Generalist PTs were contacted for participation via digital news-mails and asked to fill out an online survey which was developed based on the results of a recent qualitative study. The survey consisted of: i) demographics of the participants, ii) questions on how generalist PTs currently integrate occupational factors within their practice, and iii) asked their opinion about the integration of occupational factors within physical therapy. The PTs were also asked about their needs with regard to the integration of occupational factors and with regard to cooperation with other (occupational) health professionals. All answers (using Likert scales) are presented as the number and percentage of the respondents reporting those specific answers, whereas all other answers are presented as means and standard deviations. Of the 142 respondents, 64% indicated that occupational factors should be addressed to a greater extent within physical therapy. To have the possibility to bill for a workplace assessment

  3. Health maintenance organization penetration and the practice location choices of new physicians: a study of large metropolitan areas in the United States.

    PubMed

    Escarce, J J; Polsky, D; Wozniak, G D; Pauly, M V; Kletke, P R

    1998-11-01

    The rapid growth of health maintenance organizations is reshaping the practice opportunities available to physicians. The practice location decisions of new physicians provide a sensitive bellwether of these changes. This study assessed the effect of health maintenance organization penetration on practice location for physicians completing graduate medical education (GME). Conditional logit regression analysis was used to determine the effect of health maintenance organization penetration on practice location, controlling for other market characteristics. Subjects were physicians who finished GME between 1989 and 1994 and who located in one of the 98 US metropolitan areas with more than 500,000 population. The outcome measure was the particular metropolitan area chosen by each new physician. Early in the study period, new generalists were significantly more likely to locate in metropolitan areas with high health maintenance organization penetration than in low penetration areas, whereas new specialists' practice location choices were not associated with health maintenance organization penetration. The likelihood of choosing a high penetration relative to a low penetration area declined with time, however, for both generalists and specialists. Consequently, by the end of the study period, health maintenance organization penetration had a weak but significant negative effect on practice location for generalists and a strong negative influence on practice location for specialists. New generalists who completed graduate medical education between 1989 and 1994 were more likely than new specialists to locate in market areas with high health maintenance organization penetration; however, the proportions of both generalists and specialists who chose high penetration areas decreased during the study period. This finding may reflect reduced practice opportunities in high penetration areas relative to low penetration areas as health maintenance organizations' systems for

  4. Sex-specific developmental plasticity of generalist and specialist predatory mites (Acari: Phytoseiidae) in response to food stress.

    PubMed

    Walzer, Andreas; Schausberger, Peter

    2011-03-01

    We studied developmental plasticity under food stress in three female-biased size dimorphic predatory mite species, Phytoseiulus persimilis, Neoseiulus californicus, and Amblyseius andersoni. All three species prey on two-spotted spider mites but differ in the degree of adaptation to this prey. Phytoseiulus persimilis is a specialized spider mite predator, N. californicus is a generalist with a preference for spider mites, and A. andersoni is a broad generalist. Immature predators were offered prey patches of varying density and their survival chances, dispersal tendencies, age and size at maturity measured. Amblyseius andersoni dispersed earlier from and had lower survival chances in low density prey patches than N. californicus and P. persimilis. Age at maturity was not affected by prey density in the generalist A. andersoni, whereas both the specialist P. persimilis and the generalist N. californicus accelerated development at low prey densities. Species-specific plasticity in age at maturity reflects opposite survival strategies when confronted with limited prey: to prematurely leave and search for other food (A. andersoni) or to stay and accelerate development (P. persimilis, N. californicus). In all species, size at maturity was more plastic in females than males, indicating that males incur higher fitness costs from deviations from optimal body size.

  5. Procedure competencies and job functions of the urologic advanced practice nurse.

    PubMed

    Kleier, Jo Ann

    2009-01-01

    A 2-round modified Delphi study recruited a panel urologic advanced practice nurse experts to identify the procedure competencies and job functions unique to the role of the advanced practice nurse specializing in the care of urology patients.

  6. Doctor of Nursing Practice: The Role of the Advanced Practice Nurse.

    PubMed

    Walker, Deborah Kirk; Polancich, Shea

    2015-11-01

    To explore the evolution and emerging roles of the Doctor of Nursing Practice (DNP) Advanced Practice Nurse (APN). Published peer reviewed literature, cancer-related professional resources, and Web-based resources. The DNP education has prepared the APN for process improvement initiatives, providing quality care, and evidence-based practice translation, which are critical with the emerging trends in this complex health care environment. DNP-prepared APNs have the opportunity to impact oncology care across the cancer trajectory, in various settings, and in various innovative roles as entrepreneurs. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Food-limitation in a generalist predator

    PubMed Central

    Rutz, Christian; Bijlsma, Rob G

    2006-01-01

    Investigating food-limitation in generalist predators is difficult, because they can switch to alternative prey, when one of their staple prey becomes scarce. Apart from data on the dynamics of the predator population, a robust study requires: (i) a documentation of the predator's entire prey base; and (ii) an experimental or natural situation, where profitable dietary shifts are impossible, because several preferred prey species decline simultaneously. Here, we provide a detailed description of how food-supply has limited a generalist avian top predator, the northern goshawk Accipiter gentilis. In our study area, populations of several principal goshawk prey species crashed simultaneously during 1975–2000, whereas other extrinsic factors remained essentially unchanged. The breeding and non-breeding segments of the local goshawk population declined markedly, associated with a significant increase in nest failures. Brood size of successful pairs remained unaffected by changes in prey availability. Breeding recruitment ceased at a time when potential replacement birds (‘floaters’) were still present, providing a rare empirical demonstration of an ‘acceptance threshold’ in raptor territory choice. To investigate how goshawk diet changed in response to varying food-supplies, we make novel use of an analytical tool from biodiversity research—‘abundance–biomass–comparison curves’ (ABC curves). With increasing levels of food-stress, the dominance of principal prey species in the diet decreased, and the number of small-bodied prey species increased, as did intra-guild predation. Our finding that breeder and non-breeder segments declined in concert is unexpected. Our results carry the management implication that, in food-limited raptor populations, externally induced breeder mortality can rapidly depress population size, as losses are no longer buffered when floaters reject breeding opportunities. PMID:16846915

  8. Advance care planning for nursing home residents with dementia: policy vs. practice.

    PubMed

    Ampe, Sophie; Sevenants, Aline; Smets, Tinne; Declercq, Anja; Van Audenhove, Chantal

    2016-03-01

    The aims of this study were: to evaluate the advance care planning policy for people with dementia in nursing homes; to gain insight in the involvement of residents with dementia and their families in advance care planning, and in the relationship between the policy and the actual practice of advance care planning. Through advance care planning, nursing home residents with dementia are involved in care decisions, anticipating their reduced decision-making capacity. However, advance care planning is rarely realized for this group. Prevalence and outcomes have been researched, but hardly any research has focused on the involvement of residents/families in advance care planning. Observational cross-sectional study in 20 nursing homes. The ACP audit assessed the views of the nursing homes' staff on the advance care planning policy. In addition, individual conversations were analysed with 'ACP criteria' (realization of advance care planning) and the 'OPTION' instrument (involvement of residents/families). June 2013-September 2013. Nursing homes generally met three quarters of the pre-defined criteria for advance care planning policy. In almost half of the conversations, advance care planning was explained and discussed substantively. Generally, healthcare professionals only managed to involve residents/families on a baseline skill level. There were no statistically significant correlations between policy and practice. The evaluations of the policy were promising, but the actual practice needs improvement. Future assessment of both policy and practice is recommended. Further research should focus on communication interventions for implementing advance care planning in the daily practice. © 2015 John Wiley & Sons Ltd.

  9. Altitudinal gradients of generalist and specialist herbivory on three montane Asteraceae

    NASA Astrophysics Data System (ADS)

    Scheidel, U.; Röhl, S.; Bruelheide, H.

    Different functional types of herbivory on three montane Asteraceae were investigated in natural populations in central Germany to test the hypothesis that herbivory is decreasing with altitude. Generalist herbivory was assessed as leaf area loss, mainly caused by slugs, and, in Petasites albus, as rhizome mining by oligophagous insect larvae. Capitules were found to be parasitized by oligophagous insects in Centaurea pseudophrygia and by the specialist fly Tephritis arnicae in Arnica montana. Only the damage to leaves of P. albus showed the hypothesized decrease with increasing altitude. No altitudinal gradient could be found in the leaf and capitule damage to C. pseudophrygia. In A. montana, capitule damage increased with increasing elevation. The data suggest that abundance and activity of generalist herbivores are more affected by climatic conditions along altitudinal gradients than specialist herbivores. In all probability, specialist herbivores depend less on abiotic conditions than on their host's population characteristics, such as host population size.

  10. A Practice-Based Theory of Healing Through Therapeutic Touch: Advancing Holistic Nursing Practice.

    PubMed

    Hanley, Mary Anne; Coppa, Denise; Shields, Deborah

    2017-08-01

    For nearly 50 years, Therapeutic Touch (TT) has contributed to advancing holistic nursing practice and has been recognized as a uniquely human approach to healing. This narrative explores the development of a practice-based theory of healing through TT, which occurred between 2010 and 2016. Through the in-depth self-inquiry of participatory reflective dialogue in concert with constant narrative analysis, TT practitioners revealed the meaning of healing within the context of their TT practice. As the community of TT experts participated in an iterative process of small group and community dialogues with analysis and synthesis of emerging themes, the assumptions and concepts central to a theory of healing emerged, were clarified and verified. Exemplars of practice illustrate the concepts. A model of the theory of healing illuminates the movement and relationship among concepts and evolved over time. Feedback from nursing and inter-professional practitioners indicate that the theory of healing, while situated within the context of TT, may be useful in advancing holistic nursing practice, informing healing and caring approaches, stimulating research and education, and contributing to future transformations in health care.

  11. Impact of postgraduate education on advanced practice nurse activity - a national survey.

    PubMed

    Wilkinson, J; Carryer, J; Budge, C

    2018-03-22

    There is a wealth of international evidence concerning the contribution post-registration master's level education makes to advancing the discipline of nursing. There are approximately 277 nurse practitioners registered in NZ, but they account for only a small portion of nurses who have undertaken master's level education. The additional contribution these nurses make to the work environment through advanced practice activities has not, hitherto, been documented. To report the extent of advanced practice nurse activity associated with various levels of nursing education in a sample of nurses working in clinical practice in New Zealand. A replication of recent Australian research was done via a national cross-sectional survey of 3255 registered nurses and nurse practitioners in New Zealand using an online questionnaire to collect responses to the amended Advanced Practice Delineation survey tool. In addition, demographic data were collected including position titles and levels of postgraduate education. A positive association was found between postgraduate education at any level and more time spent in advanced practice activities. Independent of level of postgraduate education, the role a nurse holds also effects the extent of involvement in advanced practice activities. There is an additional contribution made to the work environment by nurses with master's level education which occurs even when they are not employed in an advanced practice role. These findings are of significance to workforce policy and planning across the globe as countries work to sustain health services by increasing nursing capacity effectively within available resources. © 2018 International Council of Nurses.

  12. Comparative toxicities of newer and conventional insecticides against four generalist predator species

    USDA-ARS?s Scientific Manuscript database

    Generalist insect predators play an essential role at regulating populations of Bemisia tabaci and other pests in agricultural systems, but face depredations due to insecticide applications. Evaluation of insecticide compatibility with specific predator species can provide a basis for making treatme...

  13. Mentoring advanced practice nurses in research: recommendations from a pilot program.

    PubMed

    Leung, Doris; Widger, Kimberley; Howell, Doris; Nelson, Sioban; Molassiotis, Alex

    2012-01-01

    Advanced Practice Nurses (APNs) need research skills to develop and advance their practice and, yet, many have limited access to research training and support following completion of their advanced degree. In this paper we report on the development, delivery, and evaluation of an innovative pilot program that combined research training and one-to-one mentorship for nine APNs in conducting research relevant to their practice. The program was organized within an academic institution and its affiliated hospitals in Toronto, Canada. Our experience with this program may assist those in other organizations to plan and deliver a similar program for APN research mentorship.

  14. Sex-specific developmental plasticity of generalist and specialist predatory mites (Acari: Phytoseiidae) in response to food stress

    PubMed Central

    Walzer, Andreas; Schausberger, Peter

    2011-01-01

    We studied developmental plasticity under food stress in three female-biased size dimorphic predatory mite species, Phytoseiulus persimilis, Neoseiulus californicus, and Amblyseius andersoni. All three species prey on two-spotted spider mites but differ in the degree of adaptation to this prey. Phytoseiulus persimilis is a specialized spider mite predator, N. californicus is a generalist with a preference for spider mites, and A. andersoni is a broad generalist. Immature predators were offered prey patches of varying density and their survival chances, dispersal tendencies, age and size at maturity measured. Amblyseius andersoni dispersed earlier from and had lower survival chances in low density prey patches than N. californicus and P. persimilis. Age at maturity was not affected by prey density in the generalist A. andersoni, whereas both the specialist P. persimilis and the generalist N. californicus accelerated development at low prey densities. Species-specific plasticity in age at maturity reflects opposite survival strategies when confronted with limited prey: to prematurely leave and search for other food (A. andersoni) or to stay and accelerate development (P. persimilis, N. californicus). In all species, size at maturity was more plastic in females than males, indicating that males incur higher fitness costs from deviations from optimal body size. © 2011 The Linnean Society of London, Biological Journal of the Linnean Society, 2011, 102, 650–660. PMID:22003259

  15. Advancing nursing scholarship: the Mozambique model

    PubMed Central

    Bruce, Judith C.; Dippenaar, Joan; Schmollgruber, Shelley; Mphuthi, David D.; Huiskamp, Agnes

    2017-01-01

    ABSTRACT Background: Despite the importance of Human Resources for Health for the development and functioning of health systems worldwide, many countries continue to be plagued by poor health systems and a lack of adequate health care. Health systems failures may be attributed to both quantitative and qualitative nursing shortages including the lack of advanced skills to lead health initiatives, to conduct research and to educate other nurses. The response by development partners is usually framed around the production of skilled nurses through the processes of up-skilling and scaling-up. The outcome is expanded practice but with scant attention to the professional advancement of nurses. Objectives: In this paper we present a two-phased capacity development model that adopted professionalization strategies to advance nursing scholarship and consequent postgraduate specialization of the first cohort of nurses in Mozambique. The main objectives were to: develop and implement a clinical course work master’s degree in nursing; and ensure sustainability by capacitating the host institution to continue with the master’s programme following graduation. Methods: Rigorous processes for project discussions, negotiations and monitoring were necessary amid limited resources and a challenging political climate. Forging in-country partnerships, sustaining alliances and government investment are thus key to the success of the Mozambique model. Outcomes: Notwithstanding some difficulties, the process unfolded over a five-year period, graduating the first cohort of 11 senior nurses with a master’s degree, specializing either in critical care and trauma nursing, or maternal and neonatal health. Conclusions: Bridging the skills gap between generalist and specialist nurses is essential for them to manage complex and high acuity cases and to reverse associated morbidity and mortality. We conclude that this model serves as a professionalization strategy to advance nurses

  16. Parasite specialization in a unique habitat: hummingbirds as reservoirs of generalist blood parasites of Andean birds.

    PubMed

    Moens, Michaël A J; Valkiūnas, Gediminas; Paca, Anahi; Bonaccorso, Elisa; Aguirre, Nikolay; Pérez-Tris, Javier

    2016-09-01

    Understanding how parasites fill their ecological niches requires information on the processes involved in the colonization and exploitation of unique host species. Switching to hosts with atypical attributes may favour generalists broadening their niches or may promote specialization and parasite diversification as the consequence. We analysed which blood parasites have successfully colonized hummingbirds, and how they have evolved to exploit such a unique habitat. We specifically asked (i) whether the assemblage of Haemoproteus parasites of hummingbirds is the result of single or multiple colonization events, (ii) to what extent these parasites are specialized in hummingbirds or shared with other birds and (iii) how hummingbirds contribute to sustain the populations of these parasites, in terms of both prevalence and infection intensity. We sampled 169 hummingbirds of 19 species along an elevation gradient in Southern Ecuador to analyse the host specificity, diversity and infection intensity of Haemoproteus by molecular and microscopy techniques. In addition, 736 birds of 112 species were analysed to explore whether hummingbird parasites are shared with other birds. Hummingbirds hosted a phylogenetically diverse assemblage of generalist Haemoproteus lineages shared with other host orders. Among these parasites, Haemoproteus witti stood out as the most generalized. Interestingly, we found that infection intensities of this parasite were extremely low in passerines (with no detectable gametocytes), but very high in hummingbirds, with many gametocytes seen. Moreover, infection intensities of H. witti were positively correlated with the prevalence across host species. Our results show that hummingbirds have been colonized by generalist Haemoproteus lineages on multiple occasions. However, one of these generalist parasites (H. witti) seems to be highly dependent on hummingbirds, which arise as the most relevant reservoirs in terms of both prevalence and

  17. Specialist-generalist model of body temperature regulation can be applied at the intraspecific level.

    PubMed

    Przybylska, Anna S; Boratyński, Jan S; Wojciechowski, Michał S; Jefimow, Małgorzata

    2017-07-01

    According to theoretical predictions, endothermic homeotherms can be classified as either thermal specialists or thermal generalists. In high cost environments, thermal specialists are supposed to be more prone to using facultative heterothermy than generalists. We tested this hypothesis at the intraspecific level using male laboratory mice (C57BL/cmdb) fasted under different thermal conditions (20 and 10°C) and for different time periods (12-48 h). We predicted that variability of body temperature ( T b ) and time spent with T b below normothermy would increase with the increase of environmental demands (duration of fasting and cold). To verify the above prediction, we measured T b and energy expenditure of fasted mice. We did not record torpor bouts but we found that variations in T b and time spent in hypothermia increased with environmental demands. In response to fasting, mice also decreased their energy expenditure. Moreover, animals that showed more precise thermoregulation when fed had more variable T b when fasted. We postulate that the prediction of the thermoregulatory generalist-specialist trade-off can be applied at the intraspecific level, offering a valid tool for identifying mechanistic explanations of the differences in animal responses to variations in energy supply. © 2017. Published by The Company of Biologists Ltd.

  18. Development of a conceptual policy framework for advanced practice nursing: an ethnographic study.

    PubMed

    Schober, Madrean M; Gerrish, Kate; McDonnell, Ann

    2016-06-01

    To report on a study examining policy development for advanced practice nursing from intent of policy to realization in practice. Inclusion of advanced practice nursing roles in the healthcare workforce is a worldwide trend. Optimal advanced nursing practice requires supportive policies. Little is known about how policy is developed and implemented. Ethnography using an instrumental case study approach was selected to give an in-depth understanding of the experiences of one country (Singapore) to contribute to insight into development elsewhere. The four-phase study was conducted from 2008-2012 and included document analysis (n = 47), interviews with key policy decision makers (n = 12), interviews with nursing managers and medical directors (n = 11), interviews and participant observation with advanced practice nurses (n = 15). Key policymakers in positions of authority were able to promote policy development. However, this was characterized by lack of strategic planning for implementation. A vague understanding by nursing managers and medical directors of policies, the role and its position in the healthcare workforce led to indecision and uncertainty in execution. Advanced practice nurses developed their role based on theory acquired in their academic programme but were unsure what role to assume in practice. Lack of clear guidelines led to unanticipated difficulties for institutions and healthcare systems. Strategic planning could facilitate integration of advanced practice nurses into the healthcare workforce. A Conceptual Policy Framework is proposed as a guide for a coordinated approach to policy development and implementation for advanced practice nursing. © 2016 John Wiley & Sons Ltd.

  19. Cryptic seedling herbivory by nocturnal introduced generalists impacts survival, performance of native and exotic plants.

    PubMed

    Strauss, Sharon Y; Stanton, Maureen L; Emery, Nancy C; Bradley, Carrie A; Carleton, Alexandra; Dittrich-Reed, Dylan R; Ervin, Olivia A; Gray, Levi N; Hamilton, Andrew M; Rogge, Jennifer Harrington; Harper, Skye D; Law, Kimberley Cook; Pham, Vinh Q; Putnam, Matthew E; Roth, Tara M; Theil, Jacob H; Wells, Lara M; Yoshizuka, Eric M

    2009-02-01

    Although much of the theory on the success of invasive species has been geared at escape from specialist enemies, the impact of introduced generalist invertebrate herbivores on both native and introduced plant species has been underappreciated. The role of nocturnal invertebrate herbivores in structuring plant communities has been examined extensively in Europe, but less so in North America. Many nocturnal generalists (slugs, snails, and earwigs) have been introduced to North America, and 96% of herbivores found during a night census at our California Central Valley site were introduced generalists. We explored the role of these herbivores in the distribution, survivorship, and growth of 12 native and introduced plant species from six families. We predicted that introduced species sharing an evolutionary history with these generalists might be less vulnerable than native plant species. We quantified plant and herbivore abundances within our heterogeneous site and also established herbivore removal experiments in 160 plots spanning the gamut of microhabitats. As 18 collaborators, we checked 2000 seedling sites every day for three weeks to assess nocturnal seedling predation. Laboratory feeding trials allowed us to quantify the palatability of plant species to the two dominant nocturnal herbivores at the site (slugs and earwigs) and allowed us to account for herbivore microhabitat preferences when analyzing attack rates on seedlings. The relationship between local slug abundance and percent cover of five common plant taxa at the field site was significantly negatively associated with the mean palatability of these taxa to slugs in laboratory trials. Moreover, seedling mortality of 12 species in open-field plots was positively correlated with mean palatability of these taxa to both slugs and earwigs in laboratory trials. Counter to expectations, seedlings of native species were neither more vulnerable nor more palatable to nocturnal generalists than those of

  20. High Redundancy as well as Complementary Prey Choice Characterize Generalist Predator Food Webs in Agroecosystems.

    PubMed

    Roubinet, Eve; Jonsson, Tomas; Malsher, Gerard; Staudacher, Karin; Traugott, Michael; Ekbom, Barbara; Jonsson, Mattias

    2018-05-23

    Food web structure influences ecosystem functioning and the strength and stability of associated ecosystem services. With their broad diet, generalist predators represent key nodes in the structure of many food webs and they contribute substantially to ecosystem services such as biological pest control. However, until recently it has been difficult to empirically assess food web structure with generalist predators. We utilized DNA-based molecular gut-content analyses to assess the prey use of a set of generalist invertebrate predator species common in temperate agricultural fields. We investigated the degree of specialization of predator-prey food webs at two key stages of the cropping season and analysed the link temperature of different trophic links, to identify non-random predation. We found a low level of specialization in our food webs, and identified warm and cool links which may result from active prey choice or avoidance. We also found a within-season variation in interaction strength between predators and aphid pests which differed among predator species. Our results show a high time-specific functional redundancy of the predator community, but also suggest temporally complementary prey choice due to within-season succession of some predator species.

  1. Neuroscience, Music Education and the Pre-Service Primary (Elementary) Generalist Teacher

    ERIC Educational Resources Information Center

    Collins, Anita

    2014-01-01

    For three decades, research on training in music education for pre-service primary (elementary) generalist teachers has consistently highlighted four main issues that limit its effectiveness: 1) the influence of past experiences; 2) a lack of confidence 3) a lack of musical competence and 4) limited time to address these issues in teacher…

  2. Measuring the impact of the advanced practitioner role: a practical approach.

    PubMed

    Neville, Lillian; Swift, Juliette

    2012-04-01

    This paper aims to illuminate difficulties in evaluating the advanced practitioner role and to offer a practical solution. The advanced practice role has been part of the workforce strategy in the Northwest of England since 2005. However capturing hard evidence of the impact of this role has been problematic. Current restrictions on resources require the provision of evidence of the value of roles and services. Critical analysis of literature has identified challenges in evaluating the advanced practice role. The case study design takes account of current policy initiatives, notably QIPP. There is no common approach to evaluating the role of advanced practitioners. The case study has the potential to be a useful tool to organise evidence of the impact of advanced practitioner roles. Advanced practitioners need to have appropriate knowledge and skills to provide evidence of the impact of their role. There is potential for this work to be applied to other roles across the NHS. Managers need to work in partnership with workforce planners and educationalists to support advanced practitioners to utilise their skills in methods of providing evidence that they do work of value. Clear strategic direction for advanced practitioners is advised as part of the workforce strategy. © 2012 Blackwell Publishing Ltd.

  3. Ability of a Generalist Seed Beetle to Colonize an Exotic Host: Effects of Host Plant Origin and Oviposition Host.

    PubMed

    Amarillo-Suárez, A; Repizo, A; Robles, J; Diaz, J; Bustamante, S

    2017-08-01

    The colonization of an exotic species by native herbivores is more likely to occur if that herbivore is a generalist. There is little information on the life-history mechanisms used by native generalist insects to colonize exotic hosts and how these mechanisms are affected by host properties. We examined the ability of the generalist seed beetle Stator limbatus Horn to colonize an exotic species. We compared its host preference, acceptability, performance, and egg size when ovipositing and developing on two native (Pithecellobium dulce (Roxb.) Benth and Senegalia riparia (Kunth)) and one exotic legume species (Leucaena leucocephala (Lam.)). We also analyzed the seed chemistry. We found that females recognize the exotic species as an unfavorable host for larval development and that they delayed oviposition and laid fewer and larger eggs on the exotic species than on the native species. Survivorship on the exotic host was 0%. Additionally, seeds of the native species contain five chemical compounds that are absent in the exotic species, and the exotic species contains three sterols, which are absent in the native legumes. Genetically based differences between beetles adapted to different hosts, plastic responses toward new hosts, and chemical differences among seeds are important in host colonization and recognition of the exotic host. In conclusion, the generalist nature of S. limbatus does not influence its ability to colonize L. leucocephala. Explanations for the colonization of exotic hosts by generalist native species and for the success of invasive species must be complemented with studies measuring local adaptation and plasticity.

  4. Analysis of three advanced practice roles in emergency nursing.

    PubMed

    Considine, Julie; Lucas, Elspeth; Payne, Roslyn; Kropman, Matthew; Stergiou, Helen E; Chiu, Herman

    2012-11-01

    There are many Emergency Department (ED) demand management systems that include advanced practice emergency nursing roles. The aim of this study is to examine and compare three advanced emergency nursing practice roles: ED Fast Track, Clinical Initiatives Nurse (CIN) and Rapid Intervention and Treatment Zone (RITZ). A descriptive exploratory approach was used to conduct this study at an urban district hospital in Melbourne, Australia. The study participants were patients managed in each of the three systems with advanced practice emergency nursing roles: Fast Track, CIN and RITZ. There were a total of 551 patients: 195 Fast Track patients, 163 CIN managed patients and 193 RITZ patients. CIN managed patients were older (p<0.001), with higher levels of clinical urgency (p<0.001), and higher hospital admission rates (p<0.001). CIN managed patients had shorter waiting time for nursing care (p=0.001) and lower incidence of medical assessment within the time associated with their triage category (p<0.0001). ED LOS for discharged patients was significantly longer for CIN managed patients (p<0.001). CIN managed patients had a significantly higher incidence of electrocardiography (p<0.001), blood glucose measurement (p<0.001), intravenous cannulation (p<0.001), pathology testing (p<0.001), and analgesia administration (p<0.001) when compared to Fast Track and RITZ patients. Advanced practice roles in emergency nursing can have different applications in the ED context. Clarity about role intent and scope of practice is important and should inform educational preparation and teams within which these roles operate. Copyright © 2012 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.

  5. Preparing Pre-Service Generalist Teachers to Use Creative Movement in K-6

    ERIC Educational Resources Information Center

    Kaufmann, Karen; Ellis, Becky

    2007-01-01

    University courses preparing elementary education majors to incorporate creative movement into their teaching methodology are becoming requirements in many schools of education around the country. The article addresses three questions pertinent to preparing upcoming teachers: 1. How can pre-service generalist teachers develop an appreciation of…

  6. Forest species diversity reduces disease risk in a generalist plant pathogen invasion

    Treesearch

    Sarah E. Haas; Mevin B. Hooten; David M. Rizzo; Ross K. Meentemeyer

    2011-01-01

    Empirical evidence suggests that biodiversity loss can increase disease transmission, yet our understanding of the diversity-disease hypothesis for generalist pathogens in natural ecosystems is limited. We used a landscape epidemiological approach to examine two scenarios regarding diversity effects on the emerging plant pathogen Phytophthora ramorum...

  7. Improving spatio-temporal benefit transfers for pest control by generalist predators in cotton in the southwestern U.S.

    USGS Publications Warehouse

    Wiederholt, Ruscena; Bagstad, Kenneth J.; McCracken, Gary F.; Diffendorfer, Jay E.; Loomis, John B.; Semmens, Darius J.; Russell, Amy L.; Sansone, Chris; LaSharr, Kelsie; Cryan, Paul; Reynoso, Claudia; Medellin, Rodrigo A.; Lopez-Hoffman, Laura

    2017-01-01

    Given rapid changes in agricultural practice, it is critical to understand how alterations in ecological, technological, and economic conditions over time and space impact ecosystem services in agroecosystems. Here, we present a benefit transfer approach to quantify cotton pest-control services provided by a generalist predator, the Mexican free-tailed bat (Tadarida brasiliensis mexicana), in the southwestern United States. We show that pest-control estimates derived using (1) a compound spatial–temporal model – which incorporates spatial and temporal variability in crop pest-control service values – are likely to exhibit less error than those derived using (2) a simple-spatial model (i.e., a model that extrapolates values derived for one area directly, without adjustment, to other areas) or (3) a simple-temporal model (i.e., a model that extrapolates data from a few points in time over longer time periods). Using our compound spatial–temporal approach, the annualized pest-control value was \\$12.2 million, in contrast to an estimate of \\$70.1 million (5.7 times greater), obtained from the simple-spatial approach. Using estimates from one year (simple-temporal approach) revealed large value differences (0.4 times smaller to 2 times greater). Finally, we present a detailed protocol for valuing pest-control services, which can be used to develop robust pest-control transfer functions for generalist predators in agroecosystems.

  8. [Competencies and professional profile of the advanced practice nurse].

    PubMed

    del Barrio-Linares, M

    2014-01-01

    The advanced practice nurse can foster the development of innovative approaches in the design of patient, families and community care. This study has aimed to explain the importance of the advanced practice nurse, especially that of the clinical nurse specialist (CNS), within the care setting and to go deeper into the knowledge of this nursing profile. A review of the literature. The following databases were used: CINAHL, PubMed and Medline. Search terms were 'clinical nurse specialist,' 'implementation,' and 'advanced practice nursing.' The sample included 24 publications. A synthesis of the findings generated a summary of the competencies of CNS and their definitions, with some examples in their daily practice and the outcome on its 3 spheres of influences: patients and families, staff and organization. CNS emerges in the health systems in order to improve the outcomes in the patients, staff and the organization per se because of its competence as an agent of change and transformational leader National policies and national strategies are needed to implement CNS on the Master's level in the Spanish National Health System given the evidence-based improvement in the care standards. Copyright © 2012 Elsevier España, S.L. y SEEIUC. All rights reserved.

  9. The Forest, Not the Tree(s): The Plight of the Generalist

    ERIC Educational Resources Information Center

    Reinsmith, William A.

    2006-01-01

    The great naturalist Edward O. Wilson's (1998) recent plea for the "consilience" of knowledge should strike a chord in the heart of every generalist. Invoking the unfinished agenda of the Enlightenment, Wilson has called for a rapprochement among the several branches of learning so that they can be viewed as interrelated and constituting a whole.…

  10. Win-win-win: collaboration advances critical care practice.

    PubMed

    Spence, Deb; Fielding, Sandra

    2002-10-01

    Against a background of increasing interest in education post registration, New Zealand nurses are working to advance their professional practice. Because the acquisition of highly developed clinical capabilities requires a combination of nursing experience and education, collaboration between clinicians and nurse educators is essential. However, the accessibility of relevant educational opportunities has been an ongoing issue for nurses outside the country's main centres. Within the framework of a Master of Health Science, the postgraduate certificate (critical care nursing) developed between Auckland University of Technology and two regional health providers is one such example. Students enrol in science and knowledge papers concurrently then, in the second half of the course, are supported within their practice environment to acquire advanced clinical skills and to analyse, critique and develop practice within their specialty. This paper provides an overview of the structure and pr month, distance education course focused on developing the context of critical care nursing.

  11. Complex Evolutionary Dynamics of Massively Expanded Chemosensory Receptor Families in an Extreme Generalist Chelicerate Herbivore.

    PubMed

    Ngoc, Phuong Cao Thi; Greenhalgh, Robert; Dermauw, Wannes; Rombauts, Stephane; Bajda, Sabina; Zhurov, Vladimir; Grbić, Miodrag; Van de Peer, Yves; Van Leeuwen, Thomas; Rouzé, Pierre; Clark, Richard M

    2016-12-14

    While mechanisms to detoxify plant produced, anti-herbivore compounds have been associated with plant host use by herbivores, less is known about the role of chemosensory perception in their life histories. This is especially true for generalists, including chelicerate herbivores that evolved herbivory independently from the more studied insect lineages. To shed light on chemosensory perception in a generalist herbivore, we characterized the chemosensory receptors (CRs) of the chelicerate two-spotted spider mite, Tetranychus urticae, an extreme generalist. Strikingly, T. urticae has more CRs than reported in any other arthropod to date. Including pseudogenes, 689 gustatory receptors were identified, as were 136 degenerin/Epithelial Na+ Channels (ENaCs) that have also been implicated as CRs in insects. The genomic distribution of T. urticae gustatory receptors indicates recurring bursts of lineage-specific proliferations, with the extent of receptor clusters reminiscent of those observed in the CR-rich genomes of vertebrates or C. elegans Although pseudogenization of many gustatory receptors within clusters suggests relaxed selection, a subset of receptors is expressed. Consistent with functions as CRs, the genomic distribution and expression of ENaCs in lineage-specific T. urticae expansions mirrors that observed for gustatory receptors. The expansion of ENaCs in T. urticae to > 3-fold that reported in other animals was unexpected, raising the possibility that ENaCs in T. urticae have been co-opted to fulfill a major role performed by unrelated CRs in other animals. More broadly, our findings suggest an elaborate role for chemosensory perception in generalist herbivores that are of key ecological and agricultural importance. © The Author(s) 2016. Published by Oxford University Press on behalf of the Society for Molecular Biology and Evolution.

  12. Field-based insights to the evolution of specialization: plasticity and fitness across habitats in a specialist/generalist species pair.

    PubMed

    Griffith, Timothy; Sultan, Sonia E

    2012-04-01

    Factors promoting the evolution of specialists versus generalists have been little studied in ecological context. In a large-scale comparative field experiment, we studied genotypes from naturally evolved populations of a closely related generalist/specialist species pair (Polygonum persicaria and P. hydropiper), reciprocally transplanting replicates of multiple lines into open and partially shaded sites where the species naturally co-occur. We measured relative fitness, individual plasticity, herbivory, and genetic variance expressed in the contrasting light habitats at both low and high densities. Fitness data confirmed that the putative specialist out-performed the generalist in only one environment, the favorable full sun/low-density environment to which it is largely restricted in nature, while the generalist had higher lifetime reproduction in both canopy and dense neighbor shade. The generalist, P. persicaria, also expressed greater adaptive plasticity for biomass allocation and leaf size in shaded conditions than the specialist. We found no evidence that the ecological specialization of P. hydropiper reflects either genetically based fitness trade-offs or maintenance costs of plasticity, two types of genetic constraint often invoked to prevent the evolution of broadly adaptive genotypes. However, the patterns of fitness variance and herbivore damage revealed how release from herbivory in a new range can cause an introduced species to evolve as a specialist in that range, a surprising finding with important implications for invasion biology. Patterns of fitness variance between and within sites are also consistent with a possible role for the process of mutation accumulation (in this case, mutations affecting shade-expressed phenotypes) in the evolution and/or maintenance of specialization in P. hydropiper.

  13. Field-based insights to the evolution of specialization: plasticity and fitness across habitats in a specialist/generalist species pair

    PubMed Central

    Griffith, Timothy; Sultan, Sonia E

    2012-01-01

    Factors promoting the evolution of specialists versus generalists have been little studied in ecological context. In a large-scale comparative field experiment, we studied genotypes from naturally evolved populations of a closely related generalist/specialist species pair (Polygonum persicaria and P. hydropiper), reciprocally transplanting replicates of multiple lines into open and partially shaded sites where the species naturally co-occur. We measured relative fitness, individual plasticity, herbivory, and genetic variance expressed in the contrasting light habitats at both low and high densities. Fitness data confirmed that the putative specialist out-performed the generalist in only one environment, the favorable full sun/low-density environment to which it is largely restricted in nature, while the generalist had higher lifetime reproduction in both canopy and dense neighbor shade. The generalist, P. persicaria, also expressed greater adaptive plasticity for biomass allocation and leaf size in shaded conditions than the specialist. We found no evidence that the ecological specialization of P. hydropiper reflects either genetically based fitness trade-offs or maintenance costs of plasticity, two types of genetic constraint often invoked to prevent the evolution of broadly adaptive genotypes. However, the patterns of fitness variance and herbivore damage revealed how release from herbivory in a new range can cause an introduced species to evolve as a specialist in that range, a surprising finding with important implications for invasion biology. Patterns of fitness variance between and within sites are also consistent with a possible role for the process of mutation accumulation (in this case, mutations affecting shade-expressed phenotypes) in the evolution and/or maintenance of specialization in P. hydropiper. PMID:22837826

  14. From challenges to advanced practice registered nursing role development: Qualitative interview study.

    PubMed

    Jokiniemi, Krista; Haatainen, Kaisa; Pietilä, Anna-Maija

    2015-12-01

    The aim of this study is to describe the factors hindering and facilitating the implementation of the advanced practice registered nurses role at Finnish university hospitals, and to examine the implications for its future development. A descriptive qualitative approach, using thematic individual interviews, was conducted in 2011 with a sample of 11 advanced practice registered nurses. The data were analysed using qualitative content analysis. The advanced practice registered nurses role barriers had an impact on the role development needs. In turn, the facilitating factors helped encounter the challenges of the role, therefore having an impact on both the current role achievement, as well as contributing to the future role development. The factors hindering and facilitating the advanced practice registered nurses role need to be acknowledged to support the role implementation and planning of the future of the role. © 2014 Wiley Publishing Asia Pty Ltd.

  15. [Patients without DSM-IV-disorders and/or subclinical symptoms in generalistic and specialised mental health care].

    PubMed

    Kloos, M W; Tiemens, B G; Hutschemaekers, G J M

    Our study was motivated mainly by the results from nemesis-2 which showed that four out of ten patients in ambulantory mental health care had not had any mental disorder in the previous 12 months. A dsm-iv classification of the symptoms of patients is required for receiving insured mental health care.
    To find out whether patients who attended a mental health generalistic or specialised clinic had a dsm-classified mental disorder and to assess the severity of these patients' symptoms. We have given specific attention to the characteristics of patients with subclinical symptoms who turned up at the mental health care clinics.
    dsm-iv disorders of patients in mental health care were studied by means of the mini 5.0.0 (n = 3072). The oq-45 was used to determine the severity of symptoms in both generalistic (n = 2255) and specialised mental health care (n = 5009). Logistical regression was used to determine the differences between the characteristics of patients who had clinical scores and those of patients who had subclinical scores. For this purpose we also used anonymised data from the personal health records.
    During the intake procedure at specialised mental health care clinics only 14.3 % of patients failed to meet the diagnostic criteria of a dsm-iv disorder. Also, 56.5 % of patients seen by a mental health generalist and 70,9 % of patients seen by a mental health specialist had high or very high symptomatic distress, according the oq-45. The proportion of patients with a dsm-iv disorder varied from 52.9 % for patients with subclinical oq-45 scores to 94.8 % for patients with very high oq-45 scores. Predictors of patients with subclinical oq-45 scores were similar in generalistic and specialised mental health care.
    Only a small number of patients in specialised care did not have an axis 1 dsm-iv diagnosis. Most patients in generalistic and specialised mental health care reported severe symptomatic distress. Symptoms mentioned by patients with

  16. The feasibility of introducing advanced minimally invasive surgery into surgical practice

    PubMed Central

    Birch, Daniel W.; Misra, Monali; Farrokhyar, Forough

    2007-01-01

    Background This study investigates the feasibility of performing advanced minimally invasive surgery (MIS) in a nonspecialized practice environment. Methods We conducted a cross-sectional survey of all community general surgeons currently practising in Ontario. Results Few community surgeons perform a high volume (> 10 procedures per yr) of advanced MIS. Most (70%) believe it is important to acquire additional skills in advanced MIS. The most appropriate methods for learning advanced MIS are believed to be expert mentoring (79.7%), courses (77.2%) and a colleague mentor (63.9%). A total of 57.6% of respondents have attended a course in MIS while in practice, and most have access to a reasonable variety of instrumentation. Respondents believe that 57.6% of assistants, 54.8% of nurses and 43.4% of anaesthetists are relatively inexperienced with advanced MIS. Barriers to establishing advanced MIS include limited operating room access (50%), resources or equipment (45.2%) and limited expert mentoring (43.6%). Surgeons with less than 10 years of practice found lack of trained nursing staff (7.9% v. 4.2%, p = 0.01) and experienced assistants (12% v. 6.2%, p = 0.008) to be more important barriers than did those with over 10 years of practice, respectively. Conclusion Most general surgeons working in Ontario are self-taught with respect to MIS skills, and few perform a high volume of advanced MIS. Only one-half of all respondents have access to skilled MIS operating room nurses, surgical assistants or anesthesiology. Despite this, general surgeons perceive the greatest barriers to introducing advanced MIS procedures to be limited access to operating rooms, resources or equipment and limited mentoring. This study has shown that the role of the surgical team in advanced MIS may be underestimated by many general surgeons. These data have important implications in training general surgeons and in incorporating additional advanced MIS procedures into the armamentarium of

  17. Beginning Generalist Teacher Self-Efficacy for Music Compared with Maths and English

    ERIC Educational Resources Information Center

    Garvis, Susanne

    2013-01-01

    In 2008, 201 beginning generalist teachers throughout Queensland, Australia, responded to a questionnaire intended to create a snapshot of current self-efficacy beliefs towards teaching music. Beginning teachers were asked to rank their perceived level of teacher self-efficacy for music, English and maths. Results were analysed through a series of…

  18. Weather conditions drive dynamic habitat selection in a generalist predator.

    PubMed

    Sunde, Peter; Thorup, Kasper; Jacobsen, Lars B; Rahbek, Carsten

    2014-01-01

    Despite the dynamic nature of habitat selection, temporal variation as arising from factors such as weather are rarely quantified in species-habitat relationships. We analysed habitat use and selection (use/availability) of foraging, radio-tagged little owls (Athene noctua), a nocturnal, year-round resident generalist predator, to see how this varied as a function of weather, season and availability. Use of the two most frequently used land cover types, gardens/buildings and cultivated fields varied more than 3-fold as a simple function of season and weather through linear effects of wind and quadratic effects of temperature. Even when controlling for the temporal context, both land cover types were used more evenly than predicted from variation in availability (functional response in habitat selection). Use of two other land cover categories (pastures and moist areas) increased linearly with temperature and was proportional to their availability. The study shows that habitat selection by generalist foragers may be highly dependent on temporal variables such as weather, probably because such foragers switch between weather dependent feeding opportunities offered by different land cover types. An opportunistic foraging strategy in a landscape with erratically appearing feeding opportunities in different land cover types, may possibly also explain decreasing selection of the two most frequently used land cover types with increasing availability.

  19. The Path to Advanced Practice Licensure for Clinical Nurse Specialists in Washington State.

    PubMed

    Schoonover, Heather

    The aim of this study was to provide a review of the history and process to obtaining advanced practice licensure for clinical nurse specialists in Washington State. Before 2016, Washington State licensed certified nurse practitioners, certified nurse midwives, and certified nurse anesthetists under the designation of an advanced registered nurse practitioner; however, the state did not recognize clinical nurse specialists as advanced practice nurses. The work to drive the rule change began in 2007. The Washington Affiliate of the National Association of Clinical Nurse Specialists used the Power Elite Theory to guide advocacy activities, building coalitions and support for the desired rule changes. On January 8, 2016, the Washington State Nursing Care Quality Assurance Commission voted to amend the state's advanced practice rules, including clinical nurse specialists in the designation of an advanced practice nurse. Since the rule revision, clinical nurse specialists in Washington State have been granted advanced registered nurse practitioner licenses. Driving changes in state regulatory rules requires diligent advocacy, partnership, and a deep understanding of the state's rule-making processes. To be successful in changing rules, clinical nurse specialists must build strong partnerships with key influencers and understand the steps in practice required to make the desired changes.

  20. An overview of Medicare reimbursement regulations for advanced practice nurses.

    PubMed

    Frakes, Michael A; Evans, Tracylain

    2006-01-01

    The federal government spends nearly 15% of the budget on Medicare services annually, and advanced practice nurses are eligible for reimbursement from that pool. The regulations governing reimbursement are complex because of the social, political, and financial pressures involved in their development. Although economic viability and due diligence considerations make it incumbent on advanced practice nurses to understand the rules, the profession, as a whole, has knowledge deficits in this area. The essentials of regulatory development and structure are reviewed and considerations for optimizing reimbursement are described.

  1. Does radiography advanced practice improve patient outcomes and health service quality? A systematic review.

    PubMed

    Hardy, Maryann; Johnson, Louise; Sharples, Rachael; Boynes, Stephen; Irving, Donna

    2016-06-01

    To investigate the impact of radiographer advanced practice on patient outcomes and health service quality. Using the World Health Organization definition of quality, this review followed the Centre for Reviews and Dissemination guidance for undertaking reviews in healthcare. A range of databases were searched using a defined search strategy. Included studies were assessed for quality using a tool specifically developed for reviewing studies of diverse designs, and data were systematically extracted using electronic data extraction pro forma. 407 articles were identified and reviewed against the inclusion/exclusion criteria. Nine studies were included in the final review, the majority (n = 7) focusing on advanced radiography practice within the UK. Advanced practice activities considered were radiographer reporting, leading patient review clinics and barium enema examinations. The articles were generally considered to be of low-to-moderate quality, with most evaluating advanced practice within a single centre. With respect to specific quality dimensions, the included studies considered cost reduction, patient morbidity, time to treatment and patient satisfaction. No articles reported data relating to time to diagnosis, time to recovery or patient mortality. Radiographer advanced practice is an established activity both in the UK and internationally. However, evidence of the impact of advanced practice in terms of patient outcomes and service quality is limited. This systematic review is the first to examine the evidence base surrounding advanced radiography practice and its impact on patient outcomes and health service quality.

  2. Personhood, patienthood, and clinical practice: reassessing advance directives.

    PubMed

    Rich, B A

    1998-09-01

    This article considers 2 major critiques of advance directives and offers a defense to each of them. The 1st critique is philosophical in nature and maintains that the moral authority of an advance directive is undercut by a failure of personal identity to survive the loss of decisional capacity. The response in this article is that this critique relies on a flawed and disfavored concept of persons and their persistence over time. The 2nd critique, pragmatic in nature, argues that advance directives cannot be authoritative because the requisite elements of an informed consent to or refusal of treatment are rarely present, and many such instruments are ambiguous. The author argues that if the creation of advance directives, as a form of advance care planning, is made an integral aspect of clinical practice, many more patients will elect to execute directives, and those directives will not be ambiguous.

  3. Heuristic versus Systematic Processing of Specialist versus Generalist Sources in Online Media

    ERIC Educational Resources Information Center

    Koh, Yoon Jeon; Sundar, S. Shyam

    2010-01-01

    In exploring why specialist sources (e.g., CNN.com) are more persuasive than generalist sources (e.g., CBS.com), this study examines theoretical mechanisms related to information-processing differences caused by these sources. When we have a chain of sources (Websites and agents) in online media, does specialization of one of them bias the…

  4. Establishing advanced practice for medical imaging in New Zealand

    PubMed Central

    Yielder, Jill; Young, Adrienne; Park, Shelley; Coleman, Karen

    2014-01-01

    IntroductionThis article presents the outcome and recommendations following the second stage of a role development project conducted on behalf of the New Zealand Institute of Medical Radiation Technology (NZIMRT). The study sought to support the development of profiles and criteria that may be used to formulate Advanced Scopes of Practice for the profession. It commenced in 2011, following on from initial research that occurred between 2005 and 2008 investigating role development and a possible career structure for medical radiation technologists (MRTs) in New Zealand (NZ). MethodsThe study sought to support the development of profiles and criteria that could be used to develop Advanced Scopes of Practice for the profession through inviting 12 specialist medical imaging groups in NZ to participate in a survey. ResultsFindings showed strong agreement on potential profiles and on generic criteria within them; however, there was less agreement on specific skills criteria within specialist areas. ConclusionsThe authors recommend that one Advanced Scope of Practice be developed for Medical Imaging, with the establishment of generic and specialist criteria. Systems for approval of the overall criteria package for any individual Advanced Practitioner (AP) profile, audit and continuing professional development requirements need to be established by the Medical Radiation Technologists Board (MRTB) to meet the local needs of clinical departments. It is further recommended that the NZIMRT and MRTB promote and support the need for an AP pathway for medical imaging in NZ. PMID:26229631

  5. Establishing advanced practice for medical imaging in New Zealand

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Yielder, Jill, E-mail: j.yielder@auckland.ac.nz; Young, Adrienne; Park, Shelley

    Introduction: This article presents the outcome and recommendations following the second stage of a role development project conducted on behalf of the New Zealand Institute of Medical Radiation Technology (NZIMRT). The study sought to support the development of profiles and criteria that may be used to formulate Advanced Scopes of Practice for the profession. It commenced in 2011, following on from initial research that occurred between 2005 and 2008 investigating role development and a possible career structure for medical radiation technologists (MRTs) in New Zealand (NZ). Methods: The study sought to support the development of profiles and criteria that couldmore » be used to develop Advanced Scopes of Practice for the profession through inviting 12 specialist medical imaging groups in NZ to participate in a survey. Results: Findings showed strong agreement on potential profiles and on generic criteria within them; however, there was less agreement on specific skills criteria within specialist areas. Conclusions: The authors recommend that one Advanced Scope of Practice be developed for Medical Imaging, with the establishment of generic and specialist criteria. Systems for approval of the overall criteria package for any individual Advanced Practitioner (AP) profile, audit and continuing professional development requirements need to be established by the Medical Radiation Technologists Board (MRTB) to meet the local needs of clinical departments. It is further recommended that the NZIMRT and MRTB promote and support the need for an AP pathway for medical imaging in NZ.« less

  6. Associated disease risk from the introduced generalist pathogen Sphaerothecum destruens: management and policy implications.

    PubMed

    Andreou, Demetra; Gozlan, Rodolphe Elie

    2016-08-01

    The rosette agent Sphaerothecum destruens is a novel pathogen, which is currently believed to have been introduced into Europe along with the introduction of the invasive fish topmouth gudgeon Pseudorasbora parva (Temminck & Schlegel, 1846). Its close association with P. parva and its wide host species range and associated host mortalities, highlight this parasite as a potential source of disease emergence in European fish species. Here, using a meta-analysis of the reported S. destruens prevalence across all reported susceptible hosts species; we calculated host-specificity providing support that S. destruens is a true generalist. We have applied all the available information on S. destruens and host-range to an established framework for risk-assessing non-native parasites to evaluate the risks posed by S. destruens and discuss the next steps to manage and prevent disease emergence of this generalist parasite.

  7. Host suitability affects odor association in Cotesia marginiventris: implications in generalist parasitoid host-finding

    USDA-ARS?s Scientific Manuscript database

    Insect herbivores often induce plant volatile compounds that can attract natural enemies. Cotesia marginiventris (Hymenoptera: Braconidae) is a generalist parasitoid wasp of noctuid caterpillars and is highly attracted to Spodoptera exigua-induced plant volatiles. The plasticity of C. marginiventris...

  8. Building foundations for the future: the NHS Scotland advanced practice succession planning development pathway.

    PubMed

    Currie, Kay; Grundy, Maggie

    2011-10-01

    To highlight implications for managers from the implementation of a national advanced practice succession planning development pathway within Scotland. Internationally, advanced practice posts have often developed in an ad-hoc manner, with little organizational attention to succession planning. Evaluation of a pilot national succession planning development pathway identified mechanisms which facilitate or hamper effective planning for advanced practice roles. A responsive evaluation design incorporating semi-structured questionnaires to pathway participants (n = 15) and semi-structured telephone interviews with case-site pathway participants (n = 7) and their line managers. Managers believed the development pathway was worthwhile; however, there was limited strategic planning to match individuals' development to service need. Practitioners generally perceived managers as interested in their development, although levels of practical support varied. There is concern from both managers and practitioners regarding ongoing funding for advanced practice development. The present evaluation study reiterates the need for organizational commitment to succession planning including robust service needs analysis mechanisms and adequate funding for development processes. Nurse managers are viewed as the 'gatekeepers' to opportunities for developing advanced nurse practitioners; scare resources must be targeted effectively to support succession planning through the development of selected individuals for future advanced practice posts, justified by service need. © 2011 Blackwell Publishing Ltd.

  9. Advanced practice nurses core competencies: a framework for developing and testing an advanced practice nurse discharge intervention.

    PubMed

    Cooke, Liz; Gemmill, Robin; Grant, Marcia

    2008-01-01

    The purpose of this paper was to describe evidenced-based interventions as implemented by advanced practice nurses (APNs) conducting intervention research with a vulnerable population of blood and marrow transplant patients. In addition, each of the 6 core competencies of the APN role identified by Hamric are outlined and applied using a patient case study. These competencies are the following: direct clinical practice, expert coaching and advice, consultation, research skills, clinical and professional leadership, collaboration, and ethical decision making. This article chronicles a typical patient's journey through a post-hospital discharge nursing research study involving APNs as "intervention nurses" and discusses the various aspects of the APN core competencies throughout the process.

  10. Generalist genes and the Internet generation: etiology of learning abilities by web testing at age 10.

    PubMed

    Davis, O S P; Kovas, Y; Harlaar, N; Busfield, P; McMillan, A; Frances, J; Petrill, S A; Dale, P S; Plomin, R

    2008-06-01

    A key translational issue for neuroscience is to understand how genes affect individual differences in brain function. Although it is reasonable to suppose that genetic effects on specific learning abilities, such as reading and mathematics, as well as general cognitive ability (g), will overlap very little, the counterintuitive finding emerging from multivariate genetic studies is that the same genes affect these diverse learning abilities: a Generalist Genes hypothesis. To conclusively test this hypothesis, we exploited the widespread access to inexpensive and fast Internet connections in the UK to assess 2541 pairs of 10-year-old twins for reading, mathematics and g, using a web-based test battery. Heritabilities were 0.38 for reading, 0.49 for mathematics and 0.44 for g. Multivariate genetic analysis showed substantial genetic correlations between learning abilities: 0.57 between reading and mathematics, 0.61 between reading and g, and 0.75 between mathematics and g, providing strong support for the Generalist Genes hypothesis. If genetic effects on cognition are so general, the effects of these genes on the brain are also likely to be general. In this way, generalist genes may prove invaluable in integrating top-down and bottom-up approaches to the systems biology of the brain.

  11. A Framework for Teaching Practice-Based Research with a Focus on Service Users

    ERIC Educational Resources Information Center

    Austin, Michael J.; Isokuortti, Nanne

    2016-01-01

    The integration of research and practice in social work education and agency practice is both complex and challenging. The analysis presented here builds upon the classic social work generalist framework (engagement, assessment, service planning and implementation, service evaluation, and termination) by developing a three-part framework to…

  12. Advancing practice relating to SEA alternatives

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    González, Ainhoa, E-mail: agonzal@tcd.ie; Thérivel, Riki, E-mail: levett-therivel@phonecoop.coop; Fry, John, E-mail: john.fry@ucd.ie

    Developing and assessing alternatives is a key and central stage to Strategic Environmental Assessment (SEA). However, research has repeatedly reported this stage as one of the most poorly undertaken aspects of the SEA process. Current practice limitations include belated consideration of reasonable alternatives, narrow scope of alternatives that often include unrealistic or retrofitted options, limited stakeholder and public involvement in their identification, assessment and selection, lack of systematic approaches to their assessment and comparison, and inadequate reporting of the ‘storyline’ on how they were identified, what the potential impacts are and why the preferred alternative was selected. These issues havemore » resulted in objections and judicial reviews. On the positive side, a number of good practice case studies enable extraction of key lessons and formulation of a set of general recommendations to advance practice in SEA alternatives. In this paper, practical guidance on the identification and development of alternatives, their assessment and comparison, selection of the preferred option, and documentation of the process and the reasons for selection is provided and discussed to frame good practice approaches. - Highlights: • Alternatives are one of the most poorly completed aspects of Strategic Environmental Assessment. • Current practice limitations need to be addressed to enhance SEA effectiveness. • A set of recommendations are extracted from good practice case studies. • These recommendations can be applied across jurisdictions and sectors and tailored as necessary.« less

  13. Impact of advanced laparoscopy courses on present surgical practice.

    PubMed

    Houck, Jared; Kopietz, Courtni M; Shah, Bhavin C; Goede, Matthew R; McBride, Corrigan L; Oleynikov, Dmitry

    2013-01-01

    The introduction of new surgical techniques has made training in laparoscopic procedures a necessity for the practicing surgeon, but acquisition of new surgical skills is a formidable task. This study was conducted to assess the impact of advanced laparoscopic workshops on caseload patterns of practicing surgeons. After we obtained institutional review board approval, a survey of practicing surgeons who participated in advanced laparoscopic courses was distributed; the results were analyzed for statistical significance. The courses were held at the University of Nebraska Medical Center between January 2002 and December 2010. Questionnaires were mailed, faxed, and e-mailed to surgeons. Of the 109 surgeons who participated in the advanced laparoscopy courses, 79 received surveys and 30 were excluded from the survey because of their affiliation with the University of Nebraska Medical Center. A total of 47 responses (59%) were received from 41 male and 6 female surgeons. The median response time from completion of the course to completion of the survey was 13.2 months (range, 6.8-19.1 months). The mean age of participating surgeons was 39.2 years (range, 29-51 years). The mean time since residency was 8.4 years (range, 0.8-21 years). Eleven surgeons had completed a minimal number of laparoscopic cases in residency (<50), 17 surgeons had completed a moderate number of laparoscopic procedures in residency (50-200), and 21 surgeons had completed a significant number of cases during residency (>200). Of the surgeons who responded, 94% were in private practice. Fifty-seven percent of the participating surgeons who responded reported a change in laparoscopic practice patterns after the courses. Of these surgeons, 24% had a limited residency laparoscopy exposure of <50 cases. Surgeons who were exposed to ≥50 laparoscopic cases during their residency showed a statistically significant increase in the number of laparoscopic procedures performed after their class compared with

  14. Tropical specialist vs. climate generalist: Diversification and demographic history of sister species of Carlia skinks from northwestern Australia.

    PubMed

    Afonso Silva, Ana C; Bragg, Jason G; Potter, Sally; Fernandes, Carlos; Coelho, Maria Manuela; Moritz, Craig

    2017-08-01

    Species endemic to the tropical regions are expected to be vulnerable to future climate change due in part to their relatively narrow climatic niches. In addition, these species are more likely to have responded strongly to past climatic change, and this can be explored through phylogeographic analyses. To test the hypothesis that tropical specialists are more sensitive to climate change than climate generalists, we generated and analyse sequence data from mtDNA and ~2500 exons to compare scales of historical persistence and population fluctuation in two sister species of Australian rainbow skinks: the tropical specialist Carlia johnstonei and the climate generalist C. triacantha. We expect the tropical specialist species to have deeper and finer-scale phylogeographic structure and stronger demographic fluctuations relative to the closely related climate generalist species, which should have had more stable populations through periods of harsh climate in the late Quaternary. Within C. johnstonei, we find that some populations from the northern Kimberley islands are highly divergent from mainland populations. In C. triacantha, one major clade occurs across the deserts and into the mesic Top End, and another occurs primarily in the Kimberley with scattered records eastwards. Where their ranges overlap in the Kimberley, both mitochondrial DNA and nuclear DNA suggest stronger phylogeographic structure and range expansion within the tropical specialist, whereas the climate generalist has minimal structuring and no evidence of recent past range expansion. These results are consistent with the hypothesis that tropical specialists are more sensitive to past climatic change. © 2017 John Wiley & Sons Ltd.

  15. Introducing Advanced Practice Nurses / Nurse Practitioners in health care systems: a framework for reflection and analysis.

    PubMed

    De Geest, Sabina; Moons, Philip; Callens, Betty; Gut, Chris; Lindpaintner, Lyn; Spirig, Rebecca

    2008-11-01

    An increasing number of countries are exploring the option of introducing Advanced Practice Nurses (APN), such as Nurse Practitioners (NP), as part of the health care workforce. This is particular relevant in light of the increase of the elderly and chronically ill. It is crucial that this introduction is preceded by an in depth understanding of the concept of advanced practice nursing as well as an analysis of the context. Firstly, a conceptual clarification of Advanced Practice Nurses and Nurse Practitioners is provided. Secondly, a framework is introduced that assists in the analysis of the introduction and development of Advanced Practice Nurse roles in a particular health care system. Thirdly, outcomes research on Advanced Practice Nursing is presented. Argumentation developed using data based papers and policy reports on Advanced Practice Nursing. The proposed framework consists of five drivers: (1) the health care needs of the population, (2) education, (3) workforce, (4) practice patterns and (5) legal and health policy framework. These drivers act synergistically and are dynamic in time and space. Outcomes research shows that nurse practitioners show clinical outcomes similar to or better than those of physicians. Further examples demonstrate favourable outcomes in view of the six Ds of outcome research; death, disease, disability, discomfort, dissatisfaction and dollars, for models of care in which Advanced Practice Nurses play a prominent role. Advanced Practice Nurses such as Nurse Practitioners show potential to contribute favourably to guaranteeing optimal health care. Advanced Practice Nurses will wield the greatest influence on health care by focusing on the most pressing health problems in society, especially the care of the chronically ill.

  16. Integrated health care and the advanced practice nurse.

    PubMed

    Green, A H; Conway-Welch, C

    1995-01-01

    As state-designed Medicaid reforms are enacted and commercial insurance carriers begin to manage care, advanced practice nurses (APNs) must be ready to aggressively pursue opportunities for clinical participation. Understanding the contractual obligations of becoming a provider, as well as adopting strategies for successful participation in these emerging integrated networks, will be critical for APNs. Successful contracting requires a carefully defined set of practice activities and a willingness to become a team player in a complex organization.

  17. Advanced practice nursing in child maltreatment: practice characteristics.

    PubMed

    Hornor, Gail; Herendeen, Pamela

    2014-01-01

    Child maltreatment is a problem of epidemic proportions in the United States. Pediatric nurse practitioners and other advanced practice nurses (APNs) have been caring for maltreated children for decades, yet to date no comprehensive assessment of their practice characteristics or their clinical and academic contributions to the field has been performed. The purpose of this study is to describe the practice characteristics of APNs who care for maltreated children. A descriptive design was used for this study. Child advocacy centers and children's hospitals were contacted to inquire about employment of child maltreatment APNs in their institution, and contact information for the lead APN was obtained. The Nurse Practitioner Survey was then sent to lead APNs by e-mail. The majority of APNs who work primarily in child maltreatment are pediatric nurse practitioners who work in child advocacy centers. They are providing care to children with physical and/or sexual abuse concerns; however, APNs provide care for children with all types of child maltreatment concerns. APNs play a vital role in the care of abused/neglected children. Their important contributions include not only clinical care but also the provision of clinical and didactic education to other professionals, parents, and the public. Research and publication are also essential to their role. Copyright © 2014 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.

  18. Chlorophyll degradation in the gut of generalist and specialist Lepidopteran caterpillars.

    PubMed

    Badgaa, Amarsanaa; Jia, Aiqun; Ploss, Kerstin; Boland, Wilhelm

    2014-12-01

    Plant feeding herbivores excrete most of the ingested chlorophyll (Chl) as partly degraded derivatives lacking the phytol side chain and the central magnesium ion. An ecological role of digested and degraded Chls in the interactions between insects, their food plant and other insects has been described recently. To gain more information on common degradation patterns in plant-feeding insects, the orals secretions and frass of five Lepidopteran caterpillars covering generalists and specialists, namely Spodoptera littoralis, Spodoptera eridania, Heliothis virescens, Helicoverpa armigera, Manduca sexta, and, for comparison, of the leaf beetle larva Chrysomela lapponica were analyzed for chlorophyll catabolites. The major degradation products were determined as pheohorbide a/b and pyropheophorbide a/b by using LC-MS, LC-NMR, UV, and fluorescence spectrometry. The compounds were not present in fresh leaves of the food plants (Phaseolus lunatus, Nicotiana tabacum). The catabolite spectrum in generalists and specialists was qualitatively similar and could be attributed to the action of gut proteins and the strongly alkaline milieu in the digestive tract. Due to the anaerobic environment of the larval gut, the tetrapyrrole core of the Chl catabolites was not cleaved. Substantial amounts of Chl a/b metabolites were strongly complexed by a protein in the mid-gut.

  19. The Role of the Advanced Practice Nurse in Geriatric Oncology Care.

    PubMed

    Morgan, Brianna; Tarbi, Elise

    2016-02-01

    To describe how the Advanced Practice Nurse (APN) is uniquely suited to meet the needs of older adults throughout the continuum of cancer, to explore the progress that APNs have made in gero-oncology care, and make suggestions for future directions. Google Scholar, PubMed, and CINAHL. Search terms included: "gero-oncology," "geriatric oncology," "Advanced Practice Nurse," "Nurse Practitioner," "older adult," "elderly," and "cancer." Over the last decade, APNs have made advances in caring for older adults with cancer by playing a role in prevention, screening, and diagnosis; through evidence-based gero-oncology care during cancer treatment; and in designing tailored survivorship care models. APNs must combat ageism in treatment choice for older adults, standardize comprehensive geriatric assessments, and focus on providing person-centered care, specifically during care transitions. APNs are well-positioned to help understand the complex relationship between risk factors, geriatric syndromes, and frailty and translate research into practice. Palliative care must expand beyond specialty providers and shift toward APNs with a focus on early advanced care planning. Finally, APNs should continue to establish multidisciplinary survivorship models across care settings, with a focus on primary care. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Generalist bees pollinate red-flowered Penstemon eatonii: Duality in the hummingbird pollination syndrome

    Treesearch

    James H. Cane; Rick Dunne

    2014-01-01

    The red tubular flowers of Penstemon eatonii (Plantaginaceae) typify the classic pollination syndrome for hummingbirds. Bees are thought to diminish its seed siring potential, but we found that foraging female generalist bees (Apis, Anthophora) deposited substantial amounts of conspecific pollen on P. eatonii stigmas. In the absence of hummingbirds, bee pollination of...

  1. Irrigation Principles and Practices. Appropriate Technologies for Development. Reprint R-5.

    ERIC Educational Resources Information Center

    Development and Resources Corp.

    This manual was prepared for use by Peace Corps trainees and volunteers as a resource in gaining understanding and knowledge of basic irrigation principles and practices. It is intended as a practical handbook that can be understood by a generalist, with subject areas limited to those observed as being of most frequent concern to volunteers in…

  2. Student and Preceptor Advancement in a Dedicated Education Site: Innovation in Clinical Education for Advanced Practice Nurses.

    PubMed

    Hall, Katherine C; Diffenderfer, Sandy K; Stidham, April; Mullins, Christine M

    2018-04-19

    In the 1990s, dedicated education units transformed undergraduate preceptorships, but graduate preceptorships remain static. The dyadic nurse practitioner preceptorship model supports an environment where faculty, students, and preceptors may overlook nuances that affect the teaching-learning process. This article describes an innovative clinical education model, Student and Preceptor Advancement in a Dedicated Education Site, designed to improve preceptorships for advanced practice nurses. The focus is on adaptations made to facilitate use in advanced practice nursing programs.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

  3. Exploring the scope of expanding advanced nursing practice in nurse-led clinics: a multiple-case study.

    PubMed

    Shiu, Ann T Y; Lee, Diana T F; Chau, Janita P C

    2012-08-01

    This article is a report on a study to explore the development of expanding advanced nursing practice in nurse-led clinics in Hong Kong. Nurse-led clinics serviced by advanced practice nurses, a common international practice, have been adopted in Hong Kong since 1990s. Evaluations consistently show that this practice has good clinical outcomes and contributes to containing healthcare cost. However, similar to the international literature, it remains unclear as to what the elements of good advanced nursing practice are, and which directions Hong Kong should adopt for further development of such practice. A multiple-case study design was adopted with six nurse-led clinics representing three specialties as six case studies, and including two clinics each from continence, diabetes and wound care. Each case had four embedded units of analysis. They included non-participant observation of nursing activities (9 days), nurse interviews (N = 6), doctor interviews (N = 6) and client interviews (N = 12). The data were collected in 2009. Within- and cross-case analyses were conducted. The cross-case analysis demonstrated six elements of good advanced nursing practice in nurse-led clinics, and showed a great potential to expand the practice by reshaping four categories of current boundaries, including community-hospital, wellness-illness, public-private and professional-practice boundaries. From these findings, we suggest a model to advance the scope of advanced nursing practice in nurse-led clinics. The six elements may be applied as audit criteria for evaluation of advanced nursing practice in nurse-led clinics, and the proposed model provides directions for expanding such practice in Hong Kong and beyond. © 2011 Blackwell Publishing Ltd.

  4. Acceleration of exotic plant invasion in a forested ecosystem by a generalist herbivore.

    PubMed

    Eschtruth, Anne K; Battles, John J

    2009-04-01

    The successful invasion of exotic plants is often attributed to the absence of coevolved enemies in the introduced range (i.e., the enemy release hypothesis). Nevertheless, several components of this hypothesis, including the role of generalist herbivores, remain relatively unexplored. We used repeated censuses of exclosures and paired controls to investigate the role of a generalist herbivore, white-tailed deer (Odocoileus virginianus), in the invasion of 3 exotic plant species (Microstegium vimineum, Alliaria petiolata, and Berberis thunbergii) in eastern hemlock (Tsuga canadensis) forests in New Jersey and Pennsylvania (U.S.A.). This work was conducted in 10 eastern hemlock (T. canadensis) forests that spanned gradients in deer density and in the severity of canopy disturbance caused by an introduced insect pest, the hemlock woolly adelgid (Adelges tsugae). We used maximum likelihood estimation and information theoretics to quantify the strength of evidence for alternative models of the influence of deer density and its interaction with the severity of canopy disturbance on exotic plant abundance. Our results were consistent with the enemy release hypothesis in that exotic plants gained a competitive advantage in the presence of generalist herbivores in the introduced range. The abundance of all 3 exotic plants increased significantly more in the control plots than in the paired exclosures. For all species, the inclusion of canopy disturbance parameters resulted in models with substantially greater support than the deer density only models. Our results suggest that white-tailed deer herbivory can accelerate the invasion of exotic plants and that canopy disturbance can interact with herbivory to magnify the impact. In addition, our results provide compelling evidence of nonlinear relationships between deer density and the impact of herbivory on exotic species abundance. These findings highlight the important role of herbivore density in determining impacts on

  5. Magnifying Pre-Service Generalist Teachers' Perceptions of Preparedness to Teach Primary School Physical Education

    ERIC Educational Resources Information Center

    Freak, Annette; Miller, Judith

    2017-01-01

    Background: Generalist teachers' confidence, competence and preparedness to teach Physical Education (PE) following Primary School Physical Education Teacher Education (PSPETE) has emerged as a research imperative. Yet little is known of teachers' perceptions of such matters. For teacher educators responding to the deficient delivery of primary…

  6. The Case for the Generalist in Rural Development. Peace Corps Faculty Paper No. 4.

    ERIC Educational Resources Information Center

    Lodge, George C.

    Veraguas province, Panama, is an example of the need to have generalists, not specialists, deal with the interrelated aspects of rural areas in developing nations. Intricate connections between living standards, agricultural production, market and credit structures, land tenure, the political system, the social structure, education, health,…

  7. Early Career Patterns for Social Work Graduates

    ERIC Educational Resources Information Center

    Choi, Mi Jin; Urbanski, Paul; Fortune, Anne E.; Rogers, Crystal

    2015-01-01

    This study examines master's of social work graduates' early careers. Six cohorts graduating from 2002 through 2007 (N = 246) completed a questionnaire 9-15 months after graduation. Most reported adequate or exceptional preparation on both generalist and advanced concentration practice behaviors. Almost all direct practice graduates and 2/3 of…

  8. Deriving consensus on the characteristics of advanced practice nursing: meta-summary of more than 2 decades of research.

    PubMed

    Hutchinson, Marie; East, Leah; Stasa, Helen; Jackson, Debra

    2014-01-01

    Over recent decades, there has been considerable research and debate about essential features of advanced nursing practice and differences among various categories of advanced practice nurses. This study aimed to derive an integrative description of the defining characteristics of advanced practice nursing through a meta-summary of the existing literature. A three-phase approach involved (a) systematic review of the literature to identify the specific activities characterized as advanced practice nursing, (b) qualitative meta-summary of practice characteristics extracted from manuscripts meeting inclusion criteria; and (c) statistical analysis of domains across advanced practice categories and country in which the study was completed. A descriptive framework was distilled using qualitative and quantitative results. Fifty manuscripts met inclusion criteria and were retained for analysis. Seven domains of advanced nursing practice were identified: (a) autonomous or nurse-led extended clinical practice; (b) improving systems of care; (c) developing the practice of others; (d) developing/delivering educational programs/activities; (e) nursing research/scholarship; (f) leadership external to the organization; and (g) administering programs, budgets, and personnel. Domains were similar across categories of advanced nursing practice; the domain of developing/delivering educational programs/activities was more common in Australia than in the United States or United Kingdom. Similarity at the domain level was sufficient to suggest that advanced practice role categories are less distinct than often argued. There is merit in adopting a more integrated and consistent interpretation of advanced practice nursing.

  9. Seed dispersal by specialist versus generalist foragers: the plant's perspective

    USGS Publications Warehouse

    Larson, D.L.

    1996-01-01

    I examined the seed dispersal ecology of the stem parasitic plant, desert mistletoe (Phoradendron californicum, Viscaceae), with the objectives of (1) determining the relative effectiveness of specialist and generalist foragers for seed dispersal, (2) determining the extent to which desert mistletoe fruiting characteristics correspond to those predicted for plants attracting specialist versus generalist foragers, and (3) examining the potential consequences of the observed dispersal strategy for mistletoe reproduction. Three species of birds, phainopepla, Gila woodpecker, and northern mockingbird, fed on desert mistletoe at my study site. The specialist, phainopepla, was the most abundant and the most likely to perch in host species, where defecated seeds had a greater probability of lodging in a site suitable for establishment. Gila woodpeckers, although abundant, spent little time in host plants, thus dooming most of the seeds they consumed. Mockingbirds may disperse a small number of seeds, but were abundant enough to consume only a small portion of the available fruits. As expected for plants attracting specialist frugivores, mistletoes produced fruits throughout the 6-month season in which phainopeplas reside in the Sonoran desert. Contrary to expectation, numbers of fruits produced far exceeded the amount that could be consumed by the frugivores at my study site. Fruit crop size was positively related to absolute fruit removal, but not to proportional removal at the scale of the entire study site. However, crop size was positively related to proportional removal within the neighborhood of mistletoes occupying an individual host tree. Frugivores were attracted to infected hosts, host attractiveness increased, although proportional removal of fruit declined, with number of female mistletoes. The observed dispersal ecology of desert mistletoe suggests the likelihood of increasingly clumped distributions of mistletoe plants, as more and more seeds are deposited

  10. Advanced practice nursing in Latin America and the Caribbean: regulation, education and practice.

    PubMed

    Zug, Keri Elizabeth; Cassiani, Silvia Helena De Bortoli; Pulcini, Joyce; Garcia, Alessandra Bassalobre; Aguirre-Boza, Francisca; Park, Jeongyoung

    2016-08-08

    to identify the current state of advanced practice nursing regulation, education and practice in Latin America and the Caribbean and the perception of nursing leaders in the region toward an advanced practice nursing role in primary health care to support Universal Access to Health and Universal Health Coverage initiatives. a descriptive cross-sectional design utilizing a web-based survey of 173 nursing leaders about their perceptions of the state of nursing practice and potential development of advanced practice nursing in their countries, including definition, work environment, regulation, education, nursing practice, nursing culture, and perceived receptiveness to an expanded role in primary health care. the participants were largely familiar with the advanced practice nursing role, but most were unaware of or reported no current existing legislation for the advanced practice nursing role in their countries. Participants reported the need for increased faculty preparation and promotion of curricula reforms to emphasize primary health care programs to train advanced practice nurses. The vast majority of participants believed their countries' populations could benefit from an advanced practice nursing role in primary health care. strong legislative support and a solid educational framework are critical to the successful development of advanced practice nursing programs and practitioners to support Universal Access to Health and Universal Health Coverage initiatives. identificar o estado atual da regulação, educação e prática do enfermeiro de prática avançada na América Latina e no Caribe e a percepção de líderes de enfermagem na região quanto ao papel da enfermagem de prática avançada na atenção primaria à saúde em apoio às iniciativas de Acesso Universal à Saúde e Cobertura Universal de Saúde. o estudo descritivo transversal utilizou um survey online com 173 líderes de enfermagem questionando suas percepções sobre o estado atual da pr

  11. How are physicians delivering palliative care? A population-based retrospective cohort study describing the mix of generalist and specialist palliative care models in the last year of life.

    PubMed

    Brown, Catherine Rl; Hsu, Amy T; Kendall, Claire; Marshall, Denise; Pereira, Jose; Prentice, Michelle; Rice, Jill; Seow, Hsien-Yeang; Smith, Glenys A; Ying, Irene; Tanuseputro, Peter

    2018-06-01

    To enable coordinated palliative care delivery, all clinicians should have basic palliative care skill sets ('generalist palliative care'). Specialists should have skills for managing complex and difficult cases ('specialist palliative care') and co-exist to support generalists through consultation care and transfer of care. Little information exists about the actual mixes of generalist and specialist palliative care. To describe the models of physician-based palliative care services delivered to patients in the last 12 months of life. This is a population-based retrospective cohort study using linked health care administrative data. Physicians providing palliative care services to a decedent cohort in Ontario, Canada. The decedent cohort consisted of all adults (18+ years) who died in Ontario, Canada between April 2011 and March 2015 ( n = 361,951). We describe four major models of palliative care services: (1) 53.0% of decedents received no physician-based palliative care, (2) 21.2% received only generalist palliative care, (3) 14.7% received consultation palliative care (i.e. care from both specialists and generalists), and (4) 11.1% received only specialist palliative care. Among physicians providing palliative care ( n = 11,006), 95.3% had a generalist palliative care focus and 4.7% a specialist focus; 74.2% were trained as family physicians. We examined how often a coordinated palliative care model is delivered to a large decedent cohort and identified that few actually received consultation care. The majority of care, in both the palliative care generalist and specialist models, was delivered by family physicians. Further research should evaluate how different models of care impact patient outcomes and costs.

  12. The advanced practice professionals' perspective: keys to a good working relationship between advanced practice professions and physicians.

    PubMed

    Polansky, Maura

    2013-01-01

    A strong working relationship between advanced practice professionals (APPs) and supervising oncologists is essential for reducing medical errors, retaining employees, and improving work environments. Although there is rather limited data on the unique relationship of the APP and physician, fundamental communication skills-including open communication, mutual respect, establishing expectations, and working with mutual purpose-should be the foundation of these relationships. This paper addresses various aspects of relationship building between APPs and physicians with suggestions for establishing successful working relationships.

  13. White-Nose Syndrome Fungus: A Generalist Pathogen of Hibernating Bats

    PubMed Central

    Zukal, Jan; Bandouchova, Hana; Bartonicka, Tomas; Berkova, Hana; Brack, Virgil; Brichta, Jiri; Dolinay, Matej; Jaron, Kamil S.; Kovacova, Veronika; Kovarik, Miroslav; Martínková, Natália; Ondracek, Karel; Rehak, Zdenek; Turner, Gregory G.; Pikula, Jiri

    2014-01-01

    Host traits and phylogeny can determine infection risk by driving pathogen transmission and its ability to infect new hosts. Predicting such risks is critical when designing disease mitigation strategies, and especially as regards wildlife, where intensive management is often advocated or prevented by economic and/or practical reasons. We investigated Pseudogymnoascus [Geomyces] destructans infection, the cause of white-nose syndrome (WNS), in relation to chiropteran ecology, behaviour and phylogenetics. While this fungus has caused devastating declines in North American bat populations, there have been no apparent population changes attributable to the disease in Europe. We screened 276 bats of 15 species from hibernacula in the Czech Republic over 2012 and 2013, and provided histopathological evidence for 11 European species positive for WNS. With the exception of Myotis myotis, the other ten species are all new reports for WNS in Europe. Of these, M. emarginatus, Eptesicus nilssonii, Rhinolophus hipposideros, Barbastella barbastellus and Plecotus auritus are new to the list of P. destructans-infected bat species. While the infected species are all statistically phylogenetically related, WNS affects bats from two suborders. These are ecologically diverse and adopt a wide range of hibernating strategies. Occurrence of WNS in distantly related bat species with diverse ecology suggests that the pathogen may be a generalist and that all bats hibernating within the distribution range of P. destructans may be at risk of infection. PMID:24820101

  14. White-nose syndrome fungus: a generalist pathogen of hibernating bats.

    PubMed

    Zukal, Jan; Bandouchova, Hana; Bartonicka, Tomas; Berkova, Hana; Brack, Virgil; Brichta, Jiri; Dolinay, Matej; Jaron, Kamil S; Kovacova, Veronika; Kovarik, Miroslav; Martínková, Natália; Ondracek, Karel; Rehak, Zdenek; Turner, Gregory G; Pikula, Jiri

    2014-01-01

    Host traits and phylogeny can determine infection risk by driving pathogen transmission and its ability to infect new hosts. Predicting such risks is critical when designing disease mitigation strategies, and especially as regards wildlife, where intensive management is often advocated or prevented by economic and/or practical reasons. We investigated Pseudogymnoascus [Geomyces] destructans infection, the cause of white-nose syndrome (WNS), in relation to chiropteran ecology, behaviour and phylogenetics. While this fungus has caused devastating declines in North American bat populations, there have been no apparent population changes attributable to the disease in Europe. We screened 276 bats of 15 species from hibernacula in the Czech Republic over 2012 and 2013, and provided histopathological evidence for 11 European species positive for WNS. With the exception of Myotis myotis, the other ten species are all new reports for WNS in Europe. Of these, M. emarginatus, Eptesicus nilssonii, Rhinolophus hipposideros, Barbastella barbastellus and Plecotus auritus are new to the list of P. destructans-infected bat species. While the infected species are all statistically phylogenetically related, WNS affects bats from two suborders. These are ecologically diverse and adopt a wide range of hibernating strategies. Occurrence of WNS in distantly related bat species with diverse ecology suggests that the pathogen may be a generalist and that all bats hibernating within the distribution range of P. destructans may be at risk of infection.

  15. Host-pathogen interactions and genome evolution in two generalist and specialist microsporidian pathogens of mosquitoes

    USDA-ARS?s Scientific Manuscript database

    The adaptation of two distantly related microsporidia to their mosquito hosts was investigated. Edhazardia aedis is a specialist pathogen that infects Aedes aegypti, the main vector of dengue and yellow fever arboviruses. Vavraia culicis is a generalist pathogen of several insects including Anophele...

  16. Intensive land use drives small-scale homogenization of plant- and leafhopper communities and promotes generalists.

    PubMed

    Chisté, Melanie N; Mody, Karsten; Kunz, Gernot; Gunczy, Johanna; Blüthgen, Nico

    2018-02-01

    The current biodiversity decline through anthropogenic land-use not only involves local species losses, but also homogenization of communities, with a few generalist species benefitting most from human activities. Most studies assessed community heterogeneity (β-diversity) on larger scales by comparing different sites, but little is known about impacts on β-diversity within each site, which is relevant for understanding variation in the level of α-diversity, the small-scale distribution of species and associated habitat heterogeneity. To obtain our dataset with 36,899 individuals out of 117 different plant- and leafhopper (Auchenorrhyncha) species, we sampled communities of 140 managed grassland sites across Germany by quantitative vacuum suction of five 1 m 2 plots on each site. Sites differed in land-use intensity as characterized by intensity of fertilization, mowing and grazing. Our results demonstrate a significant within-site homogenization of plant- and leafhopper communities with increasing land-use intensity. Correspondingly, density (- 78%) and γ-diversity (- 35%) declined, particularly with fertilization and mowing intensity. More than 34% of plant- and leafhopper species were significant losers and only 6% were winners of high land-use intensity, with abundant and widespread species being less affected. Increasing land-use intensity adversely affected dietary specialists and promoted generalist species. Our study emphasizes considerable, multifaceted effects of land-use intensification on species loss, with a few dominant generalists winning, and an emerging trend towards more homogenized assemblages. By demonstrating homogenization for the first time within sites, our study highlights that anthropogenic influences on biodiversity even occur on small scales.

  17. Constructing an Ethical Training for Advanced Nursing Practice: An Interactionist and Competency-Based Approach.

    PubMed

    Pariseau-Legault, Pierre; Lallier, Melisa

    2016-07-01

    Advanced practice nurses are working in a highly interdisciplinary and political context. Such situations can influence the deliberative and ethical decision-making processes in which they are also involved. This can subsequently compromise their abilities to protect their moral integrity, to find innovative and nondualistic solutions to complex ethical problems, and to collaborate with other health professionals. The authors constructed a training program inspired by discourse and narrative ethics. The objective pursued was to develop advanced practice nurses' moral integrity, highlight the ethical component of their clinical judgement, and foster the development of their deliberative competencies. The pedagogical process proposed exposes how an ethical curriculum adapted to the context in which advanced practice nurses evolve can address power relationships inherent in ethical decision making. The authors suggest that this pedagogical approach has the potential to optimize the consolidation of ethical, reflective, and deliberative competencies among advanced practice nurses. [J Nurs Educ. 2016;55(7):399-402.]. Copyright 2016, SLACK Incorporated.

  18. A review of generalist and specialist community health workers for delivering adolescent health services in sub-Saharan Africa.

    PubMed

    Koon, Adam D; Goudge, Jane; Norris, Shane A

    2013-10-26

    The health of adolescents is increasingly seen as an important international priority because the world's one point eight billion young people (aged 10 to 24 years) accounts for 15.5% of the global burden of disease and are disproportionately located in low- and middle-income countries (LMICs). Furthermore, an estimated 70% of premature adult deaths are attributable to unhealthy behaviors often initiated in adolescence (such as smoking, obesity, and physical inactivity). In order for health services to reach adolescents in LMICs, innovative service delivery models need to be explored and tested. This paper reviews the literature on generalist and specialist community health workers (CHWs) to assess their potential for strengthening the delivery of adolescent health services. We reviewed the literature on CHWs using Medline (PubMed), EBSCO Global Health, and Global Health Archive. Search terms (n = 19) were sourced from various review articles and combined with subject heading 'sub-Saharan Africa' to identify English language abstracts of original research articles on generalist and specialist CHWs. A total of 106 articles, from 1985 to 2012, and representing 24 African countries, matched our search criteria. A single study in sub-Saharan Africa used CHWs to deliver adolescent health services with promising results. Though few comprehensive evaluations of large-scale CHW programs exist, we found mixed evidence to support the use of either generalist or specialist CHW models for delivering adolescent health services. This review found that innovative service delivery approaches, such as those potentially offered by CHWs, for adolescents in sub-Saharan Africa are lacking, CHW programs have proliferated despite the absence of high quality evaluations, rigorous studies to establish the comparative effectiveness of generalist versus specialist CHW programs are needed, and further investigation of the role of CHWs in providing adolescent health services in sub

  19. A review of generalist and specialist community health workers for delivering adolescent health services in sub-Saharan Africa

    PubMed Central

    2013-01-01

    Background The health of adolescents is increasingly seen as an important international priority because the world’s one point eight billion young people (aged 10 to 24 years) accounts for 15.5% of the global burden of disease and are disproportionately located in low- and middle-income countries (LMICs). Furthermore, an estimated 70% of premature adult deaths are attributable to unhealthy behaviors often initiated in adolescence (such as smoking, obesity, and physical inactivity). In order for health services to reach adolescents in LMICs, innovative service delivery models need to be explored and tested. This paper reviews the literature on generalist and specialist community health workers (CHWs) to assess their potential for strengthening the delivery of adolescent health services. Methods We reviewed the literature on CHWs using Medline (PubMed), EBSCO Global Health, and Global Health Archive. Search terms (n = 19) were sourced from various review articles and combined with subject heading ‘sub-Saharan Africa’ to identify English language abstracts of original research articles on generalist and specialist CHWs. Results A total of 106 articles, from 1985 to 2012, and representing 24 African countries, matched our search criteria. A single study in sub-Saharan Africa used CHWs to deliver adolescent health services with promising results. Though few comprehensive evaluations of large-scale CHW programs exist, we found mixed evidence to support the use of either generalist or specialist CHW models for delivering adolescent health services. Conclusions This review found that innovative service delivery approaches, such as those potentially offered by CHWs, for adolescents in sub-Saharan Africa are lacking, CHW programs have proliferated despite the absence of high quality evaluations, rigorous studies to establish the comparative effectiveness of generalist versus specialist CHW programs are needed, and further investigation of the role of CHWs in

  20. Influence of cnicin, a sesquiterpene lactone ofCentaurea maculosa (Asteraceae), on specialist and generalist insect herbivores.

    PubMed

    Landau, I; Müller-Schärer, H; Ward, P I

    1994-04-01

    The sesquiterpene lactone cnicin was extracted fromCentaurea maculosa andCentaurea vallesiaca. We examined its effects on the ovipositional response and larval development of generalist and specialist insect herbivores associated withC. maculosa. For the oviposition trials, three plant species (C. maculosa, Achillea millefolium, andCichorium intybus), half of which were sprayed with 3% of cnicin, were exposed to the specialist mothsStenodes straminea, Agapeta zoegana, andPterolonche inspersa in field cages. All three species significantly preferredC. maculosa to other plants andP. inspersa significantly preferred cnicin-sprayed plants to untreated plants for oviposition. Tested over all species, cnicin significantly increased the number of eggs laid on a given plant. A larval diet test examined the toxicity of cnicin for larvae of the generalist noctuid mothSpodoptera littoralis. Cnicin concentrations of 3% and 6% were lethal and 1% and 0.5% seriously inhibited growth and development. The larvae of theC. maculosa specialistStenodes straminea survived at 6% cnicin, but none of the pupae hatched.Agapeta zoegana was able to survive at 1% and 3% cnicin. Both specialists had difficulties with the artificial diet, but weight increase and survival was not further reduced when cnicin was present compared with on the control diet. In conclusion, cnicin influenced host recognition by the specialist species, and larvae of the generalist did not survive on natural levels of cnicin. Growth and survival of the specialist were not influenced by cnicin but were considerably hampered on artificial diet.

  1. Generalist genes analysis of DNA markers associated with mathematical ability and disability reveals shared influence across ages and abilities

    PubMed Central

    2010-01-01

    Background The Generalist Genes Hypothesis is based upon quantitative genetic findings which indicate that many of the same genes influence diverse cognitive abilities and disabilities across age. In a recent genome-wide association study of mathematical ability in 10-year-old children, 43 SNP associations were nominated from scans of pooled DNA, 10 of which were validated in an individually genotyped sample. The 4927 children in this genotyped sample have also been studied at 7, 9 and 12 years of age on measures of mathematical ability, as well as on other cognitive and learning abilities. Results Using these data we have explored the Generalist Genes Hypothesis by assessing the association of the available measures of ability at age 10 and other ages with two composite 'SNP-set' scores, formed from the full set of 43 nominated SNPs and the sub-set of 10 SNPs that were previously found to be associated with mathematical ability at age 10. Both SNP sets yielded significant associations with mathematical ability at ages 7, 9 and 12, as well as with reading and general cognitive ability at age 10. Conclusions Although effect sizes are small, our results correspond with those of quantitative genetic research in supporting the Generalist Genes Hypothesis. SNP sets identified on the basis of their associations with mathematical ability at age 10 show associations with mathematical ability at earlier and later ages and show associations of similar magnitude with reading and general cognitive ability. With small effect sizes expected in such complex traits, future studies may be able to capitalise on power by searching for 'generalist genes' using longitudinal and multivariate approaches. PMID:20602751

  2. Temperature influences habitat preference of coral reef fishes: Will generalists become more specialised in a warming ocean?

    PubMed

    Matis, Paloma A; Donelson, Jennifer M; Bush, Stephen; Fox, Rebecca J; Booth, David J

    2018-07-01

    Climate change is expected to pose a significant risk to species that exhibit strong behavioural preferences for specific habitat types, with generalist species assumed to be less vulnerable. In this study, we conducted habitat choice experiments to determine how water temperature influences habitat preference for three common species of coral reef damselfish (Pomacentridae) that differ in their levels of habitat specialisation. The lemon damselfish Pomacentrus moluccensis, a habitat specialist, consistently selected complex coral habitat across all temperature treatments (selected based on local average seasonal temperatures naturally experienced in situ: ambient winter 22°C; ambient summer 28°C; and elevated 31°C). Unexpectedly, the neon damselfish Pomacentrus coelestis and scissortail sergeant Abudefduf sexfasciatus, both of which have more generalist habitat associations, developed strong habitat preferences (for complex coral and boulder habitat, respectively) at the elevated temperature treatment (31°C) compared to no single preferred habitat at 22°C or 28°C. The observed shifts in habitat preference with temperature suggest that we may be currently underestimating the vulnerability of some habitat generalists to climate change and highlight that the ongoing loss of complex live coral through coral bleaching could further exacerbate resource overlap and species competition in ways not currently considered in climate change models. © 2018 John Wiley & Sons Ltd.

  3. Feeding behaviour of generalist pests on Brassica juncea: implication for manipulation of glucosinolate biosynthesis pathway for enhanced resistance.

    PubMed

    Kumar, Pawan; Augustine, Rehna; Singh, Amarjeet Kumar; Bisht, Naveen C

    2017-10-01

    Differential accumulation of plant defence metabolites has been suggested to have important ecological consequence in the context of plant-insect interactions. Feeding of generalist pests on Brassica juncea showed a distinct pattern with selective exclusion of leaf margins which are high in glucosinolates. Molecular basis of this differential accumulation of glucosinolates could be explained based on differential expression profile of BjuMYB28 homologues, the major biosynthetic regulators of aliphatic glucosinolates, as evident from quantitative real-time PCR and promoter:GUS fusion studies in allotetraploid B. juncea. Constitutive overexpression of selected BjuMYB28 homologues enhanced accumulation of aliphatic glucosinolates in B. juncea. Performance of two generalist pests, Helicoverpa armigera and Spodoptera litura larvae, on transgenic B. juncea plants were poor compared to wild-type plants in a no-choice experiment. Correlation coefficient analysis suggested that weight gain of H. armigera larvae was negatively correlated with gluconapin (GNA) and glucobrassicanapin (GBN), whereas that of S. litura larvae was negatively correlated with GNA, GBN and sinigrin (SIN). Our study explains the significance and possible molecular basis of differential distribution of glucosinolates in B. juncea leaves and shows the potential of overexpressing BjuMYB28 for enhanced resistance of Brassica crops against the tested generalist pests. © 2017 John Wiley & Sons Ltd.

  4. A Game of Russian Roulette for a Generalist Dinoflagellate Parasitoid: Host Susceptibility Is the Key to Success

    PubMed Central

    Alacid, Elisabet; Park, Myung G.; Turon, Marta; Petrou, Katherina; Garcés, Esther

    2016-01-01

    Marine microbial interactions involving eukaryotes and their parasites play an important role in shaping the structure of phytoplankton communities. These interactions may alter population densities of the main host, which in turn may have consequences for the other concurrent species. The effect generalist parasitoids exert on a community is strongly dependent on the degree of host specificity. Parvilucifera sinerae is a generalist parasitoid able to infect a wide range of dinoflagellates, including toxic-bloom-forming species. A density-dependent chemical cue has been identified as the trigger for the activation of the infective stage. Together these traits make Parvilucifera-dinoflagellate hosts a good model to investigate the degree of specificity of a generalist parasitoid, and the potential effects that it could have at the community level. Here, we present for the first time, the strategy by which a generalist dinoflagellate parasitoid seeks out its host and determine whether it exhibits host preferences, highlighting key factors in determining infection. Our results demonstrate that in its infective stage, P. sinerae is able to sense potential hosts, but does not actively select among them. Instead, the parasitoids contact the host at random, governed by the encounter probability rate and once encountered, the chance to penetrate inside the host cell and develop the infection strongly depends on the degree of host susceptibility. As such, their strategy for persistence is more of a game of Russian roulette, where the chance of survival is dependent on the susceptibility of the host. Our study identifies P. sinerae as a potential key player in community ecology, where in mixed dinoflagellate communities consisting of hosts that are highly susceptible to infection, parasitoid preferences may mediate coexistence between host species, reducing the dominance of the superior competitor. Alternatively, it may increase competition, leading to species exclusion. If

  5. Antagonistic Pleiotropy and Fitness Trade-Offs Reveal Specialist and Generalist Traits in Strains of Canine Distemper Virus

    PubMed Central

    Nikolin, Veljko M.; Osterrieder, Klaus; von Messling, Veronika; Hofer, Heribert; Anderson, Danielle; Dubovi, Edward; Brunner, Edgar; East, Marion L.

    2012-01-01

    Theoretically, homogeneous environments favor the evolution of specialists whereas heterogeneous environments favor generalists. Canine distemper is a multi-host carnivore disease caused by canine distemper virus (CDV). The described cell receptor of CDV is SLAM (CD150). Attachment of CDV hemagglutinin protein (CDV-H) to this receptor facilitates fusion and virus entry in cooperation with the fusion protein (CDV-F). We investigated whether CDV strains co-evolved in the large, homogeneous domestic dog population exhibited specialist traits, and strains adapted to the heterogeneous environment of smaller populations of different carnivores exhibited generalist traits. Comparison of amino acid sequences of the SLAM binding region revealed higher similarity between sequences from Canidae species than to sequences from other carnivore families. Using an in vitro assay, we quantified syncytia formation mediated by CDV-H proteins from dog and non-dog CDV strains in cells expressing dog, lion or cat SLAM. CDV-H proteins from dog strains produced significantly higher values with cells expressing dog SLAM than with cells expressing lion or cat SLAM. CDV-H proteins from strains of non-dog species produced similar values in all three cell types, but lower values in cells expressing dog SLAM than the values obtained for CDV-H proteins from dog strains. By experimentally changing one amino acid (Y549H) in the CDV-H protein of one dog strain we decreased expression of specialist traits and increased expression of generalist traits, thereby confirming its functional importance. A virus titer assay demonstrated that dog strains produced higher titers in cells expressing dog SLAM than cells expressing SLAM of non-dog hosts, which suggested possible fitness benefits of specialization post-cell entry. We provide in vitro evidence for the expression of specialist and generalist traits by CDV strains, and fitness trade-offs across carnivore host environments caused by antagonistic

  6. Practice parameters facilitating adoption of advanced technologies for enhancing neuropsychological assessment paradigms.

    PubMed

    Parsons, Thomas D; McMahan, Timothy; Kane, Robert

    2018-01-01

    Clinical neuropsychologists have long underutilized computer technologies for neuropsychological assessment. Given the rapid advances in technology (e.g. virtual reality; tablets; iPhones) and the increased accessibility in the past decade, there is an on-going need to identify optimal specifications for advanced technologies while minimizing potential sources of error. Herein, we discuss concerns raised by a joint American Academy of Clinical Neuropsychology/National Academy of Neuropsychology position paper. Moreover, we proffer parameters for the development and use of advanced technologies in neuropsychological assessments. We aim to first describe software and hardware configurations that can impact a computerized neuropsychological assessment. This is followed by a description of best practices for developers and practicing neuropsychologists to minimize error in neuropsychological assessments using advanced technologies. We also discuss the relevance of weighing potential computer error in light of possible errors associated with traditional testing. Throughout there is an emphasis on the need for developers to provide bench test results for their software's performance on various devices and minimum specifications (documented in manuals) for the hardware (e.g. computer, monitor, input devices) in the neuropsychologist's practice. Advances in computerized assessment platforms offer both opportunities and challenges. The challenges can appear daunting but are a manageable and require informed consumers who can appreciate the issues and ask pertinent questions in evaluating their options.

  7. Advance care planning for nursing home residents with dementia: Influence of 'we DECide' on policy and practice.

    PubMed

    Ampe, Sophie; Sevenants, Aline; Smets, Tinne; Declercq, Anja; Van Audenhove, Chantal

    2017-01-01

    (1) To pilot 'we DECide' in terms of influence on advance care planning policy and practice in nursing home dementia care units. (2) To investigate barriers and facilitators for implementing 'we DECide'. This was a pre-test-post-test study in 18 nursing homes. Measurements included: compliance with best practice of advance care planning policy (ACP-audit); advance care planning practice (ACP criteria: degree to which advance care planning was discussed, and OPTION scale: degree of involvement of residents and families in conversations). Advance care planning policy was significantly more compliant with best practice after 'we DECide'; policy in the control group was not. Advance care planning was not discussed more frequently, nor were residents and families involved to a higher degree in conversations after 'we DECide'. Barriers to realizing advance care planning included staff's limited responsibilities; facilitators included support by management staff, and involvement of the whole organization. 'We DECide' had a positive influence on advance care planning policy. Daily practice, however, did not change. Future studies should pay more attention to long-term implementation strategies. Long-term implementation of advance care planning requires involvement of the whole organization and a continuing support system for health care professionals. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  8. Advanced practice nurse entrepreneurs in a multidisciplinary surgical-assisting partnership.

    PubMed

    DeCarlo, Linda

    2005-09-01

    CHANGES IN THE HEALTH CARE environment and reimbursement practices are creating opportunities for nurse entrepreneurs to be partners with other professional nurses and physicians. Advanced practice nurses (APNs) who want to step into an entrepreneurial role must have strong clinical expertise, specific personal characteristics, interpersonal skills, and business acumen. ESTABLISHING A MULTIDISCIPLINARY partnership for providing surgical assisting services has many benefits and presents many challenges.

  9. Self-Assessment in Generalist Preservice Kindergarten Teachers' Education: Insights on Training, Ability, Environments, and Policies

    ERIC Educational Resources Information Center

    Koutsoupidou, Theano

    2010-01-01

    Self-assessment can play an important role in teachers' personal and professional development and is encouraged by educational programs worldwide. This article reports on a Greek study that aimed to investigate generalist preservice kindergarten teachers' self-assessment of their music teaching ability. One hundred participants were asked to…

  10. A System Approach to Advanced Practice Clinician Standardization and High Reliability.

    PubMed

    Okuno-Jones, Susan; Siehoff, Alice; Law, Jennifer; Juarez, Patricia

    Advanced practice clinicians (APCs) are an integral part of the health care team. Opportunities exist within Advocate Health Care to standardize and optimize APC practice across the system. To enhance the role and talents of APCs, an approach to role definition and optimization of practice and a structured approach to orientation and evaluation are shared. Although in the early stages of development, definition and standardization of accountabilities in a framework to support system changes are transforming the practice of APCs.

  11. The universal, collaborative and dynamic model of specialist and advanced nursing and midwifery practice: A way forward?

    PubMed

    O'Connor, Laserina; Casey, Mary; Smith, Rita; Fealy, Gerard M; Brien, Denise O'; O'Leary, Denise; Stokes, Diarmuid; McNamara, Martin S; Glasgow, Mary Ellen; Cashin, Andrew

    2018-03-01

    To inform and guide the development of a future model of specialist and advanced nursing and midwifery practice. There is a sizable body of empirical literature supporting the unique contributions of specialist and advanced practice roles to health care. However, there is very little international evidence to inform the integration of a future model for advanced or specialist practice in the Irish healthcare system. A qualitative study was conducted to initiate this important area of inquiry. Purposive sampling was used to generate a sample of informants (n = 15) for the interviews. Nurses and midwives working in specialist and advanced practice and participants from other areas such as legislative, regulatory, policy, medicine and education were included in the sampling frame. Arguments for a new model of specialist and advanced practice were voiced. A number of participants proposed that flexibility within specialist and advanced practitioner career pathways was essential. Otherwise, there existed the possibility of being directed into specialised "silos," precluding movement to another area of integrated practice. Future specialist and advanced practice education programmes need to include topics such as the development of emotional and political intelligence. The contribution of specialist and advanced practice roles to the health service includes providing rapid access to care, seamless patient flow across services, early discharge and lead coordinator of the patient's care trajectory. There was a recommendation of moving towards a universal model to cultivate specialist and advanced nurse and midwife practitioners. The model design has Universal application in a range of contexts "U." It is Collaborative in its inclusivity of all key stakeholders "C." The model is Dynamic pertinent to accommodating movement of nurses and midwives across health continua rather than plateauing in very specialised "silos" "D." © 2017 John Wiley & Sons Ltd.

  12. Social and structural conditions for the avoidance of advance care planning in neuro-oncology: a qualitative study

    PubMed Central

    Llewellyn, Henry; Neerkin, Jane; Thorne, Lewis; Wilson, Elena; Jones, Louise; Sampson, Elizabeth L; Townsley, Emma; Low, Joseph T S

    2018-01-01

    Background Primary brain tumours newly affect >260 000 people each year worldwide. In the UK, every year >10 000 people are diagnosed with a brain tumour while >5000 die annually from the disease. Prognoses are poor, cognitive deterioration common and patients have prolonged palliative needs. Advance care planning (ACP) may enable early discussion of future care decisions. Although a core commitment in the UK healthcare strategy, and the shared responsibility of clinical teams, ACP appears uncommon in practice. Evidence around ACP practice in neuro-oncology is limited. Objectives We aimed to elicit key social and structural conditions contributing to the avoidance of ACP in neuro-oncology. Design A cross-sectional qualitative study design was used. Setting One tertiary care hospital in the UK. Participants Fifteen healthcare professionals working in neuro-oncology participated in this study, including neuro-oncologists, neurosurgeons, clinical nurse specialists, allied healthcare professionals and a neurologist. Method Semi-structured interviews were conducted with participants to explore their assumptions and experiences of ACP. Data were analysed thematically using the well-established framework method. Results Participants recognised the importance of ACP but few had ever completed formal ACP documentation. We identified eight key factors, which we suggest comprise three main conditions for avoidance: (1) difficulties being a highly emotive, time-intensive practice requiring the right ‘window of opportunity’ and (2) presence and availability of others; (3) ambiguities in ACP definition, purpose and practice. Combined, these created a ‘culture of shared avoidance’. Conclusion In busy clinical environments, ‘shared responsibility’ is interpreted as ‘others’ responsibility’ laying the basis for a culture of avoidance. To address this, we suggest a ‘generalists and specialists’ model of ACP, wherein healthcare professionals undertake

  13. Writing an employer-focused resume for advanced practice nurses.

    PubMed

    Welton, Robert H

    2013-01-01

    The most important new trend in resumes is the employer-focused resume. Writing one is not difficult, but it requires a change in focus. The focus of this type of resume is on the needs of prospective employers. This new resume format allows applicants to describe to prospective employers what they can provide related to the employer's needs as opposed to a simple listing of their academic and work experiences without relation to the prospective new job. This article provides advanced practice nurses with sources to guide construction of informative text about their advanced practice nursing skills and competencies using language familiar to employers. Resumes and curriculum vitae formats are compared, and advice is provided on developing content for either format. Guidelines are provided about listing credentials, identifying clinical proficiencies from student clinical practicum, using qualification summaries rather than an objective statement, choosing references, and including essential components in a cover letter.

  14. Specialist and generalist symbionts show counterintuitive levels of genetic diversity and discordant demographic histories along the Florida Reef Tract

    NASA Astrophysics Data System (ADS)

    Titus, Benjamin M.; Daly, Marymegan

    2017-03-01

    Specialist and generalist life histories are expected to result in contrasting levels of genetic diversity at the population level, and symbioses are expected to lead to patterns that reflect a shared biogeographic history and co-diversification. We test these assumptions using mtDNA sequencing and a comparative phylogeographic approach for six co-occurring crustacean species that are symbiotic with sea anemones on western Atlantic coral reefs, yet vary in their host specificities: four are host specialists and two are host generalists. We first conducted species discovery analyses to delimit cryptic lineages, followed by classic population genetic diversity analyses for each delimited taxon, and then reconstructed the demographic history for each taxon using traditional summary statistics, Bayesian skyline plots, and approximate Bayesian computation to test for signatures of recent and concerted population expansion. The genetic diversity values recovered here contravene the expectations of the specialist-generalist variation hypothesis and classic population genetics theory; all specialist lineages had greater genetic diversity than generalists. Demography suggests recent population expansions in all taxa, although Bayesian skyline plots and approximate Bayesian computation suggest the timing and magnitude of these events were idiosyncratic. These results do not meet the a priori expectation of concordance among symbiotic taxa and suggest that intrinsic aspects of species biology may contribute more to phylogeographic history than extrinsic forces that shape whole communities. The recovery of two cryptic specialist lineages adds an additional layer of biodiversity to this symbiosis and contributes to an emerging pattern of cryptic speciation in the specialist taxa. Our results underscore the differences in the evolutionary processes acting on marine systems from the terrestrial processes that often drive theory. Finally, we continue to highlight the Florida Reef

  15. Expansion of cytochrome P450 and cathepsin genes in the generalist herbivore brown marmorated stink bug.

    PubMed

    Bansal, Raman; Michel, Andy

    2018-01-18

    The brown marmorated stink bug (Halyomorpha halys) is an invasive pest in North America which causes severe economic losses on tree fruits, ornamentals, vegetables, and field crops. The H. halys is an extreme generalist and this feeding behaviour may have been a major contributor behind its establishment and successful adaptation in invasive habitats of North America. To develop an understanding into the mechanism of H. halys' generalist herbivory, here we specifically focused on genes putatively facilitating its adaptation on diverse host plants. We generated over 142 million reads via sequencing eight RNA-Seq libraries, each representing an individual H. halys adult. The de novo assembly contained 79,855 high quality transcripts, totalling 39,600,178 bases. Following a comprehensive transcriptome analysis, H. halys had an expanded suite of cytochrome P450 and cathepsin-L genes compared to other insects. Detailed characterization of P450 genes from the CYP6 family, known for herbivore adaptation on host plants, strongly hinted towards H. halys-specific expansions involving gene duplications. In subsequent RT-PCR experiments, both P450 and cathepsin genes exhibited tissue-specific or distinct expression patterns which supported their principal roles of detoxification and/or digestion in a particular tissue. Our analysis into P450 and cathepsin genes in H. halys offers new insights into potential mechanisms for understanding generalist herbivory and adaptation success in invasive habitats. Additionally, the large-scale transcriptomic resource developed here provides highly useful data for gene discovery; functional, population and comparative genomics as well as efforts to assemble and annotate the H. halys genome.

  16. New parasitoid-predator associations: female parasitoids do not avoid competition with generalist predators when sharing invasive prey

    NASA Astrophysics Data System (ADS)

    Chailleux, Anaïs; Wajnberg, Eric; Zhou, Yuxiang; Amiens-Desneux, Edwige; Desneux, Nicolas

    2014-12-01

    Optimal habitat selection is essential for species survival in ecosystems, and interspecific competition is a key ecological mechanism for many observed species association patterns. Specialized animal species are commonly affected by resource and interference competition with generalist and/or omnivorous competitors, so avoidance behavior could be expected. We hypothesize that specialist species may exploit broad range cues from such potential resource competitors (i.e., cues possibly common to various generalist and/or omnivorous predators) to avoid costly competition regarding food or reproduction, even in new species associations. We tested this hypothesis by studying short-term interactions between a native larval parasitoid and a native generalist omnivorous predator recently sharing the same invasive host/prey, the leaf miner Tuta absoluta. We observed a strong negative effect of kleptoparasitism (food resource stealing) instead of classical intraguild predation on immature parasitoids. There was no evidence that parasitoid females avoided the omnivorous predator when searching for oviposition sites, although we studied both long- and short-range known detection mechanisms. Therefore, we conclude that broad range cue avoidance may not exist in our biological system, probably because it would lead to too much oviposition site avoidance which would not be an efficient and, thus, beneficial strategy. If confirmed in other parasitoids or specialist predators, our findings may have implications for population dynamics, especially in the current context of increasing invasive species and the resulting creation of many new species associations.

  17. On the night shift: advanced nurse practice in emergency medicine.

    PubMed

    Jenkins, Jennifer

    2016-05-01

    Advanced nurse practitioners in the author's emergency department (ED) work autonomously and as part of a team to assess, diagnose and treat patients with unexplained and undiagnosed illnesses and injuries over a 24-hour cycle of care. The complexity of the role in EDs is often not fully understood, and expectations can vary between trusts and between different clinical areas within trusts. This article describes one night shift in the author's ED to explain the complexity of advanced nurse practitioners' roles in this environment. The article focuses on autonomous decision-making skills and the use of advanced clinical skills in the context of evidence-based practice.

  18. Motivational interviewing: a valuable tool for the psychiatric advanced practice nurse.

    PubMed

    Karzenowski, Abby; Puskar, Kathy

    2011-01-01

    Motivational Interviewing (MI) is well known and respected by many health care professionals. Developed by Miller and Rollnick (2002) , it is a way to promote behavior change from within and resolve ambivalence. MI is individualized and is most commonly used in the psychiatric setting; it is a valuable tool for the Psychiatric Advanced Nurse Practice Nurse. There are many resources that talk about what MI is and the principles used to apply it. However, there is little information about how to incorporate MI into a clinical case. This article provides a summary of articles related to MI and discusses two case studies using MI and why advanced practice nurses should use MI with their patients.

  19. Advancing the practice of systems engineering at JPL

    NASA Technical Reports Server (NTRS)

    Jansma, Patti A.; Jones, Ross M.

    2006-01-01

    In FY 2004, JPL launched an initiative to improve the way it practices systems engineering. The Lab's senior management formed the Systems Engineering Advancement (SEA) Project in order to "significantly advance the practice and organizational capabilities of systems engineering at JPL on flight projects and ground support tasks." The scope of the SEA Project includes the systems engineering work performed in all three dimensions of a program, project, or task: 1. the full life-cycle, i.e., concept through end of operations 2. the full depth, i.e., Program, Project, System, Subsystem, Element (SE Levels 1 to 5) 3. the full technical scope, e.g., the flight, ground and launch systems, avionics, power, propulsion, telecommunications, thermal, etc. The initial focus of their efforts defined the following basic systems engineering functions at JPL: systems architecture, requirements management, interface definition, technical resource management, system design and analysis, system verification and validation, risk management, technical peer reviews, design process management and systems engineering task management, They also developed a list of highly valued personal behaviors of systems engineers, and are working to inculcate those behaviors into members of their systems engineering community. The SEA Project is developing products, services, and training to support managers and practitioners throughout the entire system lifecycle. As these are developed, each one needs to be systematically deployed. Hence, the SEA Project developed a deployment process that includes four aspects: infrastructure and operations, communication and outreach, education and training, and consulting support. In addition, the SEA Project has taken a proactive approach to organizational change management and customer relationship management - both concepts and approaches not usually invoked in an engineering environment. This paper'3 describes JPL's approach to advancing the practice of

  20. Advanced practice nursing for enduring health needs management: a global perspective.

    PubMed

    Koskinen, Liisa; Mikkonen, Irma; Graham, Iain; Norman, Linda D; Richardson, Jim; Savage, Eileen; Schorn, Mavis

    2012-07-01

    Advanced practice nursing expertise has been acknowledged worldwide as one response to the challenges arising from changes in society and health care. The roots of advanced practice nursing education are at the University of Colorado where the first known programme started in 1965. In many countries advanced practice nurses (APNs) have taken responsibility for routine patient care formerly carried out by physicians in order to reduce their workload. However, more and more, APNs have taken responsibility for new service areas and quality programmes not previously provided. Chronic disease management is one of these new service areas because long-term diseases are increasingly challenging service systems globally. This article is based on an international APN partnership. The aim of the article is to describe how the partnership will design a 15 ECTS credit course on Enduring Health Need Management as a cross-cultural collaborative endeavour. The adaptation of an inquiry based learning framework will be described drawing on four main principles of the theory: authentic learning communities; student encouragement in analysing gradually more complicated problems; networking in knowledge creation and; student engagement and activity. The cross-cultural online course aims to increase APNs' intercultural competence as well as their global and international work orientation. Copyright © 2011 Elsevier Ltd. All rights reserved.

  1. The sensory substrate of multimodal communication in brown-headed cowbirds: are females sensory 'specialists' or 'generalists'?

    PubMed

    Ronald, Kelly L; Sesterhenn, Timothy M; Fernandez-Juricic, Esteban; Lucas, Jeffrey R

    2017-11-01

    Many animals communicate with multimodal signals. While we have an understanding of multimodal signal production, we know relatively less about receiver filtering of multimodal signals and whether filtering capacity in one modality influences filtering in a second modality. Most multimodal signals contain a temporal element, such as change in frequency over time or a dynamic visual display. We examined the relationship in temporal resolution across two modalities to test whether females are (1) sensory 'specialists', where a trade-off exists between the sensory modalities, (2) sensory 'generalists', where a positive relationship exists between the modalities, or (3) whether no relationship exists between modalities. We used female brown-headed cowbirds (Molothrus ater) to investigate this question as males court females with an audiovisual display. We found a significant positive relationship between female visual and auditory temporal resolution, suggesting that females are sensory 'generalists'. Females appear to resolve information well across multiple modalities, which may select for males that signal their quality similarly across modalities.

  2. Advanced psychiatric nurse practitioners' ideas and needs for supervision in private practice in South Africa.

    PubMed

    Temane, Annie M; Poggenpoel, Marie; Myburgh, Chris P H

    2014-04-07

    Supervision forms an integral part of psychiatric nursing. The value of clinicalsupervision has been demonstrated widely in research. Despite efforts made toward advancedpsychiatric nursing, supervision seems to be non-existent in this field. The aim of this study was to explore and describe advanced psychiatric nursepractitioners' ideas and needs with regard to supervision in private practice in order tocontribute to the new efforts made in advanced psychiatric nursing in South Africa. A qualitative, descriptive, exploratory, and contextual design using a phenomenological approach as research method was utilised in this study. A purposive sampling was used. Eight advanced psychiatric nurse practitioners in private practice described their ideas and needs for supervision during phenomenological interviews. Tesch's method of open coding was utilised to analyse data. After data analysis the findings were recontextualised within literature. The data analysis generated the following themes - that the supervisor should have or possess: (a) professional competencies, (b) personal competencies and (c) specificfacilitative communication skills. The findings indicated that there was a need for supervision of advanced psychiatric nurse practitioners in private practice in South Africa. This study indicates that there is need for supervision and competent supervisors in private practice. Supervision can be beneficial with regard to developing a culture of support for advanced psychiatric practitioners in private practice and also psychiatric nurse practitioners.

  3. Experimental evidence that livestock grazing intensity affects the activity of a generalist predator

    NASA Astrophysics Data System (ADS)

    Villar, Nacho; Lambin, Xavier; Evans, Darren; Pakeman, Robin; Redpath, Steve

    2013-05-01

    Grazing by domestic ungulates has substantial impacts on ecosystem structure and composition. In grasslands of the northern hemisphere, livestock grazing limits populations of small mammals, which are a main food source for a variety of vertebrate predators. However, no experimental studies have described the impact of livestock grazing on vertebrate predators. We experimentally manipulated sheep and cattle grazing intensity in the Scottish uplands to test its impact on a relatively abundant small mammal, the field vole (Microtus agrestis), and its archetypal generalist predator, the red fox (Vulpes vulpes). We demonstrate that ungulate grazing had a strong consistent negative impact on both vole densities and indices of fox activity. Ungulate grazing did not substantially affect the relationship between fox activity and vole densities. However, the data suggested that, as grazing intensity increased i) fox activity indices tended to be higher when vole densities were low, and ii) the relationship between fox activity and vole density was weaker. All these patterns are surprising given the relative small scale of our experiment compared to large red fox territories in upland habitats of Britain, and suggest that domestic grazing intensity causes a strong response in the activity of generalist predators important for their conservation in grassland ecosystems.

  4. Are mountain habitats becoming more suitable for generalist than cold-adapted lizards thermoregulation?

    PubMed

    Ortega, Zaida; Mencía, Abraham; Pérez-Mellado, Valentín

    2016-01-01

    Mountain lizards are highly vulnerable to climate change, and the continuous warming of their habitats could be seriously threatening their survival. We aim to compare the thermal ecology and microhabitat selection of a mountain lizard, Iberolacerta galani, and a widely distributed lizard, Podarcis bocagei, in a montane area. Both species are currently in close syntopy in the study area, at 1,400 m above the sea level. We determined the precision, accuracy and effectiveness of thermoregulation, and the thermal quality of habitat for both species. We also compared the selection of thermal microhabitats between both species. Results show that I. galani is a cold-adapted thermal specialist with a preferred temperature range of 27.9-29.7 °C, while P. bocagei would be a thermal generalist, with a broader and higher preferred temperature range (30.1-34.5 °C). In addition, I. galani selects rocky substrates while P. bocagei selects warmer soil and leaf litter substrates. The thermal quality of the habitat is higher for P. bocagei than for I. galani. Finally, P. bocagei achieves a significantly higher effectiveness of thermoregulation (0.87) than I. galani (0.80). Therefore, these mountain habitat conditions seem currently more suitable for performance of thermophilic generalist lizards than for cold-specialist lizards.

  5. Are mountain habitats becoming more suitable for generalist than cold-adapted lizards thermoregulation?

    PubMed Central

    Mencía, Abraham; Pérez-Mellado, Valentín

    2016-01-01

    Mountain lizards are highly vulnerable to climate change, and the continuous warming of their habitats could be seriously threatening their survival. We aim to compare the thermal ecology and microhabitat selection of a mountain lizard, Iberolacerta galani, and a widely distributed lizard, Podarcis bocagei, in a montane area. Both species are currently in close syntopy in the study area, at 1,400 m above the sea level. We determined the precision, accuracy and effectiveness of thermoregulation, and the thermal quality of habitat for both species. We also compared the selection of thermal microhabitats between both species. Results show that I. galani is a cold-adapted thermal specialist with a preferred temperature range of 27.9–29.7 °C, while P. bocagei would be a thermal generalist, with a broader and higher preferred temperature range (30.1–34.5 °C). In addition, I. galani selects rocky substrates while P. bocagei selects warmer soil and leaf litter substrates. The thermal quality of the habitat is higher for P. bocagei than for I. galani. Finally, P. bocagei achieves a significantly higher effectiveness of thermoregulation (0.87) than I. galani (0.80). Therefore, these mountain habitat conditions seem currently more suitable for performance of thermophilic generalist lizards than for cold-specialist lizards. PMID:27280076

  6. Training Advanced Writing Skills: The Case for Deliberate Practice

    ERIC Educational Resources Information Center

    Kellogg, Ronald T.; Whiteford, Alison P.

    2009-01-01

    The development of advanced writing skills has been neglected in schools of the United States, with even some college graduates lacking the level of ability required in the workplace (National Commission on Writing, 2003, 2004). The core problem, we argue, is an insufficient degree of appropriate task practice distributed throughout the secondary…

  7. Management of advanced pancreatic cancer in daily clinical practice.

    PubMed

    Giuliani, Jacopo; Piacentini, Paolo; Bonetti, Andrea

    2016-01-01

    The aim of this outcome study was to evaluate the management of advanced pancreatic cancer in a real-world clinical practice; few such experiences have been reported in the literature. A retrospective analysis was performed of all consecutive patients with advanced pancreatic ductal adenocarcinoma followed at our medical oncology unit between January 2003 and December 2013. We evaluated 78 patients, mostly with metastatic disease (64.1%). Median follow-up was 10.77 months, by which time 74 patients (94.9%) had died. Median overall survival was 8.29 months. Median age was 67 years. In univariate analysis, pain at onset (p = 0.020), ECOG performance status (p<0.001), stage (p = 0.047), first-line chemotherapy (p<0.001), second-line chemotherapy (p<0.001) and weight loss at diagnosis (p = 0.029) were factors that had an impact on overall survival. In multivariate analysis, the presence of pain at onset (p = 0.043), stage (p = 0.003) and second-line chemotherapy (p = 0.004) were confirmed as independent prognostic factors. Our data, derived from daily clinical practice, confirmed advanced pancreatic cancer as an aggressive malignant disease with a very short expected survival. Second-line treatment seems to provide an advantage in terms of overall survival in patients who showed a partial response as their best response to first-line treatment.

  8. Advanced practice nursing in performing arts health care.

    PubMed

    Weslin, Anna T; Silva-Smith, Amy

    2010-06-01

    Performing arts medicine is a growing health care profession specializing in the needs of performing artists. As part of the performing arts venue, the dancer, a combination of athlete and artist, presents with unique health care needs requiring a more collaborative and holistic health care program. Currently there are relatively few advanced practice nurses (APNs) who specialize in performing arts health care. APNs, with focus on collaborative and holistic health care, are ideally suited to join other health care professionals in developing and implementing comprehensive health care programs for the performing artist. This article focuses on the dancer as the client in an APN practice that specializes in performing arts health care.

  9. Integrating Social Neuroscience and Social Work: Innovations for Advancing Practice-Based Research

    ERIC Educational Resources Information Center

    Matto, Holly C.; Strolin-Goltzman, Jessica

    2010-01-01

    Throughout the social work profession, there is ongoing interest in building a social science agenda that can address the complex practice-based questions faced by social work professionals today. Methodological innovations and unique funding opportunities have already significantly advanced research on social work practice. Still, there is…

  10. Building a Community of Collaborative Inquiry: A Pathway to Re-Imagining Practice in Health and Physical Education

    ERIC Educational Resources Information Center

    Petrie, Kirsten; Burrows, Lisette; Cosgriff, Marg

    2014-01-01

    On-going critiques of existing practices in primary schools focus on the ability of generalist teachers to deliver quality Health and Physical Education (HPE). As well, there are concerns regarding the influx of outsider providers in school spaces and the potentially damaging body pedagogies and practices that are pervading education settings. Our…

  11. [Advanced nursing practice: a must for the quality of care and mental health services].

    PubMed

    Ricard, Nicole; Page, Claire; Laflamme, France

    2014-01-01

    New professional legislation and reorganization of mental health services have had a significant influence on mental health nursing practice. Many nurses have demonstrated clinical leadership and have been able to adapt their services to the needs of the population specially in the primary health care setting. However, many believe that the role of nurses is not sufficiently known and optimally utilized in mental health services. In this article we take a critical look at the mental health nursing practice in Quebec and at the essential requirements for its development. This review aims to: 1) describe current trends in the changing roles and the modernization of mental health nursing practice in Quebec, 2) provide an overview of the development of advanced nursing practice and its impact on the quality of mental health services; 3) clarify the concept of advanced nursing practice and position its development in Quebec and 4) propose various strategies for optimizing the role of nurses and their complementarity with other professionals providing mental health services. This review presents innovative practices developed by nurses in the context of the restructuring of mental health services. For example, new nursing roles have been developed to improve the collaboration with general practitioners groups in primary care settings and facilitate the evaluation and monitoring of patient presenting medical and psychological problems. Another interesting innovation was set up by nurses in developing a new service to allow timely access to integrated care for patients with substance abuse and mental health problems. The various testimonies reported in this article illustrate the potential contribution of these nursing innovations in improving the mental health services in Quebec. Also, in few countries, the reform of mental health services has been a good time to recognize this potential. Thus, some countries have repositioned the role of mental health nurses and

  12. From pregnancy to palliative care: advancing professional midwifery practice?

    PubMed

    Peacock, Valerie; Price, Jayne; Nurse, Sharon

    2015-11-01

    Historically midwives may have not considered palliative care as a part of their professional role. Enhanced technologies and antenatal screening have broadened the boundaries of care. However do midwives truly embrace the philosophy of palliative care into their practice? This paper presents the discussion round a case study that demonstrates the evolving area of advanced practice: perinatal palliative care. What we highlight is that midwives in fact have an important collaborative role to play in ensuring that palliative care for the baby and family starts as soon as a life-limiting condition is recognised, thus ensuring best care and support are provided for those parents and families for whom pregnancy sadly leads to palliative care. Five key lessons for practice are outlined.

  13. Advanced nursing practice hours as part of endorsement requirements for nurse practitioners in Australia: a definitional conundrum.

    PubMed

    Scanlon, Andrew; Cashin, Andrew; Watson, Ngaire; Bryce, Julianne

    2012-11-01

    To define what can be considered to be nursing practice, time that can be calculated as the practice of nursing as well as what is considered to be advanced nursing practice and how all this can be related to the current endorsement process for nurse practitioner (NP) in Australia. Current codes and guidelines cited by the Nurse and Midwifery Board of Australia related to nursing practice and NPs, cited competency standards from the Australian Midwifery Accreditation Council, as well as published material of peak nursing bodies from within Australia as well as internationally were used. Information was also obtained through government health and professional organization websites. All information in the literature regarding current and past status and nomenclature of advanced practice nursing was considered relevant. The definitional entanglement of what is considered to be nursing practice, the calculation of specific hours and what is advanced nursing practice interferes with endorsement of NPs in Australia, and a clear understanding of what is meant by advanced practice is required to move forward. Dependent on how practice is interpreted by the Nurse and Midwifery Board of Australia directly affects the outcome of the endorsement proceedings for individual NP candidates. ©2012 The Author(s) Journal compilation ©2012 American Academy of Nurse Practitioners.

  14. Diversity and phenology of the generalist predator community in apple orchards of Central Washington State (insecta, araneae)

    USDA-ARS?s Scientific Manuscript database

    Predatory insects and spiders were collected from apple orchards in two geographic regions of Central Washington State to assess seasonal phenology and diversity of the generalist predator community. Arthropods were collected from orchard canopy every 3-7 d over two growing seasons (March-October) ...

  15. Building research capacity and productivity among advanced practice nurses: an evaluation of the Community of Practice model.

    PubMed

    Gullick, Janice G; West, Sandra H

    2016-03-01

    The aim of this study was to evaluate Wenger's Community of Practice as a framework for building research capacity and productivity. While research productivity is an expected domain in influential models of advanced nursing practice, internationally it remains largely unmet. Establishment of nursing research capacity precedes productivity and consequently, there is a strong imperative to identify successful capacity-building models for nursing-focussed research in busy clinical environments. Prospective, longitudinal, qualitative descriptive design was used in this study. Bruyn's participant observation framed evaluation of a Community of Practice comprising 25 advanced practice nurses. Data from focus groups, education evaluations, blog/email transcripts and field observations, collected between 2007 and 2014, were analysed using a qualitative descriptive method. The Community of Practice model invited differing levels of participation, allowed for evolution of the research community and created a rhythm of research-related interactions and enduring research relationships. Participants described the value of research for their patients and families and the significance of the developing research culture in providing richness to their practice and visibility of their work to multidisciplinary colleagues. Extensive examples of research dissemination and enrolment in doctoral programmes further confirmed this value. A Community of Practice framework is a powerful model enabling research capacity and productivity evidenced by publication. In developing a solid foundation for a nursing research culture, it should be recognized that research skills, confidence and growth develop over an extended period of time and success depends on skilled coordination and leadership. © 2015 John Wiley & Sons Ltd.

  16. Developing an advanced practice nurse-led liver clinic.

    PubMed

    McAfee, Jean L

    2012-01-01

    End-stage liver disease (ESLD) is a leading cause of digestive disease deaths in the United States and continues to increase exponentially every year. Best practice does not currently recognize or utilize a clinic practice model for ESLD management. Advanced practice registered nurses (APRNs) can impact ESLD disease management by implementing an outpatient clinic care model to focus on treatment compliance, patient education, improvement of patient outcomes, and reduction in hospital admission rates for ESLD patients. A review of 15 research articles was completed to determine the impact APRNs can make on chronic care of ESLD patients. Results from the review support APRN analysis, assessment, diagnosis, treatment, intervention, and evaluation of ESLD patients. The literature reviewed also demonstrates that ESLD patients have improved symptom management when maintained in an outpatient setting, allowing for decreased hospital and insurance expenditures. Following evaluation of the evidence, it was concluded that an APRN-led ESLD clinic merits further study.

  17. Advance directives in the UK: legal, ethical, and practical considerations for doctors.

    PubMed

    Kessel, A S; Meran, J

    1998-05-01

    In the United Kingdom (UK), advance directives have recently received considerable attention from professional and voluntary organizations as well as medical journals and the media. However, despite such exposure, many doctors remain uncertain of the importance or relevance of advance directives with regard to their own clinical practice. This paper addresses these uncertainties by first explaining what advance directives are and then describing the current legal status of such directives in the UK. Examination of the cases underpinning this status reveals several key elements: competence, information, anticipation, applicability, and freedom from duress. Each is discussed. Although this paper focuses on legal issues, it is important that medical law does not dominate medical ethics. Accordingly, the paper also discusses some important philosophical and sociological considerations that have remained largely unexplored in the medical press. Finally, the paper deals with practical matters, including how the general practitioner might be involved.

  18. Correlates of Teacher Practices Influencing Student Outcomes in Reading Instruction for Advanced Readers

    ERIC Educational Resources Information Center

    Hunsaker, Scott L.; Nielsen, Aubree; Bartlett, Brianne

    2010-01-01

    In a professional development project, six teaching practices were posited as necessary for improving affective and cognitive outcomes for identified advanced readers. These practices were identification, organization for instruction, content, instructional strategies, continuous improvement assessment, and ambassadorship. Sixty-one teachers…

  19. The role of advanced practice providers in pediatric otolaryngology academic practices.

    PubMed

    Reilly, Brian K; Brandon, Gretchen; Shah, Rahul; Preciado, Diego; Zalzal, George

    2013-01-01

    The goal of this study was to examine the roles of Physician Assistants (PAs) and Nurse Practitioners (NPs) in pediatric academic otolaryngology programs to provide a better understanding of their scope of practice, levels of autonomy, clinical duties, teaching opportunities and research participation. An anonymous web-based electronic survey tool was sent to all pediatric otolaryngology fellowship program directors in the United States. Nurse Practitioners and Physician Assistants are utilized in approximately 3 out of every 4 pediatric otolaryngology practices. The top three job activities of both the PA and NP were: (1) seeing patients independently, (2) working alongside doctors in clinic, and (3) answering phone lines/parental calls. A higher percentage of PAs (83%), worked alongside doctors in clinic, as compared to NPs, where only 55% work alongside MDs. Over half of PAs round with the in-patient team and see consults as compared to just over one third of NPs who participate in such activities. Twenty-five percent of practices reported that PAs cover call and assist in the OR. Most PAs/NPs saw between 11 and 15 patients per clinic which provides a clear productivity advantage when looking to screen patients, provide medical care, generate surgical cases, and maximize billings. NPs and PAs have complimentary skill sets ideal for the pediatric otolaryngology workplace, although job activities and "best fit" are hospital and practice dependent. Our study suggests that the use of PAs and NPs will continue to grow to meet increased demand for services in the field of pediatric otolaryngology. Employing advanced practice providers enables academic centers to improve access, provide additional financial remuneration, reduce wait times for new patients, and allow attending physicians to meet increased practice demands. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  20. Evidence-based use of electronic clinical tracking systems in advanced practice registered nurse education: an integrative review.

    PubMed

    Branstetter, M Laurie; Smith, Lynette S; Brooks, Andrea F

    2014-07-01

    Over the past decade, the federal government has mandated healthcare providers to incorporate electronic health records into practice by 2015. This technological update in healthcare documentation has generated a need for advanced practice RN programs to incorporate information technology into education. The National Organization of Nurse Practitioner Faculties created core competencies to guide program standards for advanced practice RN education. One core competency is Technology and Information Literacy. Educational programs are moving toward the utilization of electronic clinical tracking systems to capture students' clinical encounter data. The purpose of this integrative review was to evaluate current research on advanced practice RN students' documentation of clinical encounters utilizing electronic clinical tracking systems to meet advanced practice RN curriculum outcome goals in information technology as defined by the National Organization of Nurse Practitioner Faculties. The state of the science depicts student' and faculty attitudes, preferences, opinions, and data collections of students' clinical encounters. Although electronic clinical tracking systems were utilized to track students' clinical encounters, these systems have not been evaluated for meeting information technology core competency standards. Educational programs are utilizing electronic clinical tracking systems with limited evidence-based literature evaluating the ability of these systems to meet the core competencies in advanced practice RN programs.

  1. Full Practice Authority for Advanced Practice Registered Nurses is a Gender Issue

    PubMed

    Rudner Lugo, Nancy

    2016-05-04

    In the United States, Advanced Practice Registered Nurse (APRN) regulations are determined at the state level, through legislation and rule making. The lack of an evidence base to APRN regulation has resulted in a patchwork of varied regulations and requirements for nurse practitioners. The author begins this article by reviewing the history of the Equal Rights Amendment (ERA) in the United States and describing her study that assessed APRN fullpractice authority in states that ratified the ERA versus states that opposed it. She presents the study findings, limitations of the comparison, and discussion of the findings and implications. In conclusion, the findings demonstrated that progress toward full APRN practice will require building strategies for political support and framing the need to update APRN regulations in a manner that aligns with each state’s social and political values.

  2. The impact of a comprehensive course in advanced minimal access surgery on surgeon practice

    PubMed Central

    Birch MD, Daniel W.; MD, Cliff Sample; MD, Rohit Gupta

    2007-01-01

    Introduction Practising surgeons need an effective means for learning new skills and procedures in advanced minimal access surgery (MASA). Currently, available educational methods include traditional continuing medical education symposia (1-day courses), instructional videos, mentoring, or comprehensive courses that combine lectures, skills laboratories and live surgery. The impact of comprehensive courses in advanced MASA on surgeons' knowledge, skills and practice has not been clearly established. Methods We completed a survey of all physicians who attended comprehensive courses in advanced gastrointestinal MASA held at the Centre for Minimal Access Surgery (CMAS) in Hamilton, Ont. Results Of 158 course attendees, we received 65 responses (response rate 41%). Fifty-sex men and 9 women responded, with a mean age of 44.9 years and a mean practice duration of 12.3 years. Eighty-seven percent of respondents were community-based surgeons. As a result of attending CMAS courses, respondents felt they experienced a substantial improvement in the knowledge and skills required to complete MASA. After a comprehensive course at CMAS, most respondents reported that they had introduced MASA procedures into their practice. The mean overall impact of a course on a surgeon's practice (with respect to patient referrals, procedural armamentarium and personal satisfaction) was rated by respondents at 3.92 (standard deviation [SD] 0.71; Likert scale 1–5, 1=negative, 5=positive). Conclusions A comprehensive course in advanced MASA has a positive impact on attendees' knowledge and skills. Ultimately, surgeons attending MASA courses will begin to introduce new MASA procedures into surgical practice. These courses have a distinct role in the teaching of MASA to surgeons in practice. PMID:17391609

  3. Healthcare Provider Views on Transitioning From Task Shifting to Advanced Practice Nursing in Tanzania.

    PubMed

    Mboineki, Joanes Faustine; Zhang, Weihong

    The Tanzanian health sector suffers from shortages of healthcare workers as well as uneven distribution of healthcare workers in urban and rural areas. Task shifting-delegation of tasks from professionals to other healthcare team members with less training, such as medical attendants-is practiced, compromising quality of care. Advanced practice nursing is underutilized. The purpose of this study was to explore the views of nurses and physicians on current responses to shortages of healthcare workers and the potential for utilization of advanced practice nurses. A descriptive, qualitative design was used. Purposeful sampling was used to select 20 participants. An in-depth interview guide was used to obtain information. Interviews were conducted in Swahili or English. Content analysis was used to identify themes. Shortage of human resources in rural primary healthcare facilities was identified as a major rationale for implementation of the advanced practice nurse practitioner role because the current health providers in rural health facilities are less trained and doctors are not ready to work in these settings. Opposition from physicians is expected during the course of implementing the nurse practitioner role. Professional bodies and government should reach consensus before the implementation of this role in such a way that they should agree on scope and standards of practice of nurse practitioners in Tanzania. Shortage of human resources for health is greater in rural primary healthcare facilities. Task shifting in Tanzania is neither effective nor legally recognized. Transition to advanced practice nursing roles-particularly the nurse practitioner role-can facilitate provision of optimal care. Nurse practitioners should be prepared to work in rural primary healthcare facilities.

  4. Using advanced mobile devices in nursing practice--the views of nurses and nursing students.

    PubMed

    Johansson, Pauline; Petersson, Göran; Saveman, Britt-Inger; Nilsson, Gunilla

    2014-09-01

    Advanced mobile devices allow registered nurses and nursing students to keep up-to-date with expanding health-related knowledge but are rarely used in nursing in Sweden. This study aims at describing registered nurses' and nursing students' views regarding the use of advanced mobile devices in nursing practice. A cross-sectional study was completed in 2012; a total of 398 participants replied to a questionnaire, and descriptive statistics were applied. Results showed that the majority of the participants regarded an advanced mobile device to be useful, giving access to necessary information and also being useful in making notes, planning their work and saving time. Furthermore, the advanced mobile device was regarded to improve patient safety and the quality of care and to increase confidence. In order to continuously improve the safety and quality of health care, advanced mobile devices adjusted for nursing practice should be further developed, implemented and evaluated in research. © The Author(s) 2013.

  5. Specialists and generalists coexist within a population of spider-hunting mud dauber wasps

    PubMed Central

    Taylor, Lisa A.

    2017-01-01

    Abstract Individual foraging specialization describes the phenomenon where conspecifics within a population of generalists exhibit differences in foraging behavior, each specializing on different prey types. Individual specialization is widespread in animals, yet is understudied in invertebrates, despite potential impacts to food web and population dynamics. Sceliphron caementarium (Hymenoptera: Sphecidae) is an excellent system to examine individual specialization. Females of these mud dauber wasps capture and paralyze spiders which they store in mud nests to provision their offspring. Individuals may make hundreds of prey choices in their short lifespan and fully intact prey items can be easily excavated from their mud nests, where each distinct nest cell represents a discrete foraging bout. Using data collected from a single population of S. caementarium (where all individuals had access to the same resources), we found evidence of strong individual specialization; individuals utilized different resources (with respect to prey taxa, prey ecological guild, and prey size) to provision their nests. The extent of individual specialization differed widely within the population with some females displaying extreme specialization (taking only prey from a single species) while others were generalists (taking prey from up to 6 spider families). We also found evidence of temporal consistency in individual specialization over multiple foraging events. We discuss these findings broadly in the context of search images, responses to changing prey availability, and intraspecific competition pressure. PMID:29622922

  6. Energy Therapies in Advanced Practice Oncology: An Evidence-Informed Practice Approach

    PubMed Central

    Potter, Pamela J.

    2013-01-01

    Advanced practitioners in oncology want patients to receive state-of-the-art care and support for their healing process. Evidence-informed practice (EIP), an approach to evaluating evidence for clinical practice, considers the varieties of evidence in the context of patient preference and condition as well as practitioner knowledge and experience. This article offers an EIP approach to energy therapies, namely, Therapeutic Touch (TT), Healing Touch (HT), and Reiki, as supportive interventions in cancer care; a description of the author’s professional experience with TT, HT, and Reiki in practice and research; an overview of the three energy healing modalities; a review of nine clinical studies related to oncology; and recommendations for EIP. These studies demonstrate a response to previous research design critiques. Findings indicate a positive benefit for oncology patients in the realms of pain, quality of life, fatigue, health function, and mood. Directionality of healing in immune response and cell line studies affirms the usual explanation that these therapies bring harmony and balance to the system in the direction of health. Foremost, the research literature demonstrates the safety of these therapies. In order to consider the varieties of evidence for TT, HT, and Reiki, EIP requires a qualitative examination of patient experiences with these modalities, exploration of where these modalities have been integrated into cancer care and how the practice works in the oncology setting, and discovery of the impact of implementation on provider practice and self-care. Next steps toward EIP require fleshing out the experience of these modalities by patients and health-care providers in the oncology care setting. PMID:25031994

  7. Collaborative communication: learning from advanced clinical practice patient consultations.

    PubMed

    Barratt, Julian

    2018-04-28

    Advanced nurse practitioners, and nurses aspiring to this role, are required to understand how to communicate effectively and on a collaborative basis with patients and carers during consultations, with the aim of enhancing patient outcomes such as improved patient satisfaction, ability to self-manage healthcare needs and adherence to care plans. This article explores collaborative communication in consultations and how best to achieve this, using the author's doctoral observational research based on the findings of a mixed methods observational study of communication in advanced clinical practice patient consultations. ©2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

  8. Herbivore Preference for Native vs. Exotic Plants: Generalist Herbivores from Multiple Continents Prefer Exotic Plants That Are Evolutionarily Naïve

    PubMed Central

    Morrison, Wendy E.; Hay, Mark E.

    2011-01-01

    Enemy release and biotic resistance are competing, but not mutually exclusive, hypotheses addressing the success or failure of non-native plants entering a new region. Enemy release predicts that exotic plants become invasive by escaping their co-adapted herbivores and by being unrecognized or unpalatable to native herbivores that have not been selected to consume them. In contrast, biotic resistance predicts that native generalist herbivores will suppress exotic plants that will not have been selected to deter these herbivores. We tested these hypotheses using five generalist herbivores from North or South America and nine confamilial pairs of native and exotic aquatic plants. Four of five herbivores showed 2.4–17.3 fold preferences for exotic over native plants. Three species of South American apple snails (Pomacea sp.) preferred North American over South American macrophytes, while a North American crayfish Procambarus spiculifer preferred South American, Asian, and Australian macrophytes over North American relatives. Apple snails have their center of diversity in South America, but a single species (Pomacea paludosa) occurs in North America. This species, with a South American lineage but a North American distribution, did not differentiate between South American and North American plants. Its preferences correlated with preferences of its South American relatives rather than with preferences of the North American crayfish, consistent with evolutionary inertia due to its South American lineage. Tests of plant traits indicated that the crayfish responded primarily to plant structure, the apple snails primarily to plant chemistry, and that plant protein concentration played no detectable role. Generalist herbivores preferred non-native plants, suggesting that intact guilds of native, generalist herbivores may provide biotic resistance to plant invasions. Past invasions may have been facilitated by removal of native herbivores, introduction of non

  9. 'Feeling someone is there for you' - experiences of women with vulvar neoplasia with care delivered by an Advanced Practice Nurse.

    PubMed

    Kobleder, Andrea; Mayer, Hanna; Senn, Beate

    2017-02-01

    To explore the experiences of women with vulvar neoplasia with care delivered by an Advanced Practice Nurse. Women with vulvar neoplasia suffer from a high number of symptoms and report a lack of information and support by health care professionals. Further, talking about their disease, which is still a social taboo, is difficult for them. From approaches for other patients, it can be suggested that support from an Advanced Practice Nurse can be helpful. For Advanced Practice Nurse development, implementation and evaluation, it is important to assess patients' perceptions. But so far, little is known about how patients with vulvar neoplasia experience support of an Advanced Practice Nurse. A qualitative interview study was chosen to gain understanding of the experience of women with vulvar neoplasia who received care delivered by an Advanced Practice Nurse. Narrative interviews were conducted with a purposive sample of 13 women with vulvar neoplasia after they received care from an Advanced Practice Nurse for six months. Thematic analysis was used to analyse the data from the interviews. Four main themes could be identified: a trusting relationship; accessibility; feeling safe and secure; and feeling someone is there for you. Women felt more secure and less alone in the experience of their illness through having the possibility of contacting an Advanced Practice Nurse and getting sufficient information and psychosocial support. Women with vulvar neoplasia experienced care delivered by an Advanced Practice Nurse as 'feeling someone is there for you'. Due to the localisation of the disease and the associated social taboo, psychosocial support from the Advanced Practice Nurse beyond months after surgery was very important for them. Addressing psychosocial needs in caring for women with vulvar neoplasia must be given greater attention in clinical practice. Further, continuous nursing support delivered by an Advanced Practice Nurse beyond the acute treatment phase can

  10. Advancing Empirical Scholarship to Further Develop Evaluation Theory and Practice

    ERIC Educational Resources Information Center

    Christie, Christina A.

    2011-01-01

    Good theory development is grounded in empirical inquiry. In the context of educational evaluation, the development of empirically grounded theory has important benefits for the field and the practitioner. In particular, a shift to empirically derived theory will assist in advancing more systematic and contextually relevant evaluation practice, as…

  11. Advancing Work Practices: Rethinking Online Professional Development in the Context of the Intervention-Based Sustainable Change

    ERIC Educational Resources Information Center

    Noesgaard, Signe Schack

    2016-01-01

    Purpose: The paper aims to discuss the effectiveness of e-Learning in advancing work practices. The paper investigates the assumption that e-Learning is as effective as face-to-face interventions when stimulating change. It also examines the assumption that well-designed and well-executed instructional interventions will advance work practices.…

  12. Technology and Early Science Education: Examining Generalist Primary School Teachers' Views on Tacit Knowledge Assessment Tools

    ERIC Educational Resources Information Center

    Hast, Michael

    2017-01-01

    For some time a central issue has occupied early science education discussions--primary student classroom experiences and the resulting attitudes towards science. This has in part been linked to generalist teachers' own knowledge of science topics and pedagogical confidence. Recent research in cognitive development has examined the role of…

  13. Litter chemistry, community shift, and non-additive effects drive litter decomposition changes following invasion by a generalist pathogen

    Treesearch

    Richard C. Cobb; David M. Rizzo

    2016-01-01

    Forest pathogens have strong potential to shape ecosystem function by altering litterfall, microclimate, and changing community structure. We quantified changes in litter decomposition from a set of distinct diseases caused by Phytophthora ramorum, an exotic generalist pathogen. Phytophthora ramorum causes leaf blight and...

  14. Pregnancy After Bariatric Surgery: National Survey of Obstetrician's Comfort, Knowledge, and Practice Patterns.

    PubMed

    Smid, Marcela C; Dotters-Katz, Sarah K; Mcelwain, Cora-Ann; Volckmann, Eric T; Schulkin, Jay; Stuebe, Alison M

    2017-09-01

    The objective of this study is to survey a nationally representative sample of obstetricians regarding comfort, knowledge, and practice patterns of caring for pregnant women after bariatric surgery. We conducted an online survey of US obstetricians and describe obstetrician's demographics, practice settings, and practice patterns. We assessed respondent's knowledge and recommended practices. We compared provider knowledge by years since completing residency, scope of practice (generalist or specialist), and practice setting (academic setting or other). Statistical significance was set at p < 0.05. A total of 106 completed the survey (response rate of 54%). Respondents had a median age of 47 and median 17 years in practice. Sixty-two percent were generalists. Nearly all of the respondents (94%) had some experience with caring for pregnant women after bariatric surgery and 83% reported feeling "very comfortable" (48%) or "somewhat comfortable" (35%) providing care for this population. Most (74%) were aware of increased risk of small for gestational age after surgery. Only 13% were able to correctly identify all recommended nutritional labs and 20% reported that they "did not know" which labs are recommended. There were no differences in comfort, experience, knowledge, and practice patterns by physician characteristics and practice settings. While most obstetricians are aware of perinatal risks after bariatric surgery, a substantial percentage of obstetricians are unaware of recommended practices regarding nutrition and nutritional monitoring. As bariatric surgery becomes increasingly prevalent among reproductive age women, educational interventions to increase obstetricians' knowledge of optimal care of pregnant women after bariatric surgery are urgently needed.

  15. An American and Dutch partnership for psychiatric mental health advance nursing practice: nurturing a relationship across the ocean.

    PubMed

    Maas, Lillian; Ezeobele, I Ezebuiro; Tetteroo, Marieke

    2012-07-01

    The purpose of this article is to discuss the challenges and rewards of developing and nurturing an international clinical psychiatric mental health advanced nursing practice exchange between the Netherlands and the United States. Since 1997, Rotterdam University of Applied Sciences in the Netherlands has been participating in international clinical experiences for their psychiatric mental health (PMH) advanced practice nursing students. The international experience is mandatory prior to graduation and is the first of its kind in Europe to mandate such a unique experience. This study sample included eight Dutch PMH advanced practice nursing students enrolled in a full-time master's in advanced nursing practice program. The descriptive study included reflective reports and one-on-one discussions over a 3-year period. With proper planning, an international nursing experience provides a unique opportunity for nurses to think beyond their own culture and healthcare system. Solving problems together through different perspectives creates opportunities for creative solutions. International partnerships within PMH advanced practice nursing promotes sharing of knowledge and solutions as patients and diseases have no border. © 2011 Wiley Periodicals, Inc.

  16. A Pilot of a Gerontological Advanced Practice Nurse Preventive Intervention

    ERIC Educational Resources Information Center

    Hahn, Joan Earle; Aronow, Harriet Udin

    2005-01-01

    Background: Persons with an intellectual and developmental disability frequently face barriers in accessing preventive services in community-based health care systems. As they age into middle years, they are at increased risk for functional decline. This paper presents a description of an advanced practice nurse (APN) intervention used in a pilot…

  17. Novel Concordance Between Geographic, Environmental, and Genetic Structure in the Ecological Generalist Prickly Sculpin (Cottus asper) in California.

    PubMed

    Baumsteiger, Jason; Kinziger, Andrew P; Aguilar, Andres

    2016-11-01

    Ecological generalists may contain a wealth of information concerning diversity, ecology, and geographic connectivity throughout their range. We explored these ideas in prickly sculpin (Cottus asper), a small generalist freshwater fish species where coastal forms have potentially undergone radiations into inland lacustrine and riverine environments. Using a 962bp cytochrome b mtDNA marker and 11 microsatellites, we estimated diversity, divergence times, gene flow, and structure among populations at 43 locations throughout California. We then incorporated genetic and GIS data into ecological niche models to assess ecological conditions within identified groups. Though not reciprocally monophyletic, unique mtDNA haplotypes, microsatellite clustering, and measures of isolation by distance (Coastal: r = 0.960, P < 0.001; Inland: r = 0.277, P = 0.148) suggest 2 novel taxonomic groups, Coastal and Inland (constrained to Great Central Valley). Divergence estimates of 41-191 kya combined with the regional biogeographic history suggest geographic barriers are absent between groups since divergence, but ecological niche modeling revealed significant environmental differences (t = 10.84, P < 0.001). Introgressed individuals were also discovered between groups in an ecologically and geographically intermediate region. Population structure was limited, predominately found in tributaries of the San Joaquin basin in the Inland group. Overall, C. asper exhibited substantial genetic diversity, despite its ecological generality, reflecting California's historically unique and complex hydrology. More broadly, this study illustrates variable environments within the range of a generalist species may mask genetic divergences and should not be overlooked in biodiversity assessments. © The American Genetic Association 2016. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  18. Not Musical? Identity Perceptions of Generalist Primary School Teachers in Relation to Classroom Music Teaching in England

    ERIC Educational Resources Information Center

    Stunell, Gillian

    2010-01-01

    In the author's years working as a music specialist in English primary schools she encountered confident, experienced, professional teachers who expressed anxiety about teaching music in the National Curriculum. A number of generalist teachers seemed to believe that they were not competent to teach music to their classes, since they perceived…

  19. Survey of advanced practice registered nurses disciplinary action.

    PubMed

    Hudspeth, Randall

    2007-04-02

    The nursing profession continues to struggle to find the most appropriate approach to credentialing Advanced Practice Registered Nurses (APRNs). One early step in addressing this struggle is determining the incidence of APRN disciplinary actions by boards of nursing. This article presents data from 2003 and 2004 describing the incidence of APRN disciplinary actions by United States boards of nursing. Fifty-one boards of nursing, all members of the National Council of State Boards of Nursing, were asked to report the numbers of APRN discipline cases for 2003 and 2004 which had been resolved, using a tool that differentiated disciplinary cases into four data categories: chemical impairment, exceeding scope of practice, unprofessional conduct, and safety or abuse of patients. Thirty-eight (74.5%) of 51 boards of nursing reported discipline data for a total of 125,882 APRNs showing 688 disciplinary actions were taken during 2003 and 2004. This indicates that APRNs experience a low incidence of discipline related to chemical impairment, exceeding scope of practice, unprofessional conduct, and safety or abuse of patients.

  20. Evidence for a Common Toolbox Based on Necrotrophy in a Fungal Lineage Spanning Necrotrophs, Biotrophs, Endophytes, Host Generalists and Specialists

    PubMed Central

    Andrew, Marion; Barua, Reeta; Short, Steven M.; Kohn, Linda M.

    2012-01-01

    The Sclerotiniaceae (Ascomycotina, Leotiomycetes) is a relatively recently evolved lineage of necrotrophic host generalists, and necrotrophic or biotrophic host specialists, some latent or symptomless. We hypothesized that they inherited a basic toolbox of genes for plant symbiosis from their common ancestor. Maintenance and evolutionary diversification of symbiosis could require selection on toolbox genes or on timing and magnitude of gene expression. The genes studied were chosen because their products have been previously investigated as pathogenicity factors in the Sclerotiniaceae. They encode proteins associated with cell wall degradation: acid protease 1 (acp1), aspartyl protease (asps), and polygalacturonases (pg1, pg3, pg5, pg6), and the oxalic acid (OA) pathway: a zinc finger transcription factor (pac1), and oxaloacetate acetylhydrolase (oah), catalyst in OA production, essential for full symptom production in Sclerotinia sclerotiorum. Site-specific likelihood analyses provided evidence for purifying selection in all 8 pathogenicity-related genes. Consistent with an evolutionary arms race model, positive selection was detected in 5 of 8 genes. Only generalists produced large, proliferating disease lesions on excised Arabidopsis thaliana leaves and oxalic acid by 72 hours in vitro. In planta expression of oah was 10–300 times greater among the necrotrophic host generalists than necrotrophic and biotrophic host specialists; pac1 was not differentially expressed. Ability to amplify 6/8 pathogenicity related genes and produce oxalic acid in all genera are consistent with the common toolbox hypothesis for this gene sample. That our data did not distinguish biotrophs from necrotrophs is consistent with 1) a common toolbox based on necrotrophy and 2) the most conservative interpretation of the 3-locus housekeeping gene phylogeny – a baseline of necrotrophy from which forms of biotrophy emerged at least twice. Early oah overexpression likely expands the host

  1. Challenges to implementation of advance directives of will in hospital practice.

    PubMed

    Cogo, Silvana Bastos; Lunardi, Valéria Lerch; Quintana, Alberto Manuel; Girardon-Perlini, Nara Marilene Oliveira; Silveira, Rosemary Silva da

    2016-01-01

    to understand the difficulties and limitations in the implementation of advance directives of will in the hospital context. qualitative, exploratory and descriptive study conducted by means of semi-structured interviews with nurses, resident physicians and family caregivers. The data were analyzed by using discursive textual analysis based on the framework of bioethics principles. the following categories emerged: Terminality as an expression of loss and cure as an option for care; concerns about legal implications; advance directives of will demand patient autonomy and proper communication. limitations and difficulties in practice of advance directives of will from the perspective of the participants show, apart from countless conflicts and dilemmas regarding end-of life matters, that impending death experiences obstruct patients' wishes.

  2. Management of treatment-related toxicities in advanced medullary thyroid cancer.

    PubMed

    Brose, Marcia S; Bible, Keith C; Chow, Laura Q M; Gilbert, Jill; Grande, Carolyn; Worden, Francis; Haddad, Robert

    2018-05-01

    Progress in the treatment of advanced medullary thyroid cancer (MTC) has resulted from the approval of 2 drugs within the past 5 years, vandetanib and cabozantinib. These multikinase inhibitors (MKIs) possess overlapping specificities for multiple kinase targets implicated in the progression of MTC. Both drugs are associated with toxicities, including hypertension, hemorrhage/perforation, diarrhea and other gastrointestinal events, several dermatologic events, and hypothyroidism. In addition, vandetanib is uniquely associated with QTc prolongation through interaction with myocardial potassium channels, and cabozantinib is uniquely associated with hand-foot skin reaction. Treatment-related toxicities occur frequently and can be severe or life-threatening, and patients undergoing long-term treatment will likely experience adverse events (AEs). Here we offer specific practical recommendations for managing AEs commonly occurring with vandetanib and cabozantinib. The recommended approach relies on early recognition and palliation of symptoms, dose interruption, and dose reduction as necessary in order for the patient to maintain the highest tolerable dose for as long as possible and optimal quality of life. Treatment guidelines do not specify a recommended sequence for treating with vandetanib and cabozantinib; however, most patients will receive both drugs during their lifetime. The choice for first-line therapy is individualized after a risk-benefit assessment and depends on physician preference and patient-related factors, such as comorbid conditions. Because most generalist practices may not be familiar with the intricacies of agents such as vandetanib and cabozantinib, we commend that patients with advanced MTC be managed and treated by a thyroid cancer specialist with coordination of care within a multidisciplinary team. Copyright © 2018. Published by Elsevier Ltd.

  3. Documenting Student Engagement Using an Intention/Reflection Exercise during an Advanced Pharmacy Practice Experience

    ERIC Educational Resources Information Center

    Fierke, Kerry K.; Lepp, Gardner A.

    2015-01-01

    The article shares the outcomes of a practice called Intention/Reflection (I/R) when applied to a group of ten students in a five-week course involving an international advanced pharmacy practice experience. Developed by the authors and founded on a combination of theoretical principles, this practice is unique because of the blend of formative…

  4. Advanced and specialist nursing practice: attitudes of nurses and physicians in Israel.

    PubMed

    Brodsky, Eithan; Van Dijk, Dina

    2008-01-01

    With the introduction of new and advanced nursing roles, the nursing profession is undergoing dynamic change. Realizing changes will be easier to accomplish if the nursing community and other healthcare professionals welcome the process. Recently the nursing staff mix in Israel has been undergoing a transformation: encouraging registered nurses to enhance their status by acquiring academic degrees and advanced professional training, and initiating the adoption of new nursing roles. Our goal is to evaluate Israeli nurses' and physicians' attitudes to the introduction of new nursing roles and to expanding the scope of nursing practice. Two hundred and fifteen nurses and 110 physicians from three large general hospitals and 15 community clinics filled in a questionnaire. In general the majority of the nurses supported expansion of nursing practice, and such expansion did not cause significant opposition among physicians. However when the task affected patients' health, physicians were less willing to permit nurses to perform skills previously their responsibility alone. In addition, using multiple logistic regressions, support of the expansion of nursing practice was significantly higher among nurses in management or training positions, and among academically accredited nurses. Support for expanded roles was prominent among hospital physicians, graduates from Israeli schools of medicine, and less-tenured physicians. We suggest that confirmation by various groups of physicians and nurses of standardized definitions of the new boundaries in the scope of nursing practice roles could successfully promote development of new roles and facilitate integration of the Israeli healthcare system into the global context of change. Inter- and intra-professional collaboration, agreement, and understanding regarding advanced nursing practice roles and their introduction into the healthcare system might improve the relationship between healthcare professions and ultimately increase

  5. Do patients discharged from advanced practice physiotherapy-led clinics re-present to specialist medical services?

    PubMed

    Chang, Angela T; Gavaghan, Belinda; O'Leary, Shaun; McBride, Liza-Jane; Raymer, Maree

    2017-05-15

    Objective The aim of the present study was to determine the rates of re-referral to specialist out-patient clinics for patients previously managed and discharged from an advanced practice physiotherapy-led service in three metropolitan hospitals. Methods A retrospective audit was undertaken of 462 patient cases with non-urgent musculoskeletal conditions discharged between 1 April 2014 and 30 March 2015 from three metropolitan hospitals. These patients had been discharged from the physiotherapy-led service without requiring specialist medical review. Rates and patterns of re-referral to specialist orthopaedic, neurosurgical, chronic pain, or rheumatology services within 12 months of discharge were investigated. Results Forty-six of the 462 patients (10.0%) who were managed by the physiotherapy-led service were re-referred to specialist medical orthopaedic, neurosurgical, chronic pain or rheumatology departments within 12 months of discharge. Only 22 of these patients (4.8%) were re-referred for the same condition as managed previously and discharged. Conclusions Ninety-five per cent of patients with non-urgent musculoskeletal conditions managed by an advanced practice physiotherapy-led service at three metropolitan hospitals did not re-present to access public specialist medical services for the same condition within 12 months of discharge. This is the first time that re-presentation rates have been reported for patients managed in advanced practice physiotherapy services and the findings support the effectiveness of these models of care in managing demand for speciality out-patient services. What is known about the topic? Advanced practice physiotherapy-led services have been implemented to address the needs of patients referred with non-urgent musculoskeletal conditions to hospital specialist out-patient services. Although this model is widely used in Australia, there has been very little information about whether patients managed in these services subsequently re

  6. Implementation strategy for advanced practice nursing in primary health care in Latin America and the Caribbean.

    PubMed

    Oldenburger, David; De Bortoli Cassiani, Silvia Helena; Bryant-Lukosius, Denise; Valaitis, Ruta Kristina; Baumann, Andrea; Pulcini, Joyce; Martin-Misener, Ruth

    2017-06-08

    SYNOPSIS Advanced practice nursing (APN) is a term used to describe a variety of possible nursing roles operating at an advanced level of practice. Historically, APN roles haves evolved informally, out of the need to improve access to health care services for at-risk and disadvantaged populations and for those living in underserved rural and remote communities. To address health needs, especially ones related to primary health care, nurses acquired additional skills through practice experience, and over time they developed an expanded scope of practice. More recently, APN roles have been developed more formally through the establishment of graduate education programs to meet agreed-upon competencies and standards for practice. The introduction of APN roles is expected to advance primary health care throughout Latin America and the Caribbean, where few such roles exist. The purpose of the paper is to outline an implementation strategy to guide and support the introduction of primary health care APN roles in Latin America and the Caribbean. The strategy includes the adaptation of an existing framework, utilization of recent research evidence, and application of knowledge from experts on APN and primary health care. The strategy consists of nine steps. Each step includes a national perspective that focuses on direct country involvement in health workforce planning and development and on implementation. In addition, each step incorporates an international perspective on encouraging countries that have established APN programs and positions to collaborate in health workforce development with nations without advanced practice nursing.

  7. Gender Creative or Transgender Youth and Advanced Nursing Practice.

    PubMed

    Kirouac, Nicole; Tan, Mabel

    2017-06-01

    The World Professional Association for Transgender Health (WPATH) defines gender dysphoria as "Discomfort or distress that is caused by a discrepancy between a person's gender identity and that person's sex assigned at birth (and the associated gender role and/or primary and secondary sex characteristics)" (WPATH, 2016). Gender creative (GC) and transgender (TG) youth are at high risk for severe mental health disparities if they don't receive competent and timely gender transitioning care. Although awareness and early care of TG youth in specialty clinics is improving and increasing, there is still much effort that is required to eliminate barriers to care at many levels and thus improve outcomes. Nurses, particularly advanced practice nurses, are poised to lead the way in creating safe, inclusive, family centered spaces for TG and GC children, youth and their families as well as acting as vital mentors for other nurses. The purpose of this paper is to discuss the increasing prevalence of GC and TG youth, the significance of inclusive care for GC and TG youth, treatment guidelines, and the impact parents and advanced practice nurses can have on the journey of these youth as they explore and find their place on the gender spectrum. Copyright© of YS Medical Media ltd.

  8. Disease Dynamics in Ants: A Critical Review of the Ecological Relevance of Using Generalist Fungi to Study Infections in Insect Societies.

    PubMed

    Loreto, R G; Hughes, D P

    2016-01-01

    It is assumed that social life can lead to the rapid spread of infectious diseases and outbreaks. In ants, disease outbreaks are rare and the expression of collective behaviors is invoked to explain the absence of epidemics in natural populations. Here, we address the ecological approach employed by many studies that have notably focused (89% of the studies) on two genera of generalist fungal parasites (Beauveria and Metarhizium). We ask whether these are the most representative models to study the evolutionary ecology of ant-fungal parasite interactions. To assess this, we critically examine the literature on ants and their interactions with fungal parasites from the past 114years (1900-2014). We discuss how current evolutionary ecology approaches emerged from studies focused on the biological control of pest ants. We also analyzed the ecological relevance of the laboratory protocols used in evolutionary ecology studies employing generalist parasites, as well as the rare natural occurrence of these parasites on ants. After a detailed consideration of all the publications, we suggest that using generalist pathogens such as Beauveria and Metarhizium is not an optimal approach if the goal is to study the evolutionary ecology of disease in ants. We conclude by advocating for approaches that incorporate greater realism. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Advancing the practice of health impact assessment in Canada: Obstacles and opportunities

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    McCallum, Lindsay C., E-mail: lindsay.mccallum@mail.utoronto.ca; Intrinsik Environmental Sciences Inc., 6605 Hurontario Street, Mississauga, Ontario L5T0A3; Ollson, Christopher A., E-mail: collson@intrinsik.com

    Health Impact Assessment (HIA) is recognized as a useful tool that can identify potential health impacts resulting from projects or policy initiatives. Although HIA has become an established practice in some countries, it is not yet an established practice in Canada. In order to enable broader support for HIA, this study provides a comprehensive review and analysis of the peer-reviewed and gray literature on the state of HIA practice. The results of this review revealed that, although there is an abundance of publications relating to HIA, there remains a lack of transparent, consistent and reproducible approaches and methods throughout themore » process. Findings indicate a need for further research and development on a number of fronts, including: 1) the nature of HIA triggers; 2) consistent scoping and stakeholder engagement approaches; 3) use of evidence and transparency of decision-making; 4) reproducibility of assessment methods; 5) monitoring and evaluation protocols; and, 6) integration within existing regulatory frameworks. Addressing these issues will aid in advancing the more widespread use of HIA in Canada. - Highlights: • Reviewed current state of practice in the field of HIA • Identified key obstacles and opportunities for HIA advancement • Major issues include lack of consistent approach and methodology. • No national regulatory driver hinders opportunity for widespread use of HIA. • Identified research opportunities vital to developing HIA practice in Canada.« less

  10. Advanced Critical Care Practitioners - Practical experience of implementing the Advanced Critical Care Practitioner Faculty of Intensive Care Medicine Curriculum in a London Critical Care Unit.

    PubMed

    Lee, Geraldine; Gilroy, Jo-Anne; Ritchie, Alistair; Grover, Vimal; Gull, Keetje; Gruber, Pascale

    2018-05-01

    With a chronic shortage of doctors in intensive care, alternative roles are being explored. One of these is the role of the Advanced Critical Care Practitioner. The Advanced Critical Care Practitioner Curriculum was developed by the Faculty of Intensive Care Medicine and is used to provide a structured programme of training. The Advanced Critical Care Practitioner programme consists of an academic and clinical component. This article outlines a practical approach of how the programme was developed and is currently being delivered at a single institution. This new advanced practice role offers opportunities to fill gaps in the medical workforce, improve continuity of patient care, provide mentoring and training for less experienced staff as well as offering a rewarding clinical role.

  11. Functional Diversity as a New Framework for Understanding the Ecology of an Emerging Generalist Pathogen.

    PubMed

    Morris, Aaron; Guégan, Jean-François; Benbow, M Eric; Williamson, Heather; Small, Pamela L C; Quaye, Charles; Boakye, Daniel; Merritt, Richard W; Gozlan, Rodolphe E

    2016-09-01

    Emerging infectious disease outbreaks are increasingly suspected to be a consequence of human pressures exerted on natural ecosystems. Previously, host taxonomic communities have been used as indicators of infectious disease emergence, and the loss of their diversity has been implicated as a driver of increased presence. The mechanistic details in how such pathogen-host systems function, however, may not always be explained by taxonomic variation or loss. Here we used machine learning and methods based on Gower's dissimilarity to quantify metrics of invertebrate functional diversity, in addition to functional groups and their taxonomic diversity at sites endemic and non-endemic for the model generalist pathogen Mycobacterium ulcerans, the causative agent of Buruli ulcer. Changes in these metrics allowed the rapid categorisation of the ecological niche of the mycobacterium's hosts and the ability to relate specific host traits to its presence in aquatic ecosystems. We found that taxonomic diversity of hosts and overall functional diversity loss and evenness had no bearing on the mycobacterium's presence, or whether the site was in an endemic area. These findings, however, provide strong evidence that generalist environmentally persistent bacteria such as M. ulcerans can be associated with specific functional traits rather than taxonomic groups of organisms, increasing our understanding of emerging disease ecology and origin.

  12. Nursing's next advance: an internal classification for nursing practice.

    PubMed

    Clark, J; Lang, N

    1992-01-01

    An International Classification of Nursing Practice (ICNP) is needed to support the processes of nursing practice and advance the knowledge necessary for cost-effective delivery of quality nursing care. Below, the authors present their case for developing such a system that will provide nursing with a nomenclature, a language and a classification that can be used to describe and organize nursing data. It is their belief that this landmark project is achievable and that ICN should lead the work in collaboration with its member associations, the World Health Organization and key national, international, governmental and nongovernmental groups. But to ensure that the system will be adaptable across borders, nurses and organizations are being encouraged to share their ideas and research on such a system.

  13. Preparing Rehabilitation Counselors for Private Sector Practice within a CORE Accredited Generalist Educational Model

    ERIC Educational Resources Information Center

    Zanskas, Stephen; Leahy, Michael

    2007-01-01

    As private sector rehabilitation has matured as a field of practice, the issue of how rehabilitation counselor educators can effectively prepare rehabilitation counselors for practice in this setting remains. This article reviews the literature regarding the training needs of rehabilitation counselors entering private sector practice, and proposes…

  14. Comparison of Quality Oncology Practice Initiative (QOPI) Measure Adherence Between Oncology Fellows, Advanced Practice Providers, and Attending Physicians.

    PubMed

    Zhu, Jason; Zhang, Tian; Shah, Radhika; Kamal, Arif H; Kelley, Michael J

    2015-12-01

    Quality improvement measures are uniformly applied to all oncology providers, regardless of their roles. Little is known about differences in adherence to these measures between oncology fellows, advance practice providers (APP), and attending physicians. We investigated conformance across Quality Oncology Practice Initiative (QOPI) measures for oncology fellows, advance practice providers, and attending physicians at the Durham Veterans Affairs Medical Center (DVAMC). Using data collected from the Spring 2012 and 2013 QOPI cycles, we abstracted charts of patients and separated them based on their primary provider. Descriptive statistics and the chi-square test were calculated for each QOPI measure between fellows, advanced practice providers (APPs), and attending physicians. A total of 169 patients were reviewed. Of these, 31 patients had a fellow, 39 had an APP, and 99 had an attending as their primary oncology provider. Fellows and attending physicians performed similarly on 90 of 94 QOPI metrics. High-performing metrics included several core QOPI measures including documenting consent for chemotherapy, recommending adjuvant chemotherapy when appropriate, and prescribing serotonin antagonists when prescribing emetogenic chemotherapies. Low-performing metrics included documentation of treatment summary and taking action to address problems with emotional well-being by the second office visit. Attendings documented the plan for oral chemotherapy more often (92 vs. 63%, P=0.049). However, after the chart audit, we found that fellows actually documented the plan for oral chemotherapy 88% of the time (p=0.73). APPs and attendings performed similarly on 88 of 90 QOPI measures. The quality of oncology care tends to be similar between attendings and fellows overall; some of the significant differences do not remain significant after a second manual chart review, highlighting that the use of manual data collection for QOPI analysis is an imperfect system, and there may

  15. Advanced technologies in plastic surgery: how new innovations can improve our training and practice.

    PubMed

    Grunwald, Tiffany; Krummel, Thomas; Sherman, Randy

    2004-11-01

    Over the last two decades, virtual reality, haptics, simulators, robotics, and other "advanced technologies" have emerged as important innovations in medical learning and practice. Reports on simulator applications in medicine now appear regularly in the medical, computer science, engineering, and popular literature. The goal of this article is to review the emerging intersection between advanced technologies and surgery and how new technology is being utilized in several surgical fields, particularly plastic surgery. The authors also discuss how plastic and reconstructive surgeons can benefit by working to further the development of multimedia and simulated environment technologies in surgical practice and training.

  16. Description and evaluation of an initiative to develop advanced practice nurses in mainland China.

    PubMed

    Wong, Frances Kam Yuet; Peng, Gangyi; Kan, Eva C; Li, Yajie; Lau, Ada T; Zhang, Liying; Leung, Annie F; Liu, Xueqin; Leung, Vilna O; Chen, Weiju; Li, Ming

    2010-05-01

    This paper describes an initiative to develop Advanced Practice Nurses (APNs) in mainland China and evaluation of the outcomes of the described programme. The pioneer project was an APN postgraduate programme involving 38 students conducted in Guangzhou, China during 2004-2005. Data related to curriculum content and process, student performance, self-reported competence and programme effects were collected. Quantitative data such as demographic data, student performance were analysed using descriptive statistics and the pre and post self-reported practice of competence was compared using chi-square test. Qualitative data such as case reports and interviews were examined using thematic analyses. Reflective journals and case studies revealed the attributes of APNs in managing clinical cases at advanced level, applying theory into practice and exercising evidence-based practice. The relatively modest self-reported practice of competence suggested that the graduates were novice APNs and needed continued development after the completion of the programme. This study reports the experience of an initiative in China and suggests a useful curriculum framework for educating APNs. Copyright 2009 Elsevier Ltd. All rights reserved.

  17. International Nursing: Constructing an Advanced Practice Registered Nurse Practice Model in the UAE: Using Innovation to Address Cultural Implications and Challenges in an International Enterprise.

    PubMed

    Behrens, Sue A

    Despite utilization of the advanced practice registered nurse (APRN) in the United States health care system, there is little information about the introduction, utilization, and challenges of the APRN role globally, especially in the Middle East. This article will look at how one hospital in the United Arab Emirates introduced the APRN role to a health care environment of a country where it has not been recognized historically. Cultural challenges and barriers for the implementation of the role include regulatory, societal, and institutional. Innovation and collaboration are necessary to address these challenges and barriers and to pave the way for a successful advanced practice model pilot, as well as for the future use of the role. Innovation is also one of the key performance indicators for the country's health care. However, the idea of advanced practice is a new concept that has been outside the mainstream health care practice for the United Arab Emirates. To help with the implementation, a road map was developed to outline the steps necessary to provide a safe practice environment. The plan included aligning with the ministry of health nursing and midwifery council, as well as the Health Authority of Abu Dhabi, to help them learn more about the US model of advanced practice, along with benefits, and outcomes of the role. Developing the role of the APRN will benefit the future state of the health care infrastructure for not only the United Arab Emirates but throughout the Middle East.

  18. The Effect of Communication Skills Training for Generalist Palliative Care Providers on Patient-Reported Outcomes and Clinician Behaviors: A Systematic Review and Meta-analysis.

    PubMed

    Selman, Lucy Ellen; Brighton, Lisa J; Hawkins, Amy; McDonald, Christine; O'Brien, Suzanne; Robinson, Vicky; Khan, Shaheen A; George, Rob; Ramsenthaler, Christine; Higginson, Irene J; Koffman, Jonathan

    2017-09-01

    As most end-of-life care is provided by health care providers who are generalists rather than specialists in palliative care, effective communication skills training for generalists is essential. To determine the effect of communication training interventions for generalist palliative care providers on patient-reported outcomes and trainee behaviors. Systematic review from searches of 10 databases to December 2015 (MEDLINE, EMBASE, PsycINFO, ERIC, CINAHL, CENTRAL, Web of Science, ICTRP, CORDIS, and OpenGrey) plus hand searching. Randomized controlled trials of training interventions intended to enhance generalists' communication skills in end-of-life care were included. Two authors independently assessed eligibility after screening, extracted data, and graded quality. Data were pooled for meta-analysis using a random-effects model. PRISMA guidelines were followed. Nineteen of 11,441 articles were eligible, representing 14 trials. Eleven were included in meta-analyses (patients n = 3144, trainees n = 791). Meta-analysis showed no effect on patient outcomes (standardized mean difference [SMD] = 0.10, 95% CI -0.05 to 0.24) and high levels of heterogeneity (chi-square = 21.32, degrees of freedom [df] = 7, P = 0.003; I 2  = 67%). The effect on trainee behaviors in simulated interactions (SMD = 0.50, 95% CI 0.19-0.81) was greater than in real patient interactions (SMD = 0.21, 95% CI -0.01 to 0.43) with moderate heterogeneity (chi-square = 8.90, df = 5, P = 0.11; I 2  = 44%; chi-square = 5.96, df = 3, P = 0.11; I 2  = 50%, respectively). Two interventions with medium effects on showing empathy in real patient interactions included personalized feedback on recorded interactions. The effect of communication skills training for generalists on patient-reported outcomes remains unclear. Training can improve clinicians' ability to show empathy and discuss emotions, at least in simulated consultations. Personalized feedback on recorded patient

  19. Individual and species-specific traits explain niche size and functional role in spiders as generalist predators.

    PubMed

    Sanders, Dirk; Vogel, Esther; Knop, Eva

    2015-01-01

    The function of a predator within a community is greatly based on its trophic niche, that is the number and the strength of feeding links. In generalist predators, which feed on a wide range of prey, the size and position of the trophic niche is likely determined by traits such as hunting mode, the stratum they occur in, their body size and age. We used stable isotope analyses ((13)C and (15)N) to measure the trophic niche size of nine spider species within a forest hedge community and tested for species traits and individual traits that influence stable isotope enrichment, niche size and resource use. The spiders Enoplognatha, Philodromus, Floronia, and Heliophanus had large isotopic niches, which correspond to a more generalistic feeding behaviour. In contrast, Araneus, Metellina and Agelena, as top predators in the system, had rather narrow niches. We found a negative correlation between trophic position and niche size. Differences in trophic position in spiders were explained by body size, hunting modes and stratum, while niche size was influenced by hunting mode. In Philodromus, the size of the trophic niche increased significantly with age. Fitting spiders to functional groups according to their mean body size, hunting mode and their habitat domain resulted in largely separated niches, which indicates that these traits are meaningful for separating functional entities in spiders. Functional groups based on habitat domain (stratum) caught the essential functional differences between the species with species higher up in the vegetation feeding on flying insects and herb and ground species also preying on forest floor decomposers. Interestingly, we found a gradient from large species using a higher habitat domain and having a smaller niche to smaller species foraging closer to the ground and having a larger niche. This shows that even within generalist predators, such as spiders, there is a gradient of specialism that can be predicted by functional traits.

  20. Is specialization an evolutionary dead end? Testing for differences in speciation, extinction and trait transition rates across diverse phylogenies of specialists and generalists.

    PubMed

    Day, E H; Hua, X; Bromham, L

    2016-06-01

    Specialization has often been claimed to be an evolutionary dead end, with specialist lineages having a reduced capacity to persist or diversify. In a phylogenetic comparative framework, an evolutionary dead end may be detectable from the phylogenetic distribution of specialists, if specialists rarely give rise to large, diverse clades. Previous phylogenetic studies of the influence of specialization on macroevolutionary processes have demonstrated a range of patterns, including examples where specialists have both higher and lower diversification rates than generalists, as well as examples where the rates of evolutionary transitions from generalists to specialists are higher, lower or equal to transitions from specialists to generalists. Here, we wish to ask whether these varied answers are due to the differences in macroevolutionary processes in different clades, or partly due to differences in methodology. We analysed ten phylogenies containing multiple independent origins of specialization and quantified the phylogenetic distribution of specialists by applying a common set of metrics to all datasets. We compared the tip branch lengths of specialists to generalists, the size of specialist clades arising from each evolutionary origin of a specialized trait and whether specialists tend to be clustered or scattered on phylogenies. For each of these measures, we compared the observed values to expectations under null models of trait evolution and expected outcomes under alternative macroevolutionary scenarios. We found that specialization is sometimes an evolutionary dead end: in two of the ten case studies (pollinator-specific plants and host-specific flies), specialization is associated with a reduced rate of diversification or trait persistence. However, in the majority of studies, we could not distinguish the observed phylogenetic distribution of specialists from null models in which specialization has no effect on diversification or trait persistence. © 2016

  1. Identifying opportunities to advance practice at a large academic medical center using the ASHP Ambulatory Care Self-Assessment Tool.

    PubMed

    Martirosov, Amber Lanae; Michael, Angela; McCarty, Melissa; Bacon, Opal; DiLodovico, John R; Jantz, Arin; Kostoff, Diana; MacDonald, Nancy C; Mikulandric, Nancy; Neme, Klodiana; Sulejmani, Nimisha; Summers, Bryant B

    2018-05-29

    The use of the ASHP Ambulatory Care Self-Assessment Tool to advance pharmacy practice at 8 ambulatory care clinics of a large academic medical center is described. The ASHP Ambulatory Care Self-Assessment Tool was developed to help ambulatory care pharmacists assess how their current practices align with the ASHP Practice Advancement Initiative. The Henry Ford Hospital Ambulatory Care Advisory Group (ACAG) opted to use the "Practitioner Track" sections of the tool to assess pharmacy practices within each of 8 ambulatory care clinics individually. The responses to self-assessment items were then compiled and discussed by ACAG members. The group identified best practices and ways to implement action items to advance ambulatory care practice throughout the institution. Three recommended action items were common to most clinics: (1) identify and evaluate solutions to deliver financially viable services, (2) develop technology to improve patient care, and (3) optimize the role of pharmacy technicians and support personnel. The ACAG leadership met with pharmacy administrators to discuss how action items that were both feasible and deemed likely to have a medium-to-high impact aligned with departmental goals and used this information to develop an ambulatory care strategic plan. This process informed and enabled initiatives to advance ambulatory care pharmacy practice within the system. The ASHP Ambulatory Care Self-Assessment Tool was useful in identifying opportunities for practice advancement in a large academic medical center. Copyright © 2018 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  2. Developing clinical leaders: the impact of an action learning mentoring programme for advanced practice nurses.

    PubMed

    Leggat, Sandra G; Balding, Cathy; Schiftan, Dan

    2015-06-01

    To determine whether a formal mentoring programme assists nurse practitioner candidates to develop competence in the clinical leadership competencies required in their advanced practice roles. Nurse practitioner candidates are required to show evidence of defined clinical leadership competencies when they apply for endorsement within the Australian health care system. Aiming to assist the candidates with the development or enhancement of these leadership skills, 18 nurse practitioner candidates participated in a mentoring programme that matched them with senior nurse mentors. A pre-postlongitudinal intervention study. Eighteen nurse practitioner candidates and 17 senior nurses participated in a voluntary mentoring programme that incorporated coaching and action learning over 18 months in 2012 and 2013. Participants completed a pen and paper questionnaire to document baseline measures of self-reported leadership practices prior to commencement of the programme and again at the end of the programme. The mentors and the nurse practitioner candidates qualitatively evaluated the programme as successful and quantitative data illustrated significant improvement in self-reported leadership practices among the nurse practitioner candidates. In particular, the nurse practitioner candidates reported greater competence in the transformational aspects of leadership, which is directly related to the nurse practitioner candidate clinical leadership standard. A formal, structured mentoring programme based on principles of action learning was successful in assisting Australian advanced practice nurses enhance their clinical leadership skills in preparation for formal endorsement as a nurse practitioner and for success in their advanced practice role. Mentoring can assist nurses to transition to new roles and develop knowledge and skills in clinical leadership essential for advanced practice roles. Nurse managers should make greater use of mentoring programmes to support nurses in

  3. 19 CFR 181.92 - Definitions and general NAFTA advance ruling practice.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 19 Customs Duties 2 2014-04-01 2014-04-01 false Definitions and general NAFTA advance ruling practice. 181.92 Section 181.92 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND... National Commodity Specialist Division or by such other office as designated by the Commissioner of Customs...

  4. 19 CFR 181.92 - Definitions and general NAFTA advance ruling practice.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 19 Customs Duties 2 2013-04-01 2013-04-01 false Definitions and general NAFTA advance ruling practice. 181.92 Section 181.92 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND... National Commodity Specialist Division or by such other office as designated by the Commissioner of Customs...

  5. The Vanderbilt Professional Nursing Practice Program, part 3: managing an advancement process.

    PubMed

    Steaban, Robin; Fudge, Mitzie; Leutgens, Wendy; Wells, Nancy

    2003-11-01

    Consistency of performance standards across multiple clinical settings is an essential component of a credible advancement system. Our advancement process incorporates a central committee, composed of nurses from all clinical settings within the institution, to ensure consistency of performance in inpatient, outpatient, and procedural settings. An analysis of nurses advanced during the first 18 months of the program indicates that performance standards are applicable to nurses in all clinical settings. The first article (September 2003) in this 3-part series described the foundation for and the philosophical background of the Vanderbilt Professional Nursing Practice Program (VPNPP), the career advancement program underway at Vanderbilt University Medical Center. Part 2 described the development of the evaluation tools used in the VPNPP, the implementation and management of this new system, program evaluation, and improvements since the program's inception. The purpose of this article is to review the advancement process, review the roles of those involved in the process, and to describe outcomes and lessons learned.

  6. Quality indicators for prostate radiotherapy: are patients disadvantaged by receiving treatment in a 'generalist' centre?

    PubMed

    Freeman, Amanda R; Roos, Daniel E; Kim, Laurence

    2015-04-01

    The purpose of this retrospective review was to evaluate concordance with evidence-based quality indicator guidelines for prostate cancer patients treated radically in a 'generalist' (as distinct from 'sub-specialist') centre. We were concerned that the quality of treatment may be lower in a generalist centre. If so, the findings could have relevance for many radiotherapy departments that treat prostate cancer. Two hundred fifteen consecutive patients received external beam radiotherapy (EBRT) and/or brachytherapy between 1.10.11 and 30.9.12. Treatment was deemed to be in line with evidence-based guidelines if the dose was: (i) 73.8-81 Gy at 1.8-2.0 Gy/fraction for EBRT alone (eviQ guidelines); (ii) 40-50 Gy (EBRT) for EBRT plus high-dose rate (HDR) brachytherapy boost (National Comprehensive Cancer Network (NCCN) guidelines); and (iii) 145 Gy for low dose rate (LDR) I-125 monotherapy (NCCN). Additionally, EBRT beam energy should be ≥6 MV using three-dimensional conformal RT (3D-CRT) or intensity-modulated RT (IMRT), and high-risk patients should receive neo-adjuvant androgen-deprivation therapy (ADT) (eviQ/NCCN). Treatment of pelvic nodes was also assessed. One hundred four high-risk, 84 intermediate-risk and 27 low-risk patients (NCCN criteria) were managed by eight of nine radiation oncologists. Concordance with guideline doses was confirmed in: (i) 125 of 136 patients (92%) treated with EBRT alone; (ii) 32 of 34 patients (94%) treated with EBRT + HDR BRT boost; and (iii) 45 of 45 patients (100%) treated with LDR BRT alone. All EBRT patients were treated with ≥6 MV beams using 3D-CRT (78%) or IMRT (22%). 84%, 21% and 0% of high-risk, intermediate-risk and low-risk patients received ADT, respectively. Overall treatment modality choice (including ADT use and duration where assessable) was concordant with guidelines for 176/207 (85%) of patients. The vast majority of patients were treated concordant with evidence-based guidelines suggesting that

  7. Developing a professional poster: four "ps" for advanced practice nurses to consider.

    PubMed

    Bindon, Susan L; Davenport, Joan M

    2013-01-01

    Professional posters play an important role in the dissemination of knowledge and the professional development of advanced practice nurses, graduate students, and clinical faculty. Posters should be considered an integral component in communication of professional work in practice, research, and education. The invitation to submit a poster abstract is an important opportunity for clinicians and faculty alike to consider. Though sometimes misperceived as less prestigious than a podium presentation, posters add a unique element to professional and academic events. The argument is made for posters as an equal among scholarly presentation formats. The poster serves as a tremendous opportunity for collaboration between partners and a way to communicate important findings and advertise the presenters' work. For the advanced practice nurse who is a novice in presenting best practice or evidence from research trials, the poster format may be less intimidating while allowing the invaluable sharing of results. Four critical elements of professional poster development are deciding on a clear Purpose, targeting the right People, outlining key steps in the Process, and delivering a memorable Presentation. Using the "4 Ps" as cornerstones for the work of developing, preparing, and delivering the poster to an audience, the authors aim to help organize the entire process into these essential considerations. The poster, as a means of scholarly work, is a viable and essential activity, as interdisciplinary collaboration and sharing of best practice becomes the expectation for all professional development.

  8. The Offering, Scheduling and Maintenance of Elective Advanced Pharmacy Practice Experiences

    PubMed Central

    Brown, Rex O.; Patel, Zalak V.; Foster, Stephan L.

    2015-01-01

    The Accreditation Council for Pharmacy Education (ACPE) provides standards for colleges of pharmacy to assist in the provision of pharmacy education to student pharmacists. An integral part of all college educational programs includes the provision of experiential learning. Experiential learning allows students to gain real-world experience in direct patient care during completion of the curriculum. All college of pharmacy programs provide several Advanced Pharmacy Practice Experiences (APPEs), which include a balance between the four required experiences and a number of other required or elective APPEs. Required APPEs include advanced community, advanced institutional, ambulatory care, and general medicine. The elective APPEs include a myriad of opportunities to help provide a balanced education in experiential learning for student pharmacists. These unique opportunities help to expose student pharmacists to different career tracks that they may not have been able to experience otherwise. Not all colleges offer enough elective APPEs to enable the student pharmacist to obtain experiences in a defined area. Such an approach is required to produce skilled pharmacy graduates that are capable to enter practice in various settings. Elective APPEs are scheduled logically and are based upon student career interest and site availability. This article describes the offering, scheduling and maintenance of different elective APPEs offered by The University of Tennessee College of Pharmacy. PMID:28975920

  9. Unified Parkinson's Disease Rating Scale-Motor Exam: inter-rater reliability of advanced practice nurse and neurologist assessments.

    PubMed

    Palmer, Janice L; Coats, Mary A; Roe, Catherine M; Hanko, Shelly M; Xiong, Chengjie; Morris, John C

    2010-06-01

    This paper is a report of a study to establish the inter-rater reliability of advanced practice nurse and neurologist neurological assessments which included ratings with the Unified Parkinson's Disease Rating Scale-Motor Exam. Around the world, advanced practice nurses are performing tasks once completed only by physicians. To promote consumer and provider confidence, it is important to establish that nurse and physician ratings using assessment tools are similar. In addition in research settings, when different raters are used, establishment of inter-rater reliability for study assessments is needed. Advanced practice nurses and neurologists independently recorded findings on neurological examinations of 46 participants in a study conducted between August 2007 and January 2008. An intraclass correlation coefficient was calculated to estimate overall agreement between the nurse and neurologist ratings. Agreement for individual items measured on a dichotomous scale was assessed by calculating Cohen's kappa. There was substantial agreement between advanced practice nurses and neurologists on the mean Unified Parkinson's Disease Rating Scale-Motor Exam ratings (intraclass correlation coefficient = 0.65) and the U.S. National Alzheimer's Coordinating Center Uniform Data Set neurological examination ratings of unremarkable findings (kappa = 0.74) and of gait disorder (kappa = 0.73). Moderate agreement (kappa = 0.53) was reached for the rating of whether all Unified Parkinson's Disease Rating Scale-Motor Exam items were normal. These findings are consistent with studies of the inter-rater agreement of the Unified Parkinson's Disease Rating Scale-Motor Exam and support the conduct of neurological assessments by advanced practice nurses.

  10. Suppression of soybean aphid by generalist predators results in a trophic cascade in soybeans.

    PubMed

    Costamagna, Alejandro C; Landis, Douglas A; Difonzo, Christina D

    2007-03-01

    Top-down regulation of herbivores in terrestrial ecosystems is pervasive and can lead to trophic cascades that release plants from herbivory. Due to their relatively simplified food webs, agroecosystems may be particularly prone to trophic cascades, a rationale that underlies biological control. However, theoretical and empirical studies show that, within multiple enemy assemblages, intraguild predation (IGP) may lead to a disruption of top-down control by predators. We conducted a factorial field study to test the separate and combined effects of predators and parasitoids in a system with asymmetric IGP. Specifically we combined ambient levels of generalist predators (mainly Coccinellidae) of the soybean aphid, Aphis glycines Matsumura, with controlled releases of the native parasitoid Lysiphlebus testaceipes (Cresson) and measured their impact on aphid population growth and soybean biomass and yield. We found that generalist predators provided strong, season-long aphid suppression, which resulted in a trophic cascade that doubled soybean biomass and yield. However, contrary to our expectations, L. testaceipes provided minor aphid suppression and only when predators were excluded, which resulted in nonadditive effects when both groups were combined. We found direct and indirect evidence of IGP, but because percentage parasitism did not differ between predator exclusion and ambient predator treatments, we concluded that IGP did not disrupt parasitism during this study. Our results support theoretical predictions that intraguild predators which also provide strong herbivore suppression do not disrupt top-down control of herbivores.

  11. Management intensity at field and landscape levels affects the structure of generalist predator communities.

    PubMed

    Rusch, Adrien; Birkhofer, Klaus; Bommarco, Riccardo; Smith, Henrik G; Ekbom, Barbara

    2014-07-01

    Agricultural intensification is recognised as a major driver of biodiversity loss in human-modified landscapes. Several agro-environmental measures at different spatial scales have been suggested to mitigate the negative impact of intensification on biodiversity and ecosystem services. The effect of these measures on the functional structure of service-providing communities remains, however, largely unexplored. Using two distinct landscape designs, we examined how the management options of organic farming at the field scale and crop diversification at the landscape level affect the taxonomic and functional structure of generalist predator communities and how these effects vary along a landscape complexity gradient. Organic farming as well as landscapes with longer and more diversified crop rotations enhanced the activity-density of spiders and rove beetles, but not the species richness or evenness. Our results indicate that the two management options affected the functional composition of communities, as they primarily enhanced the activity-density of functionally similar species. The two management options increased the functional similarity between spider species in regards to hunting mode and habitat preference. Organic farming enhanced the functional similarity of rove beetles. Management options at field and landscape levels were generally more important predictors of community structure when compared to landscape complexity. Our study highlights the importance of considering the functional composition of generalist predators in order to understand how agro-environmental measures at various scales shape community assemblages and ecosystem functioning in agricultural landscapes.

  12. Neonatal resuscitation: advances in training and practice

    PubMed Central

    Sawyer, Taylor; Umoren, Rachel A; Gray, Megan M

    2017-01-01

    Each year in the US, some four hundred thousand newborns need help breathing when they are born. Due to the frequent need for resuscitation at birth, it is vital to have evidence-based care guidelines and to provide effective neonatal resuscitation training. Every five years, the International Liaison Committee on Resuscitation (ILCOR) reviews the science of neonatal resuscitation. In the US, the American Heart Association (AHA) develops treatment guidelines based on the ILCOR science review, and the Neonatal Resuscitation Program (NRP) translates the AHA guidelines into an educational curriculum. In this report, we review recent advances in neonatal resuscitation training and practice. We begin with a review of the new 7th edition NRP training curriculum. Then, we examine key changes to the 2015 AHA neonatal resuscitation guidelines. The four components of the NRP curriculum reviewed here include eSim®, Performance Skills Stations, Integrated Skills Station, and Simulation and Debriefing. The key changes to the AHA neonatal resuscitation guidelines reviewed include initial steps of newborn care, positive-pressure ventilation, endotracheal intubation and use of laryngeal mask, chest compressions, medications, resuscitation of preterm newborns, and ethics and end-of-life care. We hope this report provides a succinct review of recent advances in neonatal resuscitation. PMID:28096704

  13. Comparative host selection responses of specialist (Helicoverpa assulta) and generalist (Helicoverpa armigera) moths in complex plant environments

    PubMed Central

    Li, Wei-zheng; Teng, Xiao-hui; Zhang, Hong-fei; Liu, Ting; Wang, Qiong; Guo, Xian-ru

    2017-01-01

    We tested the behavioral responses of ovipositing females and natal larvae of two sibling species, a generalist Helicoverpa armigera (Hübner) and a specialist Helicoverpa assulta (Guenée), to odor sources emitted from different combinations of six plant species (tobacco, Nicotiana tabacum; hot pepper, Capsicum annuum; tomato, Solanum esculentum; cotton, Gossypium hirsutum; peanut, Arachis hypogaea; maize, Zea mays). Under the conditions of plant materials versus corresponding controls, both stages of both species could find their corresponding host plants. However, H. assulta females and larvae exhibited a supersensitive and an insensitive response, respectively. Under the conditions of tobacco paired with each plant species, H. assulta females exhibited more specialized ovipositional response to tobacco than its sibling. When each plant species were combined with tobacco and tested against tobacco reference, peanut played an opposite role in the two species in their ovipositional responses to tobacco, and cotton can enhance the approaching response of H. armigera larvae when combined with tobacco. It seems that two attractive host plants also can act antagonistically with respect to host selection of the generalist via volatile exchange. Tomato should better be excluded from host list of H. assulta. PMID:28182679

  14. Chytrid fungus acts as a generalist pathogen infecting species-rich amphibian families in Brazilian rainforests.

    PubMed

    Valencia-Aguilar, Anyelet; Ruano-Fajardo, Gustavo; Lambertini, Carolina; da Silva Leite, Domingos; Toledo, Luís Felipe; Mott, Tamí

    2015-05-11

    The fungus Batrachochytrium dendrobatidis (Bd) is among the main causes of declines in amphibian populations. This fungus is considered a generalist pathogen because it infects several species and spreads rapidly in the wild. To date, Bd has been detected in more than 100 anuran species in Brazil, mostly in the southern portion of the Atlantic forest. Here, we report survey data from some poorly explored regions; these data considerably extend current information on the distribution of Bd in the northern Atlantic forest region. In addition, we tested the hypothesis that Bd is a generalist pathogen in this biome. We also report the first positive record for Bd in an anuran caught in the wild in Amazonia. In total, we screened 90 individuals (from 27 species), of which 39 individuals (from 22 species) were Bd-positive. All samples collected in Bahia (2 individuals), Pernambuco (3 individuals), Pará (1 individual), and Minas Gerais (1 individual) showed positive results for Bd. We found a positive correlation between anuran richness per family and the number of infected species in the Atlantic forest, supporting previous observations that Bd lacks strong host specificity; of 38% of the anuran species in the Atlantic forest that were tested for Bd infection, 25% showed positive results. The results of our study exemplify the pandemic and widespread nature of Bd infection in amphibians.

  15. The adaptation of generalist predators' diet in a multi-prey context: insights from new functional responses.

    PubMed

    Baudrot, Virgile; Perasso, Antoine; Fritsch, Clémentine; Giraudoux, Patrick; Raoul, Francis

    2016-07-01

    The ability for a generalist consumer to adapt its foraging strategy (the multi-species functional response, MSFR) is a milestone in ecology as it contributes to the structure of food webs. The trophic interaction between a generalist predator, as the red fox or the barn owl, and its prey community, mainly composed of small mammals, has been empirically and theoretically widely studied. However, the extent to which these predators adapt their diet according to both multi-annual changes in multiple prey species availability (frequency dependence) and the variation of the total prey density (density dependence) is unexplored.We provide a new general model of MSFR disentangling changes in prey preference according to variation of prey frequency (switching) and of total prey density (we propose the new concept of "rank switching"). We apply these models to two large data sets of red fox and barn owl foraging. We show that both frequency-dependent and density-dependent switching are critical properties of these two systems, suggesting that barn owl and red fox have an accurate image of the prey community in terms of frequency and absolute density. Moreover, we show that negative switching, which can lead to prey instability, is a strong property of the two systems. © 2016 by the Ecological Society of America.

  16. Enhancing presentation skills for the advanced practice nurse: strategies for success.

    PubMed

    Vollman, Kathleen M

    2005-01-01

    Professional speaking is a component of the professional practice role of the advanced practice nurse (APN). The skills to communicate effectively to one person or an audience of 100 provide the APN with the essential tools for implementing change, collaborating effectively, presenting information at professional meetings, or communicating the impact of clinical outcomes in the boardroom. Public speaking skills, a professional image, and improved communication can facilitate advancement along any career ladder. The greater your fear, the more self-confidence you will gain by stepping up to a challenge and conquering it. This article describes strategies for organizing and presenting your message in a clear and concise format. Techniques to manage the anxiety produced when attempting to articulate your thoughts is essential for effective communication. Skills for enhancing the delivery of your message through effective body language, professional image, voice modulation, and use of audiovisual aids are addressed. Creative techniques for fielding questions are key in promoting a dynamic closure and provide consistent reinforcement of the key message content.

  17. Recognized focused practice: Does sub-specialty designation offer value to the neurosurgeon?

    PubMed

    Babu, Maya A; Liau, Linda M; Meyer, Fredric B

    2017-01-01

    Vehicles for life-long assessment such as Maintenance of Certification tend to focus on generalist neurosurgical knowledge. However, as neurosurgeons advance in their careers, they tend to narrow their practice and increase volumes in certain specific types of operations. Failing to test the type of procedures most relevant to the practitioner is a lost opportunity to improve the knowledge and practice of the individual neurosurgeon. In this study, we assess the neurosurgical community's appetite for designations of board-recognized Recognized Focused Practice (RFP). We administered a validated, online, confidential survey to 4,899 neurosurgeons (2,435 American Board of Neurological Surgery (ABNS) Diplomates participating in MOC, 1,440 Diplomates certified prior to 1999 (grandfathered), and 1,024 retired Diplomates). We received 1,449 responses overall (30% response rate). A plurality of respondents were in practice 11-15 years (18.5%), in private practice (40%) and participate in MOC (61%). 49% of respondents felt that a RFP designation would not be helpful. For the 30% who felt that RFP would be helpful, 61.3% felt that it would support recognition by their hospital or practice, it would motivate them to stay current on medical knowledge (53.4%), or it would help attract patients (46.4%;). The most popular suggestions for RFP were Spine (56.2%), Cerebrovascular (62.9%), Pediatrics (64.1%), and Functional/Stereotactic (52%). A plurality of neurosurgeons (35.7%) felt that RFP should recognize neurosurgeons with accredited and non-accredited fellowship experience and sub-specialty experience. Ultimately, Recognized Focused Practice may provide value to individual neurosurgeons, but the neurosurgical community shows tepid interest for pursuing this designation.

  18. Recognized focused practice: Does sub-specialty designation offer value to the neurosurgeon?

    PubMed Central

    Liau, Linda M.; Meyer, Fredric B.

    2017-01-01

    Vehicles for life-long assessment such as Maintenance of Certification tend to focus on generalist neurosurgical knowledge. However, as neurosurgeons advance in their careers, they tend to narrow their practice and increase volumes in certain specific types of operations. Failing to test the type of procedures most relevant to the practitioner is a lost opportunity to improve the knowledge and practice of the individual neurosurgeon. In this study, we assess the neurosurgical community’s appetite for designations of board-recognized Recognized Focused Practice (RFP). We administered a validated, online, confidential survey to 4,899 neurosurgeons (2,435 American Board of Neurological Surgery (ABNS) Diplomates participating in MOC, 1,440 Diplomates certified prior to 1999 (grandfathered), and 1,024 retired Diplomates). We received 1,449 responses overall (30% response rate). A plurality of respondents were in practice 11–15 years (18.5%), in private practice (40%) and participate in MOC (61%). 49% of respondents felt that a RFP designation would not be helpful. For the 30% who felt that RFP would be helpful, 61.3% felt that it would support recognition by their hospital or practice, it would motivate them to stay current on medical knowledge (53.4%), or it would help attract patients (46.4%;). The most popular suggestions for RFP were Spine (56.2%), Cerebrovascular (62.9%), Pediatrics (64.1%), and Functional/Stereotactic (52%). A plurality of neurosurgeons (35.7%) felt that RFP should recognize neurosurgeons with accredited and non-accredited fellowship experience and sub-specialty experience. Ultimately, Recognized Focused Practice may provide value to individual neurosurgeons, but the neurosurgical community shows tepid interest for pursuing this designation. PMID:29240838

  19. Impact of Selection Practices on Career Advancement of African American Women in Community College Administration

    ERIC Educational Resources Information Center

    Yancy-Tooks, Barbara J.

    2012-01-01

    The purpose of this qualitative ethnographic study was to explore the experiences of African American women about their perceptions of factors (i.e. senior administrator selection practices, institutional practices, barriers, and coping strategies) that hinder or facilitate advancement in community college administration. The following questions…

  20. [How many generalists and how many specialists does orthopedics and traumatology need?].

    PubMed

    Achatz, G; Perl, M; Stange, R; Mutschler, M; Jarvers, J S; Münzberg, M

    2013-01-01

    The training in orthopedic and trauma surgery has changed significantly with the introduction of the new residency program. The contents taught have already been reduced in breadth and the current developments in the outpatient and particularly in the clinical landscape also contribute to increasing specialization. This trend favors structures in which comprehensive medical care for the population in Germany in orthopedic and trauma surgery appears to be endangered and in which the future efforts for e.g. polytraumatised patients need to be questioned. The Young Forum of the German Society for Orthopedics and Traumatology actively accompanies a discussion about the necessity and value of generalists to ensure the level of care in Germany in addition to the specialists.

  1. The impact of problem-based learning on students' perceptions of preparedness for advanced pharmacy practice experiences.

    PubMed

    Hogan, Shirley; Lundquist, Lisa M

    2006-08-15

    To evaluate graduating pharmacy students' perceptions of their preparedness for advanced pharmacy practice experiences and the effectiveness of problem-based learning in their preparation. A survey instrument was administered anonymously in May 2004 and May 2005 to graduating pharmacy students of the University of Mississippi School of Pharmacy. Students reported that the areas in which problem-based learning prepared them most effectively for advanced pharmacy practice experiences were retrieval of medical information (80%), discussion of disease states and drug therapies at the basic science level (56%), and evaluation of the appropriateness of a medication regimen based on patient specific information (50%). Areas in which students reported being inadequately prepared included identifying and utilizing drug assistance programs (42%) and processing prescriptions/hospital orders (40%). Data from 2 consecutive graduating classes supports that problem-based learning is an effective format for preparing pharmacy students for advanced pharmacy practice experiences in a variety of areas.

  2. [Advance directives in clinical practice : Living will, healthcare power of attorney and care directive].

    PubMed

    Hack, J; Buecking, B; Lopez, C L; Ruchholtz, S; Kühne, C A

    2017-06-01

    In clinical practice, situations continuously occur in which medical professionals and family members are confronted with decisions on whether to extend or limit treatment for severely ill patients in end of life treatment decisions. In these situations, advance directives are helpful tools in decision making according to the wishes of the patient; however, not every patient has made an advance directive and in our experience medical staff as well as patients are often not familiar with these documents. The purpose of this article is therefore to explain the currently available documents (e.g. living will, healthcare power of attorney and care directive) and the possible (legal) applications and limitations in the routine clinical practice.

  3. [Advance directives in clinical practice : Living will, healthcare power of attorney and care directive].

    PubMed

    Hack, J; Buecking, B; Lopez, C L; Ruchholtz, S; Kühne, C A

    2017-02-01

    In clinical practice, situations continuously occur in which medical professionals and family members are confronted with decisions on whether to extend or limit treatment for severely ill patients in end of life treatment decisions. In these situations, advance directives are helpful tools in decision making according to the wishes of the patient; however, not every patient has made an advance directive and in our experience medical staff as well as patients are often not familiar with these documents. The purpose of this article is therefore to explain the currently available documents (e.g. living will, healthcare power of attorney and care directive) and the possible (legal) applications and limitations in the routine clinical practice.

  4. [Advance directives in clinical practice : Living will, healthcare power of attorney and care directive].

    PubMed

    Hack, J; Buecking, B; Lopez, C L; Ruchholtz, S; Kühne, C A

    2017-12-01

    In clinical practice, situations continuously occur in which medical professionals and family members are confronted with decisions on whether to extend or limit treatment for severely ill patients in end of life treatment decisions. In these situations, advance directives are helpful tools in decision making according to the wishes of the patient; however, not every patient has made an advance directive and in our experience medical staff as well as patients are often not familiar with these documents. The purpose of this article is therefore to explain the currently available documents (e.g. living will, healthcare power of attorney and care directive) and the possible (legal) applications and limitations in the routine clinical practice.

  5. [Advance directives in clinical practice : Living will, healthcare power of attorney and care directive].

    PubMed

    Hack, J; Buecking, B; Lopez, C L; Ruchholtz, S; Kühne, C A

    2017-04-01

    In clinical practice, situations continuously occur in which medical professionals and family members are confronted with decisions on whether to extend or limit treatment for severely ill patients in end of life treatment decisions. In these situations, advance directives are helpful tools in decision making according to the wishes of the patient; however, not every patient has made an advance directive and in our experience medical staff as well as patients are often not familiar with these documents. The purpose of this article is therefore to explain the currently available documents (e.g. living will, healthcare power of attorney and care directive) and the possible (legal) applications and limitations in the routine clinical practice.

  6. Pediatric nursing practice: keeping pace with technological advances.

    PubMed

    Bowden, V R

    2000-01-01

    Over the past 25 years, extensive technological and medical advances have had a major impact on the way pediatric nursing is practiced. Pediatric nurses have expanded their nursing roles, established professional organizations and certification standards to ensure clinical competence at the bedside, and tirelessly advocated for the health care needs of children and their families. In addition, pediatric nurses have collaborated with other health care providers to institute family-centered and developmentally appropriate philosophies of care. All of these changes will assist pediatric nurses to remain focused on the most important aspect of their work: Supporting the unique needs of children and their families.

  7. Climate-associated phenological advances in bee pollinators and bee-pollinated plants.

    PubMed

    Bartomeus, Ignasi; Ascher, John S; Wagner, David; Danforth, Bryan N; Colla, Sheila; Kornbluth, Sarah; Winfree, Rachael

    2011-12-20

    The phenology of many ecological processes is modulated by temperature, making them potentially sensitive to climate change. Mutualistic interactions may be especially vulnerable because of the potential for phenological mismatching if the species involved do not respond similarly to changes in temperature. Here we present an analysis of climate-associated shifts in the phenology of wild bees, the most important pollinators worldwide, and compare these shifts to published studies of bee-pollinated plants over the same time period. We report that over the past 130 y, the phenology of 10 bee species from northeastern North America has advanced by a mean of 10.4 ± 1.3 d. Most of this advance has taken place since 1970, paralleling global temperature increases. When the best available data are used to estimate analogous rates of advance for plants, these rates are not distinguishable from those of bees, suggesting that bee emergence is keeping pace with shifts in host-plant flowering, at least among the generalist species that we investigated.

  8. Bird Communities of the Arctic Shrub Tundra of Yamal: Habitat Specialists and Generalists

    PubMed Central

    Sokolov, Vasiliy; Ehrich, Dorothée; Yoccoz, Nigel G.; Sokolov, Alexander; Lecomte, Nicolas

    2012-01-01

    Background The ratio of habitat generalists to specialists in birds has been suggested as a good indicator of ecosystem changes due to e.g. climate change and other anthropogenic perturbations. Most studies focusing on this functional component of biodiversity originate, however, from temperate regions. The Eurasian Arctic tundra is currently experiencing an unprecedented combination of climate change, change in grazing pressure by domestic reindeer and growing human activity. Methodology/Principal Findings Here we monitored bird communities in a tundra landscape harbouring shrub and open habitats in order to analyse bird habitat relationships and quantify habitat specialization. We used ordination methods to analyse habitat associations and estimated the proportions of specialists in each of the main habitats. Correspondence Analysis identified three main bird communities, inhabiting upland, lowland and dense willow shrubs. We documented a stable structure of communities despite large multiannual variations of bird density (from 90 to 175 pairs/km2). Willow shrub thickets were a hotspot for bird density, but not for species richness. The thickets hosted many specialized species whose main distribution area was south of the tundra. Conclusion/Significance If current arctic changes result in a shrubification of the landscape as many studies suggested, we would expect an increase in the overall bird abundance together with an increase of local specialists, since they are associated with willow thickets. The majority of these species have a southern origin and their increase in abundance would represent a strengthening of the boreal component in the southern tundra, perhaps at the expense of species typical of the subarctic zone, which appear to be generalists within this zone. PMID:23239978

  9. Tolerance and resistance of invasive and native Eupatorium species to generalist herbivore insects

    NASA Astrophysics Data System (ADS)

    Wang, Rui-Fang; Feng, Yu-Long

    2016-11-01

    Invasive plants are exotic species that escape control by native specialist enemies. However, exotic plants may still be attacked by locally occurring generalist enemies, which can influence the dynamics of biological invasions. If invasive plants have greater defensive (resistance and tolerance) capabilities than indigenous plants, they may experience less damage from native herbivores. In the present study, we tested this prediction using the invasive plant Eupatorium adenophorum and two native congeners under simulated defoliation and generalist herbivore insect (Helicoverpa armigera and Spodoptera litura) treatments. E. adenophorum was less susceptible and compensated more quickly to damages in biomass production from both treatments compared to its two congeners, exhibiting greater herbivore tolerance. This strong tolerance to damage was associated with greater resource allocation to aboveground structures, leading to a higher leaf area ratio and a lower root: crown mass ratio than those of its native congeners. E. adenophorum also displayed a higher resistance index (which integrates acid detergent fiber, nitrogen content, carbon/nitrogen ratio, leaf mass per area, toughness, and trichome density) than its two congeners. Thus, H. armigera and S. litura performed poorly on E. adenophorum, with less leaf damage, a lengthened insect developmental duration, and decreased pupating: molting ratios compared to those of the native congeners. Strong tolerance and resistance traits may facilitate the successful invasion of E. adenophorum in China and may decrease the efficacy of leaf-feeding biocontrol agents. Our results highlight both the need for further research on defensive traits and their role in the invasiveness and biological control of exotic plants, and suggest that biocontrol of E. adenophorum in China would require damage to the plant far in excess of current levels.

  10. Advanced clinical insights & practice: ischemic heart disease.

    PubMed

    Benner, Randall W; Zavarella, Matthew S

    2008-03-01

    This issue sees the debut of a new series of continuing education articles. The series, Advanced Clinical Insights & Practice, is designed to provide continuing education to an ever-expanding realm of paramedicine that needs more of it: the critical care transport paramedic. Secondly, and equally important, are the benefits that can be reaped by other certification levels reading this feature. For EMT-Basics and Intermediates, it will provide a great enhancement to your core knowledge, although most of the interventions discussed will be beyond your traditional scope. For paramedics, it will augment both your pathophysiological understanding and clinical assessment/management skills of diseases and injuries discussed. Ultimately though, it is hoped that anyone who reads these articles will become a better clinician. The next article will appear in the July issue.

  11. Characteristics determining host suitability for a generalist parasite.

    PubMed

    Stokke, Bård G; Ratikainen, Irja I; Moksnes, Arne; Røskaft, Eivin; Schulze-Hagen, Karl; Leech, David I; Møller, Anders Pape; Fossøy, Frode

    2018-04-19

    Host quality is critical for parasites. The common cuckoo Cuculus canorus is a generalist avian brood parasite, but individual females show strong preference for a specific host species. Here, we use three extensive datasets to investigate different host characteristics determining cuckoo host selection at the species level: (i) 1871 population-specific parasitism rates collected across Europe; (ii) 14 K cases of parasitism in the United Kingdom; and (iii) 16 K cases of parasitism in Germany, with data collected during the period 1735-2013. We find highly consistent effects of the different host species traits across our three datasets: the cuckoo prefers passerine host species of intermediate size that breed in grass- or shrubland and that feed their nestlings with insects, and avoids species that nest in cavities. Based on these results, we construct a novel host suitability index for all passerine species breeding in Europe, and show that host species known to have a corresponding cuckoo host race (gens) rank among the most suitable hosts in Europe. The distribution of our suitability index shows that host species cannot be classified as suitable or not but rather range within a continuum of suitability.

  12. Building a sustainable workforce in a rural and remote health service: A comprehensive and innovative Rural Generalist training approach.

    PubMed

    Orda, Ulrich; Orda, Sabine; Sen Gupta, Tarun; Knight, Sabina

    2017-04-01

    Historically it has been challenging to recruit and retain an appropriately trained medical workforce to care for rural and remote Australians. This paper describes the Queensland North West Hospital and Health Service (NWHHS) workforce redesign, developing education strategies and pathways to practice, thereby improving service provision, recruitment and retention of staff. The Mount Isa-based Medical Education Unit sought accreditation for a Rural Generalist (RG) training pathway from Internship to Fellowship with the Australian College of Rural and Remote Medicine (ACRRM) and the Regional Training Provider (RTP). This approach enhanced the James Cook University (JCU) undergraduate pathway for rurally committed students while improving recruitment and retention of RMOs/Registrars. Accreditation was achieved through collaboration with training providers, accreditation agencies, ACRRM and a local general practice. The whole pathway from ignore Internship to Fellowship is offered with the RG Intern intake as a primary allocation site beginning in 2016. Comprehensive supervision and excellent clinical exposure provide an interesting and rewarding experience - for staff at all levels. Since 2013 RMO locum rates have been <1%. Registrars on the ACRRM pathway and Interns increased from 0 to 7 positions each in 2015, with similar achievements in SMO staffing. Three RMOs expressed interest in a Registrar position, CONCLUSIONS: Appropriate governance is needed to develop and advertise the program. This includes the NWHHS, the RG Pathway and JCU. © 2016 National Rural Health Alliance Inc.

  13. Randomized clinical trial to evaluate mental practice in enhancing advanced laparoscopic surgical performance.

    PubMed

    Louridas, M; Bonrath, E M; Sinclair, D A; Dedy, N J; Grantcharov, T P

    2015-01-01

    Mental practice, the cognitive rehearsal of a task without physical movement, is known to enhance performance in sports and music. Investigation of this technique in surgery has been limited to basic operations. The purpose of this study was to develop mental practice scripts, and to assess their effect on advanced laparoscopic skills and surgeon stress levels in a crisis scenario. Twenty senior surgical trainees were randomized to either conventional training or mental practice groups, the latter being trained by an expert performance psychologist. Participants' skills were assessed while performing a porcine laparoscopic jejunojejunostomy as part of a crisis scenario in a simulated operating room, using the Objective Structured Assessment of Technical Skill (OSATS) and bariatric OSATS (BOSATS) instruments. Objective and subjective stress parameters were measured, as well as non-technical skills using the Non-Technical Skills for Surgeons rating tool. An improvement in OSATS (P = 0.003) and BOSATS (P = 0.003) scores was seen in the mental practice group compared with the conventional training group. Seven of ten trainees improved their technical performance during the crisis scenario, whereas four of the ten conventionally trained participants deteriorated. Mental imagery ability improved significantly following mental practice training (P = 0.011), but not in the conventional group (P = 0.083). No differences in objective or subjective stress levels or non-technical skills were evident. Mental practice improves technical performance for advanced laparoscopic tasks in the simulated operating room, and allows trainees to maintain or improve their performance despite added stress. © 2014 BJS Society Ltd. Published by John Wiley & Sons Ltd.

  14. Examination for the Certificate in Advanced Practice in Cervical Cytology--the first year's experience.

    PubMed

    Smith, P A; Hewer, E M

    2003-06-01

    Following the decision to establish an Advanced Biomedical Scientist Practitioner grade for senior biomedical scientists in the NHS Cervical Screening Programme, a conjoint examination board has been appointed by the Royal College of Pathologists and Institute of Biomedical Science to oversee the Certificate in Advanced Practice in Cervical Cytology examination. The examination consists of a multiple-choice paper, short-answer written questions and practical microscopy sections covering screening of unmarked slides, and more complex discussion cases. In the first year there were 58 entries with 29 successful candidates, a pass rate of 50%. The standard of performance in the examination showed a wide range, and some candidates appear to have underestimated the degree of preparation, knowledge or level of microscopy skill required.

  15. Integrating advanced practice providers into medical critical care teams.

    PubMed

    McCarthy, Christine; O'Rourke, Nancy C; Madison, J Mark

    2013-03-01

    Because there is increasing demand for critical care providers in the United States, many medical ICUs for adults have begun to integrate nurse practitioners and physician assistants into their medical teams. Studies suggest that such advanced practice providers (APPs), when appropriately trained in acute care, can be highly effective in helping to deliver high-quality medical critical care and can be important elements of teams with multiple providers, including those with medical house staff. One aspect of building an integrated team is a practice model that features appropriate coding and billing of services by all providers. Therefore, it is important to understand an APP's scope of practice, when they are qualified for reimbursement, and how they may appropriately coordinate coding and billing with other team providers. In particular, understanding when and how to appropriately code for critical care services (Current Procedural Terminology [CPT] code 99291, critical care, evaluation and management of the critically ill or critically injured patient, first 30-74 min; CPT code 99292, critical care, each additional 30 min) and procedures is vital for creating a sustainable program. Because APPs will likely play a growing role in medical critical care units in the future, more studies are needed to compare different practice models and to determine the best way to deploy this talent in specific ICU settings.

  16. Discovering the nature of advanced nursing practice in high dependency care: a critical care nurse consultant's experience.

    PubMed

    Fairley, Debra

    2005-06-01

    This paper describes how a critical care nurse consultant's clinical role has evolved within a surgical high dependency unit (SHDU) in a large teaching hospitals trust. In order to provide some background to role development, an overview of the research exploring the nature of advanced nursing practice in the context of critical care will be presented. From the outset, advanced nursing practice was not perceived as the acquisition and application of technical procedures usually undertaken by doctors, but possibly an integration of medicine and nursing where holistic nursing assessment is combined with symptom-focused physical examination. A reflective account of practical problems encountered relating to role integration, professional autonomy, legal and consent issues, non-medical prescribing, and role evaluation will be presented. A model of working that can be applied to high dependency units, integrating the role of the advanced nurse practitioner within the clinical team, will be described.

  17. The Impact of New Technologic and Molecular Advances in the Daily Practice of Gastrointestinal and Hepatobiliary Pathology.

    PubMed

    Xue, Yue; Farris, Alton Brad; Quigley, Brian; Krasinskas, Alyssa

    2017-04-01

    The practice of anatomic pathology, and of gastrointestinal pathology in particular, has been dramatically transformed in the past decade. In addition to the multitude of diseases, syndromes, and clinical entities encountered in daily clinical practice, the increasing integration of new technologic and molecular advances into the field of gastroenterology is occurring at a fast pace. Application of these advances has challenged pathologists to correlate newer methodologies with existing morphologic criteria, which in many instances still provide the gold standard for diagnosis. This review describes the impact of new technologic and molecular advances on the daily practice of gastrointestinal and hepatobiliary pathology. We discuss new drugs that can affect the gastrointestinal tract and liver, new endoluminal techniques, new molecular tests that are often performed reflexively, new imaging techniques for evaluating hepatocellular carcinoma, and modified approaches to the gross and histologic assessment of tissues that have been exposed to neoadjuvant therapies.

  18. Literacy Agents Online: E-Discussion Forums for Advancing Adults' Literacy Practices

    ERIC Educational Resources Information Center

    Guzzetti, Barbara J.; Foley, Leslie M.

    2014-01-01

    This study explored how adults used a self-selected online forum to advance their own and others' literacy practices. The study was a discourse-centered online ethnography using triangulated methods, including analysis of list archives, semi-structured and informal interviews, and document collection. These data were analyzed by discourse…

  19. Addressing Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome in Advanced Practice Nursing Education.

    ERIC Educational Resources Information Center

    Nokes, Kathleen M.; Stein, Gary L.

    1997-01-01

    A survey of 23 advanced practice nursing programs showed only 3 had HIV-specific graduate-level nursing courses. Recommendations were made for HIV-specific courses, integration of HIV content into other courses, use of Centers for Disease Control and Occupational Safety and Health Administration guidelines, and subspecialties in HIV nursing. (SK)

  20. Goals and potential career advancement of licensed practical nurses in Japan.

    PubMed

    Ikeda, Mari; Inoue, Katsuya; Kamibeppu, Kiyoko

    2008-10-01

    To investigate the effects of personal and professional variables on career advancement intentions of working Licensed Practical Nurses (LPNs). In Japan, two levels of professional nursing licensures, the LPN and the registered nurse (RN), are likely to be integrated in the future. Therefore, it is important to know the career advancement intentions of LPNs. Questionnaires were sent to a sample of 356 LPNs. Analysis of variance (anova) and discriminative analysis were used. We found that those who had a positive image of LPNs along with a positive image of RNs were identified as showing interest in career advancement. The results of anova showed that age had a negative effect; however, discriminative analysis suggested that age is not as significant compared with other variables. Our results indicate that the 'image of RNs', and 'role-acceptance factors' have an effect on career advancement intentions of LPNs. Our results suggest that Nursing Managers should create a supportive working environment where the LPN would feel encouraged to carry out the nursing role, thereby creating a positive image of nursing in general which would lead to career motivation and pursuing RN status.

  1. Explaining postnatal growth plasticity in a generalist brood parasite

    NASA Astrophysics Data System (ADS)

    Remeš, Vladimír

    2010-03-01

    Selection of a particular host has clear consequences for the performance of avian brood parasites. Experimental studies showed that growth rate and fledging mass of brood parasites varied between host species independently of the original host species. Finding correlates of this phenotypic plasticity in growth is important for assessing adaptiveness and potential fitness consequences of host choice. Here, I analyzed the effects of several host characteristics on growth rate and fledging mass of the young of brown-headed cowbird ( Molothrus ater), a generalist, non-evicting brood parasite. Cowbird chicks grew better in fast-developing host species and reached higher fledging mass in large hosts with fast postnatal development. A potential proximate mechanism linking fast growth and high fledging mass of cowbird with fast host development is superior food supply in fast-developing foster species. So far, we know very little about the consequences of the great plasticity in cowbird growth for later performance of the adult parasite. Thus, cowbird species could become interesting model systems for investigating the role of plasticity and optimization in the evolution of growth rate in birds.

  2. Climate change alters the structure of arctic marine food webs due to poleward shifts of boreal generalists.

    PubMed

    Kortsch, Susanne; Primicerio, Raul; Fossheim, Maria; Dolgov, Andrey V; Aschan, Michaela

    2015-09-07

    Climate-driven poleward shifts, leading to changes in species composition and relative abundances, have been recently documented in the Arctic. Among the fastest moving species are boreal generalist fish which are expected to affect arctic marine food web structure and ecosystem functioning substantially. Here, we address structural changes at the food web level induced by poleward shifts via topological network analysis of highly resolved boreal and arctic food webs of the Barents Sea. We detected considerable differences in structural properties and link configuration between the boreal and the arctic food webs, the latter being more modular and less connected. We found that a main characteristic of the boreal fish moving poleward into the arctic region of the Barents Sea is high generalism, a property that increases connectance and reduces modularity in the arctic marine food web. Our results reveal that habitats form natural boundaries for food web modules, and that generalists play an important functional role in coupling pelagic and benthic modules. We posit that these habitat couplers have the potential to promote the transfer of energy and matter between habitats, but also the spread of pertubations, thereby changing arctic marine food web structure considerably with implications for ecosystem dynamics and functioning. © 2015 The Authors.

  3. Intraguild interactions among specialised pollen feeders and generalist phytoseiids and their effect on citrus rust mite suppression.

    PubMed

    Maoz, Yonatan; Gal, Shira; Argov, Yael; Domeratzky, Sylvie; Coll, Moshe; Palevsky, Eric

    2016-05-01

    Antagonistic interactions among predators with shared prey are thought to hamper their ability to suppress herbivores. Our aim was to quantify intraguild interactions in omnivorous predatory mite assemblages in the presence of pollen, and assess their effect on pest populations. We focused on the following naturally occurring phytoseiid species in Israeli citrus orchards and their ability to suppress a key pest, the citrus rust mite (CRM) Phyllocoptruta oleivora (Eriophyidae): the generalists Amblyseius swirskii and Typhlodromus athiasae and the specialised pollen feeders Iphiseius degenerans, Euseius scutalis, E. stipulatus and E. victoriensis. Evaluations were performed on two spatial scales, tree seedlings and leaf discs. On seedlings, experiments were conducted to quantify the interactions between predators in the presence of pollen and its effects on CRM suppression. On leaf discs, intraguild interactions were studied between pairs of phytoseiid species in the presence of pollen without CRM. On seedlings, the specialised pollen predators were more effective at suppressing CRM populations than the generalist predators. In most cases, the more aggressive intraguild predator was the specialised pollen feeder. Similarly, leaf-disc experiments suggest that in these interactions the specialised pollen feeders tend to be the intraguild predators more often than the intraguild prey. © 2015 Society of Chemical Industry.

  4. Climate change alters the structure of arctic marine food webs due to poleward shifts of boreal generalists

    PubMed Central

    Kortsch, Susanne; Primicerio, Raul; Fossheim, Maria; Dolgov, Andrey V.; Aschan, Michaela

    2015-01-01

    Climate-driven poleward shifts, leading to changes in species composition and relative abundances, have been recently documented in the Arctic. Among the fastest moving species are boreal generalist fish which are expected to affect arctic marine food web structure and ecosystem functioning substantially. Here, we address structural changes at the food web level induced by poleward shifts via topological network analysis of highly resolved boreal and arctic food webs of the Barents Sea. We detected considerable differences in structural properties and link configuration between the boreal and the arctic food webs, the latter being more modular and less connected. We found that a main characteristic of the boreal fish moving poleward into the arctic region of the Barents Sea is high generalism, a property that increases connectance and reduces modularity in the arctic marine food web. Our results reveal that habitats form natural boundaries for food web modules, and that generalists play an important functional role in coupling pelagic and benthic modules. We posit that these habitat couplers have the potential to promote the transfer of energy and matter between habitats, but also the spread of pertubations, thereby changing arctic marine food web structure considerably with implications for ecosystem dynamics and functioning. PMID:26336179

  5. Quantifying predator dependence in the functional response of generalist predators.

    PubMed

    Novak, Mark; Wolf, Christopher; Coblentz, Kyle E; Shepard, Isaac D

    2017-06-01

    A long-standing debate concerns how functional responses are best described. Theory suggests that ratio dependence is consistent with many food web patterns left unexplained by the simplest prey-dependent models. However, for logistical reasons, ratio dependence and predator dependence more generally have seen infrequent empirical evaluation and then only so in specialist predators, which are rare in nature. Here we develop an approach to simultaneously estimate the prey-specific attack rates and predator-specific interference (facilitation) rates of predators interacting with arbitrary numbers of prey and predator species in the field. We apply the approach to surveys and experiments involving two intertidal whelks and their full suite of potential prey. Our study provides strong evidence for predator dependence that is poorly described by the ratio dependent model over manipulated and natural ranges of species abundances. It also indicates how, for generalist predators, even the qualitative nature of predator dependence can be prey-specific. © 2017 John Wiley & Sons Ltd/CNRS.

  6. An advanced practice psychiatric nurse's guide to professional writing.

    PubMed

    Campanelli, Peter C; Feferman, Robert; Keane, Chris; Lieberman, Harvey J; Roberson, Deborah

    2007-10-01

    Many good ideas are not communicated to the community of mental health practitioners because advanced practice psychiatric nurses (APPNs) are not being well informed about writing for public dissemination. This study aims to support APPNs through the various stages of manuscript preparation so they can enlarge the scope of their written contributions to the mental health field. An appreciation for the skills, mechanics, and attitudes that support the authoring enterprise can result in APPNs enjoying the multiple benefits that accrue to those who write about their professional activities for clinical, administrative, advocacy, fund-raising, and other purposes.

  7. Unified Parkinson’s Disease Rating Scale-Motor Exam: Inter-rater reliability of advanced practice nurse and neurologist assessments

    PubMed Central

    Palmer, Janice L.; Coats, Mary A.; Roe, Catherine M.; Hanko, Shelly M.; Xiong, Chengjie; Morris, John C.

    2010-01-01

    Aim This paper is a report of a study to establish the inter-rater reliability of advanced practice nurse and neurologist neurological assessments which included ratings with the Unified Parkinson’s Disease Rating Scale-Motor Exam. Background Around the world, advanced practice nurses are performing tasks once completed by only physicians. To promote consumer and provider confidence, it is important to establish that nurse and physician ratings using assessment tools are similar. In addition in research settings, when different raters are used, establishment of inter-rater reliability for study assessments is needed. Method Advanced practice nurses and neurologists independently recorded findings on neurological examinations of 46 participants in a study conducted between August 2007 and January 2008. An intraclass correlation coefficient was calculated to estimate overall agreement between the nurse and neurologist ratings. Agreement for individual items measured on a dichotomous scale was assessed by calculating Cohen’s kappa. Results There was substantial agreement between advanced practice nurses and neurologists on the mean Unified Parkinson’s Disease Rating Scale-Motor Exam ratings (intraclass correlation coefficient = 0.65) and the U.S. National Alzheimer’s Coordinating Center Uniform Data Set neurological examination ratings of unremarkable findings (kappa = 0.74) and of gait disorder (kappa = 0.73). Moderate agreement (kappa = 0.53) was reached for the rating of whether all Unified Parkinson’s Disease Rating Scale-Motor Exam items were normal. Conclusion These findings are consistent with studies of the inter-rater agreement of the Unified Parkinson’s Disease Rating Scale-Motor Exam and support the conduct of neurological assessments by advanced practice nurses. PMID:20546368

  8. Capacity Ratios to Assess the Solvency of a College’s Advanced Pharmacy Practice Experience Program

    PubMed Central

    McClellan, Nicole H.; Byrd, Debbie C.

    2013-01-01

    Objective. To use the capacity ratio to determine solvency in 10 advanced pharmacy practice experiences (APPEs) offered by a college of pharmacy. Methods. Availability in each APPE was determined based on preceptor responses, and student need was tabulated from 3 preference forms. Capacity ratios were calculated by dividing preceptor availability by the sum of student requests plus 20% of student requests; ratios ≥ 1 indicated solvency. For the 3 required APPEs, minimum capacity ratios were calculated by dividing availability by the sum of student number plus 20% of the student number. When possible, the capacity ratio for the APPE was calculated by geographic zone. Results. The 3 required APPEs had statewide minimum capacity ratios that were consistent with solvency: advanced community (2.8), advanced institutional (1.6), and ambulatory care (2.5). Only 3 of 7 elective APPEs demonstrated solvency. The elective APPEs for which requests exceeded availability were association management (0.8), emergency medicine (0.8), cardiology (0.6), and human immunodeficiency virus (HIV) ambulatory care clinic (0.4). Analysis by zone revealed additional insolvent practice experiences in some locations. Conclusions. The capacity ratio allowed for assessment of 10 APPEs and identification of practice experience areas that need expansion. While the capacity ratio is a proposed standardized assessment, it does have some limitations, such as an inability to account for practice experience quality, scheduling conflicts, and geographic zone issues. PMID:23519687

  9. Advanced nursing practice and Newton's three laws of motion.

    PubMed

    Sturgeon, David

    This article considers the reasons for the development of advanced practice roles among nurses and other healthcare professions. It explores the implications of financial constraints, consumer preferences and the development of new healthcare services on the reorganization of professional boundaries. It makes use of Sir Isaac Newton's three laws of motion to demonstrate how professional development in nursing has taken place in response to a number of external influences and demands. It also considers the significance of skill mix for the nursing profession, in particular the development and likely expansion of the physician assistant role. The application of different professionals and grades within a healthcare team or organization is central to the Government's Agenda for Change proposals and nurses have successfully adopted a number of roles traditionally performed by doctors. Nurses have demonstrated that they are capable of providing high quality care and contributing directly to positive patient outcome. Advanced nursing roles should not only reflect the changing nature of healthcare work, they should also be actively engaged in reconstructing healthcare boundaries.

  10. Complete-block scheduling for advanced pharmacy practice experiences.

    PubMed

    Hatton, Randy C; Weitzel, Kristin W

    2013-12-01

    An innovative approach to meeting increased student demand for advanced pharmacy practice experiences (APPEs) is described, including lessons learned during a two-year pilot project. To achieve more efficient allocation of preceptor resources, the University of Florida College of Pharmacy (UFCOP) adopted a new APPE rotation model in which 20 pharmacy students per year complete all required and elective APPEs at one practice site, an affiliated academic medical center. Relative to the prevailing model of experiential training for Pharm.D. students, the "complete-block scheduling" model offers a number of potential benefits to students, preceptors, and the pharmacy school. In addition to potentially reduced student housing expenses and associated conveniences, complete-block scheduling may enable (1) more efficient use of teaching resources, (2) increased collaboration among preceptors, (3) greater continuity and standardization of educational experiences, and (4) enhanced opportunities for students to engage in longer and more complex research projects. The single-site APPE rotation model also can provide value to the training site by enabling the extension of clinical pharmacy services; for example, UFCOP students perform anticoagulation monitoring and discharge medication counseling at the host institution. Despite logistical and other challenges encountered during pilot testing of the new scheduling model, the program has been well received by students and preceptors alike. Complete-block APPE scheduling is a viable model for some health systems to consider as a means of streamlining experiential education practices and helping to ensure high-quality clinical rotations for Pharm.D. students.

  11. An Advanced Pharmacy Practice Experience in Sports Pharmacy

    PubMed Central

    2008-01-01

    Objective To establish and evaluate an advanced pharmacy practice experience (APPE) in sports pharmacy. Design Students actively participated in a variety of activities for this new 6-week elective APPE, including drug-testing collections, delivering presentations, and providing drug information. Students also learned about assays, compounding, and dispensing medications specifically for athletes, and visited various athletic medical facilities. Student were given written and practical certification examinations for drug-testing collections, and their specimen measurements were compared to those obtained by the testing laboratory for validation; satisfaction surveys were obtained from testing sites; and presentation evaluations were obtained from audience participants. Assessment Students were able to accurately measure pH and specific gravity of urine samples and all students passed the certification examination. Students rated the APPE very high. Also, students received high satisfaction ratings on surveys administered to the officials of the schools where they tested and members of the groups to whom they gave presentations. Conclusion Students gained experience and insight into the various roles of pharmacists in sports pharmacy and developed confidence in their ability to conduct drug-testing collections. PMID:18322580

  12. A Strategic Approach for Developing an Advanced Practice Workforce: From Postgraduate Transition-to-Practice Fellowship Programs and Beyond.

    PubMed

    Taylor, Dennis A; Broyhill, Britney S; Burris, Allison M; Wilcox, Mary Ann

    The healthcare provider landscape is rapidly changing. Given the imminent retirement of baby boomer physicians, implementation of the Affordable Care Act, and the increased utilization of health care services by an ever-aging population, the supply of providers cannot keep pace with the demand for services. This has led to an increased utilization of advanced clinical practitioners (ACPs). This article shows how one large highly-matrixed health care system approached identifying this workforce, and how thought leaders worked collaboratively with physicians, administrators, and ACPs to meet a growing demand for providers. Carolinas HealthCare System developed a 3-pronged approach to this opportunity. The development of a Center for Advanced Practice was explored and implemented. This Center serves as a 2-way conduit of information and ideas between system administrators and providers. It also serves as a central source of regulatory and practice information for administrators and providers. The growing number of open ACP positions, along with the reluctance to employ novice and new graduate ACPs, led to the development of a postgraduate transition to practice fellowship program. This program's clinical tracks and curriculum are described. Finally, a collaborative effort between the health care system and a local university resulted in the local offering of an acute care nurse practitioner program, which allowed system nurses to continue their education without the need for relocation. Higher satisfaction and engagement, lower turnover, better career opportunities, more satisfied administrators, and physicians all contributed to the overwhelming success of this initiative.

  13. Advanced Practice Clinician Training for Neurology.

    PubMed

    Ermak, David M; Cox, Lori; Ahmed, Aiesha

    2017-04-26

    The specialty of Neurology is faced with a fundamental problem of economics: supply and demand. The projected increase in provider supply is unlikely to keep up with projected increases in patient-care demand. Many large academic centers have used residents to meet this patient-care demand. However, the conflict between education of residents and patient-care needs has created a hindrance to both of those missions. Many specialties have been using advanced practice clinicians (APCs) to help address the need for patient care. In the setting of a residency program, this availability of APCs can help to alleviate patient-care demands for the resident and allow for better allocated educational time. Neurology has not historically been a popular choice for APCs and a standardized educational curriculum for a Neurology APC has not been established. The authors share an example curriculum recently implemented for training new inpatient Neurology APCs. This curriculum includes a 12-week program complete with rotations through various subspecialties and proposes fundamental lecture topics for use in education. The authors share their expectations for clinical duties that evolve over the course of the 12-week program in conjunction with expectations for increasing clinical knowledge as well as efficiency in system utilization. The addition of APCs to support a busy inpatient Neurology practice has obvious beneficial implications but the integration and education of this new staff must be structured and well-designed to support the confidence of the APC in both their knowledge and their role as an indispensable member of the care team.

  14. Advanced practice nursing students' knowledge, self-efficacy, and attitudes related to depression in older adults: teaching holistic depression care.

    PubMed

    Delaney, Colleen; Barrere, Cynthia

    2012-01-01

    The aim of this study was to examine the knowledge, attitudes, and self-efficacy of advanced practice nursing students toward depression in older adults. Findings suggest that advanced practice nursing students are interested in caring for the whole person and desired more information on the physical and emotional-spiritual needs of older patients with depression. Suggestions for holistic nursing depression care education are presented.

  15. The roles of critical care advanced practice nurse.

    PubMed

    Sung, Young Hee; Yi, Young Hee; Kwon, In Gak; Cho, Yong Ae

    2006-12-01

    To determine and compare the perception among nurses and doctors of the roles and tasks of critical care advanced practice nurses (APNs) in order to establish standardized and formally agreed role criteria for such critical care APNs. This study measured and analyzed the necessity of each of the roles and tasks of critical care APNs, as perceived by nurses and doctors, through a survey of 121 participants: 71 nurses in 7 intensive care units (ICUs) at a general hospital in Seoul, and 50 doctors who used ICUs. Data collection utilized a questionnaire of 128 questions in the following fields: direct practice (79), leadership and change agent (17), consultation and collaboration (15), education and counseling (11), and research (6). Both the nurses' and the doctors' groups confirmed the necessity of critical care APNs, with doctors who frequently used ICUs indicating a particularly strong need. As for the priority of each role of critical care APNs, the nurses considered direct practice to be the most critical, followed by education and counseling, research, consultation and collaboration, and leadership and change agent. The doctors also considered direct practice to be the most critical, followed by education and counseling, consultation and collaboration, research, and leadership and change agent. There was a statistically significant difference between how the two groups regarded all the roles, except for the consultation and collaboration roles. As for the necessity of each role of critical care APNs, the nurses considered research to be the most necessary, followed by education and counseling, consultation and collaboration, leadership and change agent, and direct practice. The doctors, on the other hand, considered education and counseling to be the most necessary, followed by research, consultation and collaboration, leadership and change agent, and direct practice. The responses of the two groups to all the roles, except for education and counseling roles

  16. Cost-effectiveness of a WOC Advanced Practice Nurse in the Acute Care and Outpatient Setting

    PubMed Central

    2014-01-01

    Increasing numbers of advanced practice nurses who practice within the WOC specialty are challenged by the need to justify their role by demonstrating clinical and fiscal benefits to the employing agency. This View From Here column describes the steps I took while completing such an analysis for a position for a nurse practitioner with WOC certification in upstate New York. PMID:24918767

  17. The generalist Inga subnuda subsp. luschnathiana (Fabaceae): negative effect of floral visitors on reproductive success?

    PubMed

    Avila, R; Pinheiro, M; Sazima, M

    2015-05-01

    Inga species are characterised by generalist or mixed pollination system. However, this feature does not enhance reproductive rates in species with very low fruit set under natural conditions. Some ecological and genetic factors are associated with this feature, and to test the effect of massive visits on pollination success in Inga subnuda subsp. luschnathiana, we studied the efficacy of polyads deposited on stigmas of flowers isolated from visitors and polyads exposed to visitors. The proportion of polyads fixed in stigmas decreased after exposure to visitors (24 h) in comparison to stigmas isolated from visitors (hummingbirds, bees, wasps, hawkmoths and bats), and fruit set was very low. Furthermore, nectar production, sugar composition and other floral biology traits were evaluated. Increased nectar production, sugar availability and sucrose dominance during the night indicates adaptation to nocturnal visitors and supports their role as main pollinators; although the brush-flower morphology, time of anthesis, nectar dynamics and chemical composition also allow daytime visitors. Thus the species is an important resource for a diverse group of floral visitors. We conclude that excess visits (diurnal and nocturnal) are responsible for the decrease in fixed polyads in stigmas of I. subnuda subsp. luschnathiana flowers, thus contributing, with others factors, to its low fruit set. Therefore, the generalist pollination system does not result in reproductive advantages because the low fruit set in natural conditions could be the result of a negative effect of visitors/pollinators. © 2014 German Botanical Society and The Royal Botanical Society of the Netherlands.

  18. Geographic variation in feeding preference of a generalist herbivore: the importance of seaweed chemical defenses.

    PubMed

    McCarty, Amanda T; Sotka, Erik E

    2013-08-01

    The ecological impacts of generalist herbivores depend on feeding preferences, which can vary across and within herbivore species. Among mesoherbivores, geographic variation in host use can occur because host plants have a more restricted geographic distribution than does the herbivore, or there is local evolution in host preference, or both. We tested the role of local evolution using the marine amphipod Ampithoe longimana by rearing multiple amphipod populations from three regions (subtropical Florida, warm-temperate North Carolina and cold-temperate New England) and assaying their feeding preferences toward ten seaweeds that occur in some but not all regions. Six of the ten seaweeds produce anti-herbivore secondary metabolites, and we detected geographic variation in feeding preference toward five (Dictyota menstrualis, Dictyota ciliolata, Fucus distichus, Chondrus crispus and Padina gymnospora, but not Caulerpa sertularioides). Amphipod populations that co-occur with a chemically-rich seaweed tended to have stronger feeding preferences for that seaweed, relative to populations that do not co-occur with the seaweed. A direct test indicated that geographic variation in feeding preference toward one seaweed (D. ciliolata) is mediated by feeding tolerance for lipophilic secondary metabolites. Among the four seaweeds that produce no known secondary metabolites (Acanthophora, Ectocarpus, Gracilaria and Hincksia/Feldmannia spp.), we detected no geographic variation in feeding preference. Thus, populations are more likely to evolve greater feeding preferences for local hosts when those hosts produce secondary metabolites. Microevolution of feeding behaviors of generalist marine consumers likely depends on the availability and identity of local hosts and the strength of their chemical defenses.

  19. A Qualitative Analysis of an Advanced Practice Nurse-Directed Transitional Care Model Intervention

    ERIC Educational Resources Information Center

    Bradway, Christine; Trotta, Rebecca; Bixby, M. Brian; McPartland, Ellen; Wollman, M. Catherine; Kapustka, Heidi; McCauley, Kathleen; Naylor, Mary D.

    2012-01-01

    Purpose: The purpose of this study was to describe barriers and facilitators to implementing a transitional care intervention for cognitively impaired older adults and their caregivers lead by advanced practice nurses (APNs). Design and Methods: APNs implemented an evidence-based protocol to optimize transitions from hospital to home. An…

  20. Advanced unambiguous state discrimination attack and countermeasure strategy in a practical B92 QKD system

    NASA Astrophysics Data System (ADS)

    Ko, Heasin; Choi, Byung-Seok; Choe, Joong-Seon; Youn, Chun Ju

    2018-01-01

    Even though unconditional security of B92 quantum key distribution (QKD) system is based on the assumption of perfect positive-operator-valued measures, practical B92 systems only utilize two projective measurements. Unfortunately, such implementation may degrade the security of the B92 QKD system due to Eve's potential attack exploiting the imperfection of system. In this paper, we propose an advanced attack strategy with an unambiguous state discrimination (USD) measurement which makes practical B92 QKD systems insecure even under a lossless channel. In addition, we propose an effective countermeasure against the advanced USD attack model by monitoring double-click events. We further address a fundamental approach to make the B92 QKD system tolerable to attack strategies with USD measurements using a multi-qubit scheme.

  1. Meaningful Use of Data in Care Coordination by the Advanced Practice Registered Nurse: The TeleFamilies Project

    PubMed Central

    Looman, Wendy S.; Erickson, Mary M.; Garwick, Ann W.; Cady, Rhonda G.; Kelly, Anne; Pettey, Carrie; Finkelstein, Stanley M.

    2012-01-01

    Meaningful use of electronic health records to coordinate care requires skillful synthesis and integration of subjective and objective data by practitioners to provide context for information. This is particularly relevant in the coordination of care for children with complex special health care needs. The purpose of this paper is to present a conceptual framework and example of meaningful use within an innovative telenursing intervention to coordinate care for children with complex special health care needs. The TeleFamilies intervention engages an advanced practice nurse in a full-time care coordinator role within an existing hospital-based medical home for children with complex special health care needs. Care coordination is facilitated by the synthesis and integration of internal and external data using an enhanced electronic health record and telehealth encounters via telephone and videoconferencing between the advanced practice nurse and the family at home. The advanced practice nurse’s ability to maintain an updated plan of care that is shared across providers and systems and build a relationship over time with the patient and family supports meaningful use of these data. PMID:22948406

  2. Generalist care managers for the treatment of depressed medicaid patients in North Carolina: a pilot study.

    PubMed

    Landis, Suzanne E; Gaynes, Bradley N; Morrissey, Joseph P; Vinson, Nina; Ellis, Alan R; Domino, Marisa E

    2007-03-05

    In most states, mental illness costs are an increasing share of Medicaid expenditures. Specialized depression care managers (CM) have consistently demonstrated improvements in patient outcomes relative to usual primary care (UC), but are costly and may not be fully utilized in smaller practices. A generalist care manager (GCM) could manage multiple chronic conditions and be more accepted and cost-effective than the specialist depression CM. We designed a pilot program to demonstrate the feasibility of training/deploying GCMs into primary care settings. We randomized depressed adult Medicaid patients in 2 primary care practices in Western North Carolina to a GCM intervention or to UC. GCMs, already providing services in diabetes and asthma in both study arms, were further trained to provide depression services including self-management, decision support, use of information systems, and care management. The following data were analyzed: baseline, 3- and 6-month Patient Health Questionnaire (PHQ9) scores; baseline and 6-month Short Form (SF) 12 scores; Medicaid claims data; questionnaire on patients' perceptions of treatment; GCM case notes; physician and office staff time study; and physician and office staff focus group discussions. Forty-five patients were enrolled, the majority with preexisting depression. Both groups improved; the GCM group did not demonstrate better clinical and functional outcomes than the UC group. Patients in the GCM group were more likely to have prescriptions of correct dosing by chart data. GCMs most often addressed comorbid conditions (36%), then social issues (27%) and appointment reminders (14%). GCMs recorded an average of 46 interactions per patient in the GCM arm. Focus group data demonstrated that physicians valued using GCMs. A time study documented that staff required no more time interacting with GCMs, whereas physicians spent an average of 4 minutes more per week. GCMs can be trained in care of depression and other chronic

  3. Climate-associated phenological advances in bee pollinators and bee-pollinated plants

    PubMed Central

    Bartomeus, Ignasi; Ascher, John S.; Wagner, David; Danforth, Bryan N.; Colla, Sheila; Kornbluth, Sarah; Winfree, Rachael

    2011-01-01

    The phenology of many ecological processes is modulated by temperature, making them potentially sensitive to climate change. Mutualistic interactions may be especially vulnerable because of the potential for phenological mismatching if the species involved do not respond similarly to changes in temperature. Here we present an analysis of climate-associated shifts in the phenology of wild bees, the most important pollinators worldwide, and compare these shifts to published studies of bee-pollinated plants over the same time period. We report that over the past 130 y, the phenology of 10 bee species from northeastern North America has advanced by a mean of 10.4 ± 1.3 d. Most of this advance has taken place since 1970, paralleling global temperature increases. When the best available data are used to estimate analogous rates of advance for plants, these rates are not distinguishable from those of bees, suggesting that bee emergence is keeping pace with shifts in host-plant flowering, at least among the generalist species that we investigated. PMID:22143794

  4. Implementation of a professional portfolio: a tool to demonstrate professional development for advanced practice.

    PubMed

    Chamblee, Tracy B; Dale, Juanita Conkin; Drews, Barbie; Spahis, Joanna; Hardin, Teri

    2015-01-01

    The literature has a gap related to professional development for APRNs. In the United States, many health care organizations use clinical advancement programs for registered nurses, but APRNs are not often included in these programs. If APRNs are included, advancement opportunities are very limited. At CMC, implementation of a professional portfolio resulted in increased satisfaction among APPs regarding their ability to showcase professional growth and expertise, as well as the uniqueness of their advanced practice. Use of the professional portfolio led to improved recognition by APS and organizational leaders of APP performance excellence during the annual performance evaluation, as well as improved recognition among APP colleagues in terms of nominations for honors and awards.

  5. Work-based learning: supporting advanced perioperative practice.

    PubMed

    Quick, Julie

    2010-07-01

    The arrival of work-based learning awards in professional education offers an alternative route for healthcare professionals looking to undertake post-registration education. The unique way that work-based learning integrates individual learning needs with that of role requirements makes the award an ideal choice for the advanced perioperative practitioner (APP) who wishes to combine academic study with professional development. As an experienced and professionally qualified practitioner (Thatcher 2003) the APP will have an accumulation of knowledge, skills and experience that may go unrecognised in alternative awards. The term APP refers to a nurse, ODP or allied healthcare professional who undertakes a role that challenges the traditional boundaries of care within the perioperative environment (Radford 2004), such as that of a surgical care practitioner (SCP). Here Julie Quick, a SCP, examines the changes within post-registration education and in particular describes why work-based learning awards may be an appropriate choice for practitioners working at a higher level of practice.

  6. A renal transplantation advanced pharmacy practice experience.

    PubMed

    Chisholm, Marie A

    2006-02-15

    To establish and evaluate an ambulatory care renal transplantation clinic advanced pharmacy practice experience (APPE). Students spend 5 weeks performing pharmaceutical care activities for renal transplant patients, presenting health-related topics, and conducting research. A paired t test was used to determine differences between students' pre- and post-APPE test scores. Standardized evaluations completed by the preceptor and the students were used to evaluate learning and the APPE. Posttest scores were significantly higher than pretest scores (n = 17; 88.2 +/- 7.3 vs 55.9 +/- 22.4; p < 0.001). Overall, students found this APPE enjoyable and believed that it increased their knowledge concerning transplant medicine and patient care. With the recommendation that all transplant programs have clinical pharmacy services, it is imperative to train students to care for transplant patients. Information in this manuscript can be used as a guide for utilizing the combined resources from schools of pharmacy and transplantation centers to implement a renal transplant ambulatory care APPE.

  7. A Systematic Review of End-of-Life Care Communication Skills Training for Generalist Palliative Care Providers: Research Quality and Reporting Guidance.

    PubMed

    Brighton, Lisa Jane; Koffman, Jonathan; Hawkins, Amy; McDonald, Christine; O'Brien, Suzanne; Robinson, Vicky; Khan, Shaheen A; George, Rob; Higginson, Irene J; Selman, Lucy Ellen

    2017-09-01

    End-of-life care (EoLC) communication skills training for generalist palliative care providers is recommended in policy guidance globally. Although many training programs now exist, there has been no comprehensive evidence synthesis to inform future training delivery and evaluation. To identify and appraise how EoLC communication skills training interventions for generalist palliative care providers are developed, delivered, evaluated, and reported. Systematic review. Ten electronic databases (inception to December 2015) and five relevant journals (January 2004 to December 2015) were searched. Studies testing the effectiveness of EoLC communication skills training for generalists were included. Two independent authors assessed study quality. Descriptive statistics and narrative synthesis are used to summarize the findings. From 11,441 unique records, 170 reports were identified (157 published, 13 unpublished), representing 160 evaluation studies of 153 training interventions. Of published papers, eight were of low quality, 108 medium, and 41 high. Few interventions were developed with service user involvement (n = 7), and most were taught using a mixture of didactics (n = 123), reflection and discussion (n = 105), and role play (n = 86). Evaluation designs were weak: <30% were controlled, <15% randomized participants. Over half (n = 85) relied on staff self-reported outcomes to assess effectiveness, and 49% did not cite psychometrically validated measures. Key information (e.g., training duration, participant flow) was poorly reported. Despite a proliferation of EoLC communication skills training interventions in the literature, evidence is limited by poor reporting and weak methodology. Based on our findings, we present a CONSORT statement supplement to improve future reporting and encourage more rigorous testing. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

  8. Comprehensive nursing case management. An advanced practice model.

    PubMed

    Taylor, P

    1999-01-01

    Under managed care and capitated reimbursement systems, case management is a core strategy for providing high-quality, cost-effective care by decreasing fragmentation, enhancing quality, ensuring efficient use of resources, and containing costs. Although case management is used in various areas of the healthcare arena, it suffers from a lack of consensus regarding its definition, essential components, and appropriate application. The purpose of this paper is to examine the components and limitations of existing case management models, outline the competencies of an effective case manager, and present a model of advanced practice nursing case management that focuses on a continuum of care that integrates medical and psychosocial resources to promote optimal clinical fiscal outcomes and enables patients to work as partners with the healthcare team in facilitating and maintaining their physical and emotional well-being.

  9. Neighborhood geographical factors and the presence of advanced community pharmacy practice sites in Greater Chicago.

    PubMed

    Johnson, Charisse L; Crawford, Stephanie Y; Lin, Swu-Jane; Salmon, J Warren; Smith, Miriam Mobley

    2009-02-19

    To determine the availability of experiential learning opportunities in culturally diverse areas and to identify opportunities and barriers to attract and sustain sites for the University of Illinois at Chicago College of Pharmacy. Utilizing variables of census tract income, racial/ethnicity composition and crime index, data analyses included descriptive statistics and multivariate logistic regression. Faculty members involved in experiential education were interviewed to identify other factors influencing site placement and selection for community-based advanced pharmacy practice experiences (APPEs). Median family income and Asian population were significantly higher and black population was significantly lower in census tracts with community APPE sites than in census tracts without APPE sites (p < 0.05). No significant differences were found in the population variables of white and Latino populations and crime index. The Asian population variable was the only significant predictor of an APPE site (p = 0.0148) when controlling for other variables. Distance from the College, pharmacy staffing issues, goodwill, influence of district and corporate managers, and strategic initiatives were critical considerations in site establishment and overall sustainability. Advanced community pharmacy practice sites were fairly well distributed across metropolitan Chicago, indicating that exposure to diverse populations during the advanced community practice experiences parallels with strategic College objectives of expanding and diversifying experiential sites to enhance pharmacy students' abilities to meet emerging patient care challenges and opportunities.

  10. Inter-professional work based learning within an MSc in Advanced Practice: lessons from one UK higher education programme.

    PubMed

    Gaskell, Lynne; Beaton, Susan

    2010-09-01

    This paper will describe the implementation of inter-professional work based education (IPE) in one postgraduate Advanced Practitioner programme in the UK. The concept of Advanced Practice has developed as a response of a number of drivers including change in junior doctor training; government policy and increasing demands on the central government funded UK health service (the NHS). The programme was commissioned by the then greater Manchester Strategic Health Authority (now NHS North West) to meet service needs. The educational philosophy underpinning the MSc Advanced Practice (health and social care) provided by the University of Salford is IPE linked to work based learning. The process of work based learning (WBL) and inter-professional learning underpinning the programme will be discussed in relation to feedback from university staff, Advanced Practitioner (AP) students and employer feedback taken from programme and module evaluations. We argue that IPE at this level facilitates a greater understanding of the connectivity between professionals working in the health care system in the UK; a better understanding of the skills and knowledge base of colleagues; more inter-professional working and appropriate referrals in the work place. This has raised the profile of Advanced Practice (AP) in the region and ultimately resulted in better patient care with more effective and efficient use of resources (Acton Shapiro, 2006, 2008). (c) 2009 Elsevier Ltd. All rights reserved.

  11. The role of the clinical nurse specialist/neonatal nurse practitioner in a breastfeeding clinic: a model of advanced practice.

    PubMed

    Gibbins, S A; Green, P E; Scott, P A; MacDonell, J W

    2000-03-01

    A commitment to quality health care requires the development of innovative models of care. An example of such a model is the Clinical Nurse Specialist/Neonatal Nurse Practitioner in the role as consultant to Lactation Consultants in a large breastfeeding clinic. The role of the Clinical Nurse Specialist/Neonatal Nurse Practitioner in this ambulatory setting encompasses all the dimensions of the advanced practice model including research, leadership, education, and clinical practice. The evolution of this model of care is described. A conceptual framework of this advanced practice model is presented, supported by examples of the role in the clinic.

  12. Prescriptive authority for advanced practice nurses: current and future perspectives.

    PubMed

    McDermott, K C

    1995-09-01

    To present an overview of the issues related to prescriptive authority and advanced practice nurses (APNs) in oncology. Professional journals and books, print media, and professional and government releases. Discussion of issues related to complex political, educational, economic, and healthcare environmental factors. Strategies to achieve increased recognition for APN prescriptive authority include increasing APNs' knowledge about the effects of the political process on prescriptive authority, educating legislators and consumers, promoting standardization of pharmacology curricula, and encouraging formation of coalitions. Failure to pass a national healthcare plan, escalating managed-care markets, and the reform efforts of individual states to forge their own healthcare initiatives will challenge the APN's ability to practice and prescribe. The subject of prescriptive authority highlights the controversies and debates that APNs encounter in a dynamic healthcare environment. These include the complexity of state-to-state regulations, non-nursing professions making key decisions regarding scope of practice and prescriptive authority, and the challenge for APNs to carve out new roles while overcoming state regulatory inconsistencies and market-reform barriers. If not resolved, these issues will continue to prevent qualified APNs from providing appropriate and comprehensive care to patients with cancer.

  13. Advancing technician practice: Deliberations of a regulatory board.

    PubMed

    Adams, Alex J

    2018-01-01

    In 2016, the Idaho State Board of Pharmacy (U.S.) undertook a major rulemaking initiative to advance pharmacy practice by broadening the ability of pharmacists to delegate tasks to pharmacy technicians. The new rules of the Board thus moved the locus of control in technician scope of practice from law to pharmacist delegation. Pharmacist delegation is individualistic and takes into account the individual technician's capabilities, the pharmacist's comfort level, facility policies, and the risk mitigation strategies present at the facility, among other factors. State law limits, by contrast, are rigid and can mean that pharmacists are unable to delegate tasks that are or could otherwise be within the abilities of their technicians. The expanded technician duties are in two domains: 1) medication dispensing support (e.g., tech-check-tech, accepting verbal prescriptions, transferring prescriptions, and performing remote data entry); and 2) technical support for pharmacist clinical services (e.g., administering immunizations). This commentary reviews the evidence behind these expanded duties, as well as the key regulatory decision points for each task. The Board's rules and approach may prove useful to other states and even other governing bodies outside the U.S. as they consider similar issues. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Community-based clinical education increases motivation of medical students to medicine of remote area: comparison between lecture and practice.

    PubMed

    Tani, Kenji; Yamaguchi, Harutaka; Tada, Saaya; Kondo, Saki; Tabata, Ryo; Yuasa, Shino; Kawaminami, Shingo; Nakanishi, Yoshinori; Ito, Jun; Shimizu, Nobuhiko; Obata, Fumiaki; Shin, Teruki; Bando, Hiroyasu; Kohno, Mitsuhiro

    2014-01-01

    In this study, we administered a questionnaire to medical students to evaluate the effect of community-based clinical education on their attitudes to community medicine and medicine in remote area. Questionnaires were given 4 times to all the students from first-year to sixth-year. Of 95 students, 65 students (68.4%) who completed all questionnaires, were used in this study. The intensity of students' attitudes was estimated by using visual analogue scale. The intensity of interest, a sense of fulfillment and passion in medicine of remote area was significantly increased after the community-based practice. On the other hand, the level of understanding in medicine in remote area was increased by the lecture not by the practice. The intensity of desire both to become a generalist and a specialist was significantly increased when the grade went up. Most of sixth-year students desired to have abilities of a generalist and a specialist simultaneously. This study shows that the community-based practice is more meaningful in increasing motivation in medicine in remote area than the lecture, and suggests that it is important to prepare more courses to experience community medicine to increase the number of physicians who desire to work in remote area.

  15. Factors influencing the development and implementation of advanced radiographer practice in Australia – a qualitative study using an interpretative phenomenological approach

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Page, Barbara A, E-mail: barbpage09@gmail.com; Bernoth, Maree; Davidson, Rob

    2014-09-15

    The purpose of this study was to explore the factors influencing the implementation or the lack of implementation of advanced practitioner role in Australia. This study uses an interpretative phenomenological approach to explore the in-depth real life issues, which surround the advanced practitioner as a solution to radiologist workforce shortages in Australia. Research participants are radiographers, radiation therapists and health managers registered with the Australian Institute of Radiography (AIR) and holding senior professional and AIR Board positions with knowledge of current advanced practice. In total, seven interviews were conducted revealing education, governance, technical, people issues, change management, government, costs andmore » timing as critical factors influencing advanced practice in Australia. Seven participants in this study perceived an advanced practice role might have major benefits and a positive impact on the immediate and long-term management of patients. Another finding is the greater respect and appreciation of each other's roles and expertise within the multidisciplinary healthcare team. Engagement is required of the critical stakeholders that have been identified as ‘blockers’ (radiologists, health departments) as well as identified allies (e.g. emergency clinicians, supportive radiologists, patient advocacy groups). The research supports that the AIR has a role to play for the professional identity of radiographers and shaping the advanced practice role in Australia.« less

  16. An Exploratory Study Investigating the Impact of a Differentiate Framework of Instruction on Generalist Teachers Perceived Confidence to Teach Visual Arts

    ERIC Educational Resources Information Center

    Eddles-Hirsch, Katrina

    2017-01-01

    This article reports on an exploratory study that addressed the low confidence levels of 80 generalist primary student teachers enrolled in a mandatory visual arts course. Previous studies in this area have found that a cycle of neglect exists in Australia, as a result of educators' lack of confidence in their ability to teach visual arts. This is…

  17. Ecological and morphological traits predict depth-generalist fishes on coral reefs

    PubMed Central

    Bridge, Tom C. L.; Luiz, Osmar J.; Coleman, Richard R.; Kane, Corinne N.; Kosaki, Randall K.

    2016-01-01

    Ecological communities that occupy similar habitats may exhibit functional convergence despite significant geographical distances and taxonomic dissimilarity. On coral reefs, steep gradients in key environmental variables (e.g. light and wave energy) restrict some species to shallow depths. We show that depth-generalist reef fishes are correlated with two species-level traits: caudal fin aspect ratio and diet. Fishes with high aspect ratio (lunate) caudal fins produce weaker vortices in the water column while swimming, and we propose that ‘silent swimming’ reduces the likelihood of detection and provides an advantage on deeper reefs with lower light irradiance and water motion. Significant differences in depth preference among trophic guilds reflect variations in the availability of different food sources along a depth gradient. The significance of these two traits across three geographically and taxonomically distinct assemblages suggests that deep-water habitats exert a strong environmental filter on coral reef-fish assemblages. PMID:26791616

  18. Integrating interprofessional collaboration skills into the advanced practice registered nurse socialization process.

    PubMed

    Farrell, Kathleen; Payne, Camille; Heye, Mary

    2015-01-01

    The emergence of interprofessional collaboration and practice as a means to provide patient-centered care and to decrease the current fragmentation of health care services in the 21st century provides a clear and unique opportunity for the advanced practice registered nurse (APRN) to assume a key role. For APRNs and other health care providers, to participate effectively as team members requires an interprofessional mindset. Development of interprofessional skills and knowledge for the APRN has been hindered by a silo approach to APRN role socialization. The Institute of Medicine Report (IOM; 2010) states that current health care systems should focus on team collaboration to deliver accessible, high-quality, patient-centered health care that addresses wellness and prevention of illness and adverse events, management of chronic illness, and increased capacity of all providers on the team. The purpose of this article is to demonstrate the need to incorporate interprofessional education (IPE) into the socialization models used in advanced practice nursing programs. IPE requires moving beyond profession-specific educational efforts to engage students of different health care professions in interactive learning. Being able to work effectively as member of a clinical team while a student is a fundamental part of that learning (Interprofessional Education Collaborative Expert Panel, 2011). The objective of IPE curriculum models in graduate nursing programs is to educate APRNs in the development of an interprofessional mindset. Interprofessional collaboration and coordination are needed to achieve seamless transitions for patients between providers, specialties, and health care settings (IOM, 2010). Achieving the vision requires the continuous development of interprofessional competencies by APRNs as part of the learning process, so that upon entering the workforce, APRNs are ready to practice effective teamwork and team-based care. Socialization of the professional APRN

  19. Attributes of advanced practice registered nurse care coordination for children with medical complexity.

    PubMed

    Cady, Rhonda G; Kelly, Anne M; Finkelstein, Stanley M; Looman, Wendy S; Garwick, Ann W

    2014-01-01

    Care coordination is an essential component of the pediatric health care home. This study investigated the attributes of relationship-based advanced practice registered nurse care coordination for children with medical complexity enrolled in a tertiary hospital-based health care home. Retrospective review of 2,628 care coordination episodes conducted by telehealth over a consecutive 3-year time period for 27 children indicated that parents initiated the majority of episodes and the most frequent reason was acute and chronic condition management. During this period, care coordination episodes tripled, with a significant increase (p < .001) between years 1 and 2. The increased episodes could explain previously reported reductions in hospitalizations for this group of children. Descriptive analysis of a program-specific survey showed that parents valued having a single place to call and assistance in managing their child's complex needs. The advanced practice registered nurse care coordination model has potential for changing the health management processes for children with medical complexity. Copyright © 2014 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.

  20. Health Care Providers’ Attitudes and Practices Regarding the use of Advance Directives in a Military Health Care Setting

    DTIC Science & Technology

    1998-10-02

    PROVIDERS’ ATTITUDES AND PRACTICES REGARDING THE USE OF ADVANCE DIRECTIVES IN A MILITARY HEALTH CARE SETTING by Bridget L. Larew, Maj, USAF, NC Thesis...entitled: "HEALTH CARE PROVIDER’S ATTITUDES AND PRACTICES REGARDING THE PURPOSE AND USE OF ADVANCE DIRECTIVES IN A MILITARY HEALTH CARE SETTING" beyond...health care, recognized under State law (whether statutory or as recognized by the courts of the State) and relating to the provision of such care

  1. Limber Pine (Pinus flexilis James), a Flexible Generalist of Forest Communities in the Intermountain West.

    PubMed

    Windmuller-Campione, Marcella A; Long, James N

    2016-01-01

    As forest communities continue to experience interactions between climate change and shifting disturbance regimes, there is an increased need to link ecological understanding to applied management. Limber pine (Pinus flexilis James.), an understudied species of western North America, has been documented to dominate harsh environments and thought to be competitively excluded from mesic environments. An observational study was conducted using the Forest Inventory and Analysis Database (FIAD) to test the competitive exclusion hypothesis across a broad elevational and geographic area within the Intermountain West, USA. We anticipated that competitive exclusion would result in limber pine's absence from mid-elevation forest communities, creating a bi-modal distribution. Using the FIAD database, limber pine was observed to occur with 22 different overstory species, which represents a surprising number of the woody, overstory species commonly observed in the Intermountain West. There were no biologically significant relationships between measures of annual precipitation, annual temperature, or climatic indices (i.e. Ombrothermic Index) and limber pine dominance. Limber pine was observed to be a consistent component of forest communities across elevation classes. Of the plots that contained limber pine regeneration, nearly half did not have a live or dead limber pine in the overstory. However, limber pine regeneration was greater in plots with higher limber pine basal area and higher average annual precipitation. Our results suggest limber pine is an important habitat generalist, playing more than one functional role in forest communities. Generalists, like limber pine, may be increasingly important, as managers are challenged to build resistance and resilience to future conditions in western forests. Additional research is needed to understand how different silvicultural systems can be used to maintain multi-species forest communities.

  2. The league of extraordinary generalists: a qualitative study of professional identity and perceptions of role of GPs working on a national after hours helpline in Australia.

    PubMed

    McKenzie, Rosemary; Williamson, Michelle

    2016-04-22

    Telephone triage and advice services (TTAS) have become commonplace in western health care systems particularly as an aid to patient access and demand management in the after hours period. In 2011 an after hours general practitioner (GP) helpline was established as a supplementary service to existing 24-h nurse-TTAS in Australia. Callers to the service in the after hours period who are triaged by a nurse as needing to see a GP immediately or within 24 h may speak with a GP on the line to obtain further assessment and advice. While much research has been undertaken on the roles of nurses in TTAS and the professional identities and attitudes to new technology of community-based GPs, little is known of the perceptions of role and identity of GPs providing after hours advice on primary care helplines. This qualitative study explored the perceptions of professional identity and role, motivations and contributions to the health system of GPs employed on the Australian afterhours GP helpline in 2011-2013. The study took a phenomenographic approach seeking to understand the essence of being a telephone GP, probing professional identity while also exploring role tensions. Twelve GPs, or 15% of the helpline GP workforce participated in the qualitative study. The GPs experienced both personal and professional benefits and believed they were strengthening patient care and the Australian health system. However the role required a re-alignment of practice that challenged professional autonomy, the doctor-patient relationship and commitment to continuity of care. Some GPs made this role realignment more readily than others and were well suited to the helpline role. There was a strong collegial bond amongst the helpline GPs which facilitated the maintenance of professional autonomy. Telephone GP assessment and advice does not demonstrate the same breadth as face-to-face practice and provides little opportunity for continuity of care, but this has not prevented those performing the

  3. Delta's Key to the TOEFL iBT[R]: Advanced Skill Practice. Revised Edition

    ERIC Educational Resources Information Center

    Gallagher, Nancy

    2012-01-01

    Delta's Key to the TOEFL iBT: Advanced Skill Practice is a revised and updated edition of Delta's Key to the Next Generation TOEFL Test. Since the introduction of the TOEFL iBT in 2005, there have been significant changes to some of the test questions, particularly the integrated writing and integrated speaking tasks. The new 2011 edition of…

  4. The perceived benefits of a two-year period of extended specialty training in general practice: the trainees' perspective.

    PubMed

    Agius, Steven; Lewis, Barry; Kirk, Bob; Hayden, Jacky

    2014-01-01

    Evidence suggests that, in the UK, the current three-year specialty training period in general practice is inadequate for equipping newly qualified GPs with mastery in all the necessary clinical and generic skills that would allow them to respond with optimum effect to the complexities and uncertainties of the generalist workplace. The North Western Deanery initiated an innovative pilot programme of extended (by 24 months) specialty training in general practice (GPST4-5). Nine ST3 trainees who had just 'graduated' from GPST, holding nMRCGP, were recruited, thereby formally deferring their application for a Certificate of Completion of Training (CCT). The programme was evaluated using established qualitative research techniques. Semi-structured interviews were conducted at fixed points and data were analysed for recurring discourses and themes using a framework thematic analysis. We obtained evidence of the benefits of extended specialty training in encouraging the development of clinical mastery alongside additional specialist skills, generalist and leadership competencies. We also identified the enabling factors for beneficial extended training, including workplace-based training under educational mentorship, combined with a blended learning programme and sustained expert- and peer-support.

  5. Inclusion of Specialist and Generalist Stimuli in Attract-and-Kill Programs: Their Relative Efficacy in Apple Maggot Fly (Diptera: Tephritidae) Pest Management.

    PubMed

    Morrison, William R; Lee, Doo-Hyung; Reissig, W Harvey; Combs, David; Leahy, Kathleen; Tuttle, Arthur; Cooley, Daniel; Leskey, Tracy C

    2016-08-01

    Investigating the chemical ecology of agricultural systems continues to be a salient part of integrated pest management programs. Apple maggot fly, a key pest of apple in eastern North America, is a visual specialist with attraction to host fruit-mimicking cues. These cues have been incorporated into red spherical traps used for both monitoring and behaviorally based management. Incorporating generalist or specialist olfactory cues can potentially increase the overall success of this management system. The primary aim of this study was to evaluate the attractiveness of a generalist olfactory cue, ammonium carbonate, and the specialist olfactory cue, a five-component apple volatile blend, when included as a component of a red attracticidal sphere system. Secondly, we assessed how critical it was to maintain minimal deviation from the optimal, full-round specialist visual stimulus provided by red spheres. Finally, attracticidal spheres were deployed with specialist olfactory cues in commercial apple orchards to evaluate their potential for effective management of apple maggot. Ammonium carbonate did not increase residency, feeding time, or mortality in the laboratory-based trials. Field deployment of specialist olfactory cues increased apple maggot captures on red spheres, while the generalist cue did not. Apple maggot tolerated some deviation from the optimal visual stimulus without reducing captures on red spheres. Attracticidal spheres hung in perimeter trees in orchards resulted in acceptable and statistically identical levels of control compared with standard insecticide programs used by growers. Overall, our study contributes valuable information for developing a reliable attract-and-kill system for apple maggot. Published by Oxford University Press on behalf of Entomological Society of America 2016. This work is written by US Government employees and is in the public domain in the United States.

  6. Conducting Reflective, Hands-On Research with Advanced Characterization Instruments: A High-Level Undergraduate Practical Exploring Solid-State Polymorphism

    ERIC Educational Resources Information Center

    Coles, S. J.; Mapp, L. K.

    2016-01-01

    An undergraduate practical exercise has been designed to provide hands-on, instrument-based experience of advanced characterization techniques. A research experience approach is taken, centered around the concept of solid-state polymorphism, which requires a detailed knowledge of molecular and crystal structure to be gained by advanced analytical…

  7. Practical management of everolimus-related toxicities in patients with advanced solid tumors.

    PubMed

    Grünwald, Viktor; Weikert, Steffen; Pavel, Marianne E; Hörsch, Dieter; Lüftner, Diana; Janni, Wolfgang; Geberth, Matthias; Weber, Matthias M

    2013-01-01

    Everolimus is an orally administered inhibitor of the mammalian target of rapamycin (mTOR), an intracellular protein kinase downstream of the phosphatidylinositol 3-kinase/AKT pathway involved in key components of tumorigenesis, including cell growth, proliferation, and angiogenesis. In the advanced cancer setting, based on favorable results from phase III trials, everolimus is indicated for the treatment of advanced renal cell carcinoma, advanced neuroendocrine tumors of pancreatic origin, and advanced hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancer. Additional oncology indications for everolimus include renal angiomyolipoma with tuberous sclerosis complex and subependymal giant-cell astrocytoma. Although it is generally well tolerated, with most adverse events of mild to moderate severity and manageable, everolimus exhibits a distinct adverse event profile that warrants guidance for proper diagnostic and medical management. This guidance is particularly important given the potential for widespread long-term use of everolimus. This review will focus on the most relevant toxicities associated with mTOR inhibitors and on their management. Practical treatment recommendations are presented for stomatitis, noninfectious pneumonitis, rash, selected metabolic abnormalities, and infections. Provided these events are rapidly identified and treated, the vast majority should resolve with minimal effect on treatment outcomes and patients' quality of life. Copyright © 2013 S. Karger AG, Basel.

  8. Developing and sustaining specialist and advanced practice roles in nursing and midwifery: A discourse on enablers and barriers.

    PubMed

    Fealy, Gerard M; Casey, Mary; O'Leary, Denise F; Mcnamara, Martin S; O'Brien, Denise; O'Connor, Laserina; Smith, Rita; Stokes, Diarmuid

    2018-06-12

    The aim of this discursive paper is to collate, synthesise and discuss published evidence and expert professional opinion on enablers and barriers to the development and sustainability of specialist and advanced practice roles in nursing and midwifery. Expanded practice is a response to population health needs, healthcare costs and practitioners' willingness to expand their scope of practice through enhanced responsibility, accountability and professional autonomy. This discursive paper is based on a rapid review of literature on enablers and barriers to the development and sustainability of specialist and advanced practice roles and is part of a wider policy analysis. We analysed and synthesised of 36 research articles, reviews and discussion papers on enablers and barriers in the development and sustainability of expanded practice roles. Several factors enable role expansion, including: role clarity; credentialing and endorsement; availability of education for expanded roles; individual practitioners' dispositions towards role expansion; support from peers, other professionals and the work organisation; and costs. Where limited or absent, these same factors can constrain role expansion. Enabling nurses and midwives to practice to their full scope of education and expertise is a global challenge for disciplinary leadership, a national challenge for professional regulation, and a local challenge for employers and individual clinicians. These challenges need to be addressed through multi-stakeholder coordinated efforts at these four levels. This discursive paper synthesises empirical evidence and expert professional opinion on the factors that enable or hinder the development and sustainability of specialist and advanced practice roles. Providing a critical appraisal of current knowledge, it provides a reference source for disciplinary debate and policy development regarding the nursing and midwifery resource and informs clinicians of the myriad issues that can

  9. Job satisfaction of advanced practice nurses in the Veterans Health Administration.

    PubMed

    Faris, Judith A; Douglas, Marilyn K; Maples, Deanna C; Berg, Laurie R; Thrailkill, Ann

    2010-01-01

    The purpose of this study was to describe the level of job satisfaction and barriers to practice for advanced practice nurses (APNs) employed by the Veterans Health Administration (VHA). The Misener Nurse Practitioner Job Satisfaction Survey (MNPJSS) and an investigator-developed questionnaire were completed by a self-selected, convenience sample of 1,983 APNs who responded to an internal VHA email invitation (61% response rate) to participate in an anonymous on-line survey. Respondents reported being minimally satisfied with their job overall, most satisfied with their benefits and least satisfied with professional growth and intrapractice collegiality. They scored lower than their private sector peers for total job satisfaction and all subscales except benefits, as compared to samples of three smaller studies. Clinical nurse specialists reported greater job satisfaction then NPs. The most frequently cited barriers to practice were: too many non-APN tasks, lack of administrative support, and inadequate time to do research. Strategies for improving professional growth and intra-practice collegiality are needed. APNs' job satisfaction may be improved in these areas by mentoring of new APN graduates and administrative approval for participating in research. Additional administrative support is needed to decrease the amount of non-APN tasks and clerical duties.

  10. Financial viability, benefits and challenges of employing a nurse practitioner in general practice.

    PubMed

    Helms, Christopher; Crookes, Jo; Bailey, David

    2015-04-01

    This case study examines the financial viability, benefits and challenges of employing a primary healthcare (PHC) nurse practitioner (NP) in a bulk-billing healthcare cooperative in the Australian Capital Territory. There are few empirical case reports in the Australian literature that demonstrate financial sustainability of this type of healthcare professional in primary healthcare. This case study demonstrates that the costs of employing a PHC-NP in general practice are offset by direct and indirect Medicare billings generated by the PHC-NP, resulting in a cost-neutral healthcare practitioner. The success of this model relies on bidirectional collaborative working relationships amongst general practitioners and NPs. PHC-NPs should have a generalist scope of practice and specialist expertise in order to maximise their utility within the general practice environment.

  11. Relationships among factors affecting advanced practice registered nurses' job satisfaction and intent to leave: A systematic review.

    PubMed

    Han, Robin M; Carter, Patricia; Champion, Jane Dimmitt

    2018-02-01

    This systematic review explores relationships between advanced practice registered nurses' (APRN) job satisfaction and intent to leave. There exists a dearth of APRN providers compared with the ever-growing need for their services. Furthermore, the organizational costs associated with the APRN turnover are extremely high. It, therefore, behooves practice administrators to understand what factors most contribute to APRN job satisfaction and retention. A search of research databases CINAHL, PubMed, and PsycINFO, using keywords "Advanced Practice Registered Nurse," "job satisfaction," "intent to leave," "anticipated turnover," and "Nurse Practitioner" to yield articles included in this review. The strength of existing evidence for this topic is weak. Studies have found that extrinsic factors, such as administrative support and salary, significantly contribute to job dissatisfaction, whereas intrinsic factors, such as autonomy and finding work meaningful, most significantly contribute to job satisfaction. Additional research is needed to better understand the factors relating to APRN job satisfaction and dissatisfaction, and how those factors influence practitioners' intent to leave. Efforts to improve APRN job satisfaction will have positive implications for provider retention, practices, and patients. Administrators should consider the job satisfaction factors identified herein when implementing practice improvement and retention efforts.

  12. Enhancing the quality and safety of care through training generalist doctors: a longitudinal, mixed-methods study of a UK broad-based training programme.

    PubMed

    Bullock, Alison; Webb, Katie Louise; Muddiman, Esther; MacDonald, Janet; Allery, Lynne; Pugsley, Lesley

    2018-04-12

    Changing patient demographics make it ever more challenging to maintain the quality and safety of care. One approach to addressing this is the development of training for generalist doctors who can take a more holistic approach to care. The purpose of the work we report here is to consider whether a broad-based training programme prepares doctors for a changing health service. We adopted a longitudinal, mixed-methods approach, collecting questionnaire data from trainees on the broad-based training (BBT) programme in England (baseline n=62) and comparator trainees in the same regions (baseline n=90). We held 15 focus groups with BBT trainees and one-to-one telephone interviews with trainees post-BBT (n=21) and their Educational Supervisors (n=9). From questionnaire data, compared with comparator groups, BBT trainees were significantly more confident that their training would result in: wider perspectives, understanding specialty complementarity, ability to apply learning across specialties, manage complex patients and provide patient-focused care. Data from interviews and focus groups provided evidence of positive consequences for patient care from BBT trainees' ability to apply knowledge from other specialties. Specifically, insights from BBT enabled trainees to tailor referrals and consider patients' psychological as well as physical needs, thus adopting a more holistic approach to care. Unintended consequences were revealed in focus groups where BBT trainees expressed feelings of isolation. However, when we explored this sentiment on questionnaire surveys, we found that at least as many in the comparator groups sometimes felt isolated. Practitioners with an understanding of care across specialty boundaries can enhance patient care and reduce risks from poor inter-specialty communication. Internationally, there is growing recognition of the place of generalism in medical practice and the need to take a more person-centred approach. Broad-based approaches to

  13. Forest species diversity reduces disease risk in a generalist plant pathogen invasion

    USGS Publications Warehouse

    Haas, Sarah E.; Hooten, Mevin B.; Rizzo, David M.; Meentemeyer, Ross K.

    2011-01-01

    Empirical evidence suggests that biodiversity loss can increase disease transmission, yet our understanding of the 'diversity-disease hypothesis' for generalist pathogens in natural ecosystems is limited. We used a landscape epidemiological approach to examine two scenarios regarding diversity effects on the emerging plant pathogen Phytophthora ramorum across a broad, heterogeneous ecoregion: (1) an amplification effect exists where disease risk is greater in areas with higher plant diversity due to the pathogen's wide host range, or (2) a dilution effect where risk is reduced with increasing diversity due to lower competency of alternative hosts. We found evidence for pathogen dilution, whereby disease risk was lower in sites with higher species diversity, after accounting for potentially confounding effects of host density and landscape heterogeneity. Our results suggest that although nearly all plants in the ecosystem are hosts, alternative hosts may dilute disease transmission by competent hosts, thereby buffering forest health from infectious disease.

  14. Importance of direct patient care in advanced pharmacy practice experiences.

    PubMed

    Rathbun, R Chris; Hester, E Kelly; Arnold, Lindsay M; Chung, Allison M; Dunn, Steven P; Harinstein, Lisa M; Leber, Molly; Murphy, Julie A; Schonder, Kristine S; Wilhelm, Sheila M; Smilie, Kristine B

    2012-04-01

    The Accreditation Council for Pharmacy Education issued revised standards (Standards 2007) for professional programs leading to the Doctor of Pharmacy degree in July 2007. The new standards require colleges and schools of pharmacy to provide pharmacy practice experiences that include direct interaction with diverse patient populations. These experiences are to take place in multiple practice environments (e.g., community, ambulatory care, acute care medicine, specialized practice areas) and must include face-to-face interactions between students and patients, and students and health care providers. In 2009, the American College of Clinical Pharmacy (ACCP) identified concerns among their members that training for some students during the fourth year of pharmacy curriculums are essentially observational experiences rather than encounters where students actively participate in direct patient care activities. These ACCP members also stated that there is a need to identify effective mechanisms for preceptors to balance patient care responsibilities with students' educational needs in order to fully prepare graduates for contemporary, patient-centered practice. The 2010 ACCP Educational Affairs Committee was charged to provide recommendations to more effectively foster the integration of pharmacy students into direct patient care activities during advanced pharmacy practice experiences (APPEs). In this commentary, the benefits to key stakeholders (pharmacy students, APPE preceptors, clerkship sites, health care institutions, academic pharmacy programs) of this approach are reviewed. Recommendations for implementation of direct patient care experiences are also provided, together with discussion of the practical issues associated with delivery of effective APPE. Examples of ambulatory care and acute care APPE models that successfully integrate pharmacy students into the delivery of direct patient care are described. Enabling students to engage in high-quality patient care

  15. Cervical cancer screening in adolescents: an evidence-based internet education program for practice improvement among advanced practice nurses.

    PubMed

    Choma, Kim; McKeever, Amy E

    2015-02-01

    The literature reports great variation in the knowledge levels and application of the recent changes of cervical cancer screening guidelines into clinical practice. Evidence-based screening guidelines for the prevention and early detection of cervical cancer offers healthcare providers the opportunity to improve practice patterns among female adolescents by decreasing psychological distress as well as reducing healthcare costs and morbidities associated with over-screening. The purpose of this pilot intervention study was to determine the effects of a Web-based continuing education unit (CEU) program on advanced practice nurses' (APNs) knowledge of current cervical cancer screening evidence-based recommendations and their application in practice. This paper presents a process improvement project as an example of a way to disseminate updated evidence-based practice guidelines among busy healthcare providers. This Web-based CEU program was developed, piloted, and evaluated specifically for APNs. The program addressed their knowledge level of cervical cancer and its relationship with high-risk human papillomavirus. It also addressed the new cervical cancer screening guidelines and the application of those guidelines into clinical practice. Results of the study indicated that knowledge gaps exist among APNs about cervical cancer screening in adolescents. However, when provided with a CEU educational intervention, APNs' knowledge levels increased and their self-reported clinical practice behaviors changed in accordance with the new cervical cancer screening guidelines. Providing convenient and readily accessible up-to-date electronic content that provides CEU enhances the adoption of clinical practice guidelines, thereby decreasing the potential of the morbidities associated with over-screening for cervical cancer in adolescents and young women. © 2014 Sigma Theta Tau International.

  16. Limber Pine (Pinus flexilis James), a Flexible Generalist of Forest Communities in the Intermountain West

    PubMed Central

    Windmuller-Campione, Marcella A.; Long, James N.

    2016-01-01

    As forest communities continue to experience interactions between climate change and shifting disturbance regimes, there is an increased need to link ecological understanding to applied management. Limber pine (Pinus flexilis James.), an understudied species of western North America, has been documented to dominate harsh environments and thought to be competitively excluded from mesic environments. An observational study was conducted using the Forest Inventory and Analysis Database (FIAD) to test the competitive exclusion hypothesis across a broad elevational and geographic area within the Intermountain West, USA. We anticipated that competitive exclusion would result in limber pine’s absence from mid-elevation forest communities, creating a bi-modal distribution. Using the FIAD database, limber pine was observed to occur with 22 different overstory species, which represents a surprising number of the woody, overstory species commonly observed in the Intermountain West. There were no biologically significant relationships between measures of annual precipitation, annual temperature, or climatic indices (i.e. Ombrothermic Index) and limber pine dominance. Limber pine was observed to be a consistent component of forest communities across elevation classes. Of the plots that contained limber pine regeneration, nearly half did not have a live or dead limber pine in the overstory. However, limber pine regeneration was greater in plots with higher limber pine basal area and higher average annual precipitation. Our results suggest limber pine is an important habitat generalist, playing more than one functional role in forest communities. Generalists, like limber pine, may be increasingly important, as managers are challenged to build resistance and resilience to future conditions in western forests. Additional research is needed to understand how different silvicultural systems can be used to maintain multi-species forest communities. PMID:27575596

  17. Building to Make a Difference: Advanced Practice Nurses' Experience of Power.

    PubMed

    Schoales, Catherine A; Bourbonnais, Frances Fothergill; Rashotte, Judy

    2018-02-01

    Power is necessary for nurses to affect change in patient care and to move the nursing profession forward. Despite the evolving body of nursing research on power, there have been no studies that have investigated the nature of advanced practice nurses' (APNs') power. The purpose of this study was to explore the APNs' lived experience of power. Interpretive phenomenology guided the method and analysis. Eight APNs employed in a single Canadian tertiary care teaching health-care organization engaged in in-depth interviews. The overarching theme, building to make a difference, reflected the APNs' perception of power in their practice, which involved a passion to facilitate change in practice to improve patient care. Building to make a difference involved three themes: building on, building with, and building for. The APNs experienced more power-a process they described as power creep-when they used soft power that was shared with others to affect positive change in health care. These findings contribute to our understanding of how power is perceived and manifested in the APN role, thus further enabling organizations to create working conditions to support the APNs' endeavors to empower others.

  18. Neonatal physical therapy. Part I: clinical competencies and neonatal intensive care unit clinical training models.

    PubMed

    Sweeney, Jane K; Heriza, Carolyn B; Blanchard, Yvette

    2009-01-01

    To describe clinical training models, delineate clinical competencies, and outline a clinical decision-making algorithm for neonatal physical therapy. In these updated practice guidelines, advanced clinical training models, including precepted practicum and residency or fellowship training, are presented to guide practitioners in organizing mentored, competency-based preparation for neonatal care. Clinical competencies in neonatal physical therapy are outlined with advanced clinical proficiencies and knowledge areas specific to each role. An algorithm for decision making on examination, evaluation, intervention, and re-examination processes provides a framework for clinical reasoning. Because of advanced-level competency requirements and the continuous examination, evaluation, and modification of procedures during each patient contact, the intensive care unit is a restricted practice area for physical therapist assistants, physical therapist generalists, and physical therapy students. Accountable, ethical physical therapy for neonates requires advanced, competency-based training with a preceptor in the pediatric subspecialty of neonatology.

  19. Qualitative Analysis of Common Definitions for Core Advanced Pharmacy Practice Experiences

    PubMed Central

    Danielson, Jennifer; Weber, Stanley S.

    2014-01-01

    Objective. To determine how colleges and schools of pharmacy interpreted the Accreditation Council for Pharmacy Education’s (ACPE’s) Standards 2007 definitions for core advanced pharmacy practice experiences (APPEs), and how they differentiated community and institutional practice activities for introductory pharmacy practice experiences (IPPEs) and APPEs. Methods. A cross-sectional, qualitative, thematic analysis was done of survey data obtained from experiential education directors in US colleges and schools of pharmacy. Open-ended responses to invited descriptions of the 4 core APPEs were analyzed using grounded theory to determine common themes. Type of college or school of pharmacy (private vs public) and size of program were compared. Results. Seventy-one schools (72%) with active APPE programs at the time of the survey responded. Lack of strong frequent themes describing specific activities for the acute care/general medicine core APPE indicated that most respondents agreed on the setting (hospital or inpatient) but the student experience remained highly variable. Themes were relatively consistent between public and private institutions, but there were differences across programs of varying size. Conclusion. Inconsistencies existed in how colleges and schools of pharmacy defined the core APPEs as required by ACPE. More specific descriptions of core APPEs would help to standardize the core practice experiences across institutions and provide an opportunity for quality benchmarking. PMID:24954931

  20. A stakeholder-driven agenda for advancing the science and practice of scale-up and spread in health.

    PubMed

    Norton, Wynne E; McCannon, C Joseph; Schall, Marie W; Mittman, Brian S

    2012-12-06

    Although significant advances have been made in implementation science, comparatively less attention has been paid to broader scale-up and spread of effective health programs at the regional, national, or international level. To address this gap in research, practice and policy attention, representatives from key stakeholder groups launched an initiative to identify gaps and stimulate additional interest and activity in scale-up and spread of effective health programs. We describe the background and motivation for this initiative and the content, process, and outcomes of two main phases comprising the core of the initiative: a state-of-the-art conference to develop recommendations for advancing scale-up and spread and a follow-up activity to operationalize and prioritize the recommendations. The conference was held in Washington, D.C. during July 2010 and attended by 100 representatives from research, practice, policy, public health, healthcare, and international health communities; the follow-up activity was conducted remotely the following year. Conference attendees identified and prioritized five recommendations (and corresponding sub-recommendations) for advancing scale-up and spread in health: increase awareness, facilitate information exchange, develop new methods, apply new approaches for evaluation, and expand capacity. In the follow-up activity, 'develop new methods' was rated as most important recommendation; expanding capacity was rated as least important, although differences were relatively minor. Based on the results of these efforts, we discuss priority activities that are needed to advance research, practice and policy to accelerate the scale-up and spread of effective health programs.

  1. Framework for Evaluating the Impact of Advanced Practice Nursing Roles.

    PubMed

    Bryant-Lukosius, Denise; Spichiger, Elisabeth; Martin, Jacqueline; Stoll, Hansruedi; Kellerhals, Sabine Degen; Fliedner, Monica; Grossmann, Florian; Henry, Morag; Herrmann, Luzia; Koller, Antje; Schwendimann, René; Ulrich, Anja; Weibel, Lukas; Callens, Betty; De Geest, Sabina

    2016-03-01

    To address the gap in evidence-based information required to support the development of advanced practice nursing (APN) roles in Switzerland, stakeholders identified the need for guidance to generate strategic evaluation data. This article describes an evaluation framework developed to inform decisions about the effective utilization of APN roles across the country. A participatory approach was used by an international group of stakeholders. Published literature and an evidenced-based framework for introducing APN roles were analyzed and applied to define the purpose, target audiences, and essential elements of the evaluation framework. Through subsequent meetings and review by an expert panel, the framework was developed and refined. A framework to evaluate different types of APN roles as they evolve to meet dynamic population health, practice setting, and health system needs was created. It includes a matrix of key concepts to guide evaluations across three stages of APN role development: introduction, implementation, and long-term sustainability. For each stage, evaluation objectives and questions examining APN role structures, processes, and outcomes from different perspectives (e.g., patients, providers, managers, policy-makers) were identified. A practical, robust framework based on well-established evaluation concepts and current understanding of APN roles can be used to conduct systematic evaluations. The evaluation framework is sufficiently generic to allow application in developed countries globally, both for evaluation as well as research purposes. © 2016 Sigma Theta Tau International.

  2. Shifting public health practice to advance health equity: recommendations from experts and community leaders.

    PubMed

    Knight, Erin K

    2014-01-01

    While the evidence base regarding the social determinants of health and their relationship to health inequities grows, the field of public health is challenged to translate this knowledge into practice changes that advance health equity. Drawing on the knowledge, beliefs, and experiences of public health experts and community leaders working to advance health equity, our objective was to develop and disseminate recommendations for changing public health practice to better address this problem. We conducted semistructured, qualitative telephone interviews (n = 25) with key informants. Interviews were recorded and transcribed, and data were coded and analyzed using both inductive and deductive methods. Member checks were used to enhance quality. A purposeful sample of key informants was selected from content experts and community leaders involved with the development of the Unnatural Causes public impact campaign. Participants represented state and local health departments, community-based organizations, national research/advocacy organizations, and academic institutions across the country. Participants distinguished between social determinants of health and their structural precursors in social and political institutions. They believed that the field of public health has an obligation to address health inequities and shifts in practice are needed that focus more attention on societal factors that underlie such inequities. According to participants, specific practice changes are difficult to identify because actions should be community specific and community driven. Recommended approaches that may be adapted to community-based needs and assets include building nontraditional partnerships, engaging in political advocacy, promoting community leadership, collecting better data on social conditions and institutional factors, and enhancing communication for health equity. Recommended shifts in practice may be facilitated by revisiting our understanding of the 3 core

  3. Chronic morbidities after traumatic brain injury: an update for the advanced practice nurse.

    PubMed

    Bay, Esther H; Chartier, Kattlynn S

    2014-06-01

    Emerging data suggest that traumatic brain injury (TBI) is a disease process with considerable long-range morbidities requiring lifelong monitoring and treatment. Multiple chronic morbidities develop across the life span after TBI, including mental health disorders, headaches, seizures, and neuroendocrine imbalances as well as chronic diseases. Still, there has been limited focus on effective guides and strategies for helping persons with TBI meet their chronic health needs as they live with the consequences of TBI. The advanced practice nurse is well positioned to participate collaboratively in practices that promote health screening and chronic disease management after TBI to ameliorate distress and enhance quality of life as persons with TBI live with lifelong consequences.

  4. Infusing informatics into interprofessional education: the iTEAM (Interprofessional Technology Enhanced Advanced practice Model) project.

    PubMed

    Skiba, Diane J; Barton, Amy J; Knapfel, Sarah; Moore, Gina; Trinkley, Katy

    2014-01-01

    The iTEAM goal is to prepare advanced practice nurses, physicians and pharmacists with the interprofessional (IP) core competencies (informatics, patient centric, quality-focused, evidence based care) to provide technology enhanced collaborative care by: offering technology enhanced learning opportunities through a required informatics course, advanced practice courses (team based experiences with both standardized and virtual patients) and team based clinical experiences including e-health experiences. The innovative features of iTEAM project will be achieved through use of social media strategies, a web accessible Electronic Health Records (EHRs) system, a Virtual Clinic/Hospital in Second Life, various e-health applications including traditional telehealth tools and consumer oriented tools such as patient portals, social media consumer groups and mobile health (m-health) applications for health and wellness functions. It builds upon the schools' rich history of IP education and includes clinical partners, such as the VA and other clinical sites focused on care for underserved patient populations.

  5. Report on the APNA National Psychiatric Mental Health Advanced Practice Registered Nurse Survey.

    PubMed

    Delaney, Kathleen R; Drew, Barbara L; Rushton, Amy

    2018-06-01

    Further exploration of the practice roles of psychiatric mental health (PMH) advanced practice registered nurses (APRNs) is warranted. In March of 2016, the American Psychiatric Nurses Association (APNA) conducted a national survey to gather data on the demographics, practice roles, and activities of certified PMH APRNs. The e-mail survey contained 46 questions consistent with minimum data set requirements of the Forum of State Nursing Workforce Centers. The data indicate that PMH APRNs are a clinically active workforce; the majority deliver a wide variety of mental health services including diagnosis and management of both acute and chronic mental illness, prescribing, and providing psychotherapy. PMH APRNs are delivering care to clients dealing with a range of serious mental illnesses across the life span in a variety of roles. It will be critical to monitor the activities and outcomes of this expanding behavioral health care workforce.

  6. Advanced practice physiotherapy in patients with musculoskeletal disorders: a systematic review

    PubMed Central

    2012-01-01

    Background The convergence of rising health care costs and physician shortages have made health care transformation a priority in many countries resulting in the emergence of new models of care that often involve the extension of the scope of practice for allied health professionals. Physiotherapists in advanced practice/extended scope roles have emerged as key providers in such new models, especially in settings providing services to patients with musculoskeletal disorders. However, evidence of the systematic evaluation of advance physiotherapy practice (APP) models of care is scarce. A systematic review was done to update the evaluation of physiotherapists in APP roles in the management of patients with musculoskeletal disorders. Methods Structured literature search was conducted in 3 databases (Medline, Cinahl and Embase) for articles published between 1980 and 2011. Included studies needed to present original quantitative data that addressed the impact or the effect of APP care. A total of 16 studies met all inclusion criteria and were included. Pairs of raters used four structured quality appraisal methodological tools depending on design of studies to analyse included studies. Results Included studies varied in designs and objectives and could be categorized in four areas: diagnostic agreement or accuracy compared to medical providers, treatment effectiveness, economic efficiency or patient satisfaction. There was a wide range in the quality of studies (from 25% to 93%), with only 43% of papers reaching or exceeding a score of 70% on the methodological quality rating scales. Their findings are however consistent and suggest that APP care may be as (or more) beneficial than usual care by physicians for patients with musculoskeletal disorders, in terms of diagnostic accuracy, treatment effectiveness, use of healthcare resources, economic costs and patient satisfaction. Conclusions The emerging evidence suggests that physiotherapists in APP roles provide equal

  7. Technological advances in the treatment of trauma: a review of promising practices.

    PubMed

    Paul, Lisa A; Hassija, Christina M; Clapp, Joshua D

    2012-11-01

    Given the availability of empirically supported practices for addressing posttraumatic stress disorder and other forms of trauma-related distress, the development and implementation of new technology to deliver these treatments is exciting. Technological innovations in this literature aim to expand availability of empirically based intervention, increase treatment adherence and acceptability, and overcome barriers commonly encountered with conventional trauma-focused treatment. Much of the current research on these technological developments consists of brief reviews and case studies of the separate therapy modalities. Although this work serves to document the appeal and utility of these innovations, it does not provide comprehensive information about the host of options available. To that end, the three general categories of technological advances in trauma therapy (i.e., videoconferencing, e-Health, virtual reality) are reviewed here, including information regarding their empirical support and suggestions for future research and clinical practice.

  8. Nestedness in Arbuscular Mycorrhizal Fungal Communities along Soil pH Gradients in Early Primary Succession: Acid-Tolerant Fungi Are pH Generalists

    PubMed Central

    Kawahara, Ai; An, Gi-Hong; Miyakawa, Sachie; Sonoda, Jun

    2016-01-01

    Soil acidity is a major constraint on plant productivity. Arbuscular mycorrhizal (AM) fungi support plant colonization in acidic soil, but soil acidity also constrains fungal growth and diversity. Fungi in extreme environments generally evolve towards specialists, suggesting that AM fungi in acidic soil are acidic-soil specialists. In our previous surveys, however, some AM fungi detected in strongly acidic soils could also be detected in a soil with moderate pH, which raised a hypothesis that the fungi in acidic soils are pH generalists. To test the hypothesis, we conducted a pH-manipulation experiment and also analyzed AM fungal distribution along a pH gradient in the field using a synthesized dataset of the previous and recent surveys. Rhizosphere soils of the generalist plant Miscanthus sinensis were collected both from a neutral soil and an acidic soil, and M. sinensis seedlings were grown at three different pH. For the analysis of field communities, rhizosphere soils of M. sinensis were collected from six field sites across Japan, which covered a soil pH range of 3.0–7.4, and subjected to soil trap culture. AM fungal community compositions were determined based on LSU rDNA sequences. In the pH-manipulation experiment the acidification of medium had a significant impact on the compositions of the community from the neutral soil, but the neutralization of the medium had no effect on those of the community from the acidic soil. Furthermore, the communities in lower -pH soils were subsets of (nested in) those in higher-pH soils. In the field communities a significant nestedness pattern was observed along the pH gradient. These observations suggest that the fungi in strongly acidic soils are pH generalists that occur not only in acidic soil but also in wide ranges of soil pH. Nestedness in AM fungal community along pH gradients may have important implications for plant community resilience and early primary succession after disturbance in acidic soils. PMID

  9. Nestedness in Arbuscular Mycorrhizal Fungal Communities along Soil pH Gradients in Early Primary Succession: Acid-Tolerant Fungi Are pH Generalists.

    PubMed

    Kawahara, Ai; An, Gi-Hong; Miyakawa, Sachie; Sonoda, Jun; Ezawa, Tatsuhiro

    2016-01-01

    Soil acidity is a major constraint on plant productivity. Arbuscular mycorrhizal (AM) fungi support plant colonization in acidic soil, but soil acidity also constrains fungal growth and diversity. Fungi in extreme environments generally evolve towards specialists, suggesting that AM fungi in acidic soil are acidic-soil specialists. In our previous surveys, however, some AM fungi detected in strongly acidic soils could also be detected in a soil with moderate pH, which raised a hypothesis that the fungi in acidic soils are pH generalists. To test the hypothesis, we conducted a pH-manipulation experiment and also analyzed AM fungal distribution along a pH gradient in the field using a synthesized dataset of the previous and recent surveys. Rhizosphere soils of the generalist plant Miscanthus sinensis were collected both from a neutral soil and an acidic soil, and M. sinensis seedlings were grown at three different pH. For the analysis of field communities, rhizosphere soils of M. sinensis were collected from six field sites across Japan, which covered a soil pH range of 3.0-7.4, and subjected to soil trap culture. AM fungal community compositions were determined based on LSU rDNA sequences. In the pH-manipulation experiment the acidification of medium had a significant impact on the compositions of the community from the neutral soil, but the neutralization of the medium had no effect on those of the community from the acidic soil. Furthermore, the communities in lower -pH soils were subsets of (nested in) those in higher-pH soils. In the field communities a significant nestedness pattern was observed along the pH gradient. These observations suggest that the fungi in strongly acidic soils are pH generalists that occur not only in acidic soil but also in wide ranges of soil pH. Nestedness in AM fungal community along pH gradients may have important implications for plant community resilience and early primary succession after disturbance in acidic soils.

  10. Advance care planning for residents in aged care facilities: what is best practice and how can evidence-based guidelines be implemented?

    PubMed

    Lyon, Cheryl

    2007-12-01

    Background  Advance care planning in a residential care setting aims to assist residents to make decisions about future healthcare and to improve end-of-life care through medical and care staff knowing and respecting the wishes of the resident. The process enables individuals and others who are important to them, to reflect on what is important to the resident including their beliefs/values and preferences about care when they are dying. This paper describes a project conducted as part of the Joanna Briggs Institute Clinical Aged Care Fellowship Program implemented at the Manningham Centre in metropolitan Melbourne in a unit providing services for 46 low and high care residents. Objectives  The objectives of the study were to document implementation of best practice in advance care planning in a residential aged care facility using a cycle of audit, feedback and re-audit cycle audit with a clinical audit software program, the Practical Application of Clinical Evidence System. The evidence-based guidelines found in 'Guidelines for a Palliative Approach in Residential Aged Care' were used to inform the process of clinical practice review and to develop a program to implement advance care planning. Results  The pre-implementation audit results showed that advance care planning practice was not based on high level evidence as initial compliance with five audit criteria was 0%. The barriers to implementation that became apparent during the feedback stage included the challenge of creating a culture where advance care planning policy, protocols and guidelines could be implemented, and advance care planning discussions held, by adequately prepared health professionals and carers. Opportunities were made to equip the resident to discuss their wishes with family, friends and healthcare staff. Some residents made the decision to take steps to formally document those wishes and/or appoint a Medical Enduring Power of Attorney to act on behalf of the resident when they

  11. Collaborating across services to advance evidence-based nursing practice.

    PubMed

    Kenny, Deborah J; Richard, Maggie L; Ceniceros, Xochitl; Blaize, Kelli

    2010-01-01

    Military medical treatment facilities offer a unique environment in which to develop a culture of evidence-based practice (EBP). Distinctive issues arise in the context of changed patient care demographics because of a war-injured population. These issues offer an opportunity to enhance the quality of care through the use and adaptation of research findings in this special nursing environment. In addition, the colocation of two military medical centers offers the prospect of collaborative efforts to create a regional culture for nursing EBP. The purposes of this study were to describe the processes of a collaborative project to train nurses in EBP and to share resources in developing and implementing evidence-based clinical nursing guidelines in two large military medical centers in the Northeastern United States and to discuss the collective efforts of nurse researchers, leadership, advanced practice nurses, and staff nurses in each hospital to facilitate the EBP process. A description of the organizational structure and the climate for EBP of each facility is provided followed by discussion of training efforts and the inculcation of an organizational culture for EBP. Contextual barriers and facilitators were encountered throughout the project. The two nurse researchers leading the projects were able to overcome the barriers and capitalize on opportunities to promote EBP. Three evidence-based clinical practice guidelines were developed at each facility and are currently in various stages of implementation. Despite the barriers, EBP continues to be at the forefront of military nursing practice in the U.S. National Capital Region. Clear communication and regular meetings were essential to the success of the collaborative project within and between the two military hospitals. Military-specific barriers to EBP included high team attrition and turnover because of the war mission and the usual high staff turnover at military hospitals. Military facilitators included a

  12. Building shared experience to advance practical application of pathway-based toxicology: liver toxicity mode-of-action.

    PubMed

    Willett, Catherine; Caverly Rae, Jessica; Goyak, Katy O; Minsavage, Gary; Westmoreland, Carl; Andersen, Melvin; Avigan, Mark; Duché, Daniel; Harris, Georgina; Hartung, Thomas; Jaeschke, Hartmut; Kleensang, Andre; Landesmann, Brigitte; Martos, Suzanne; Matevia, Marilyn; Toole, Colleen; Rowan, Andrew; Schultz, Terry; Seed, Jennifer; Senior, John; Shah, Imran; Subramanian, Kalyanasundaram; Vinken, Mathieu; Watkins, Paul

    2014-01-01

    A workshop sponsored by the Human Toxicology Project Consortium (HTPC), "Building Shared Experience to Advance Practical Application of Pathway-Based Toxicology: Liver Toxicity Mode-of-Action" brought together experts from a wide range of perspectives to inform the process of pathway development and to advance two prototype pathways initially developed by the European Commission Joint Research Center (JRC): liver-specific fibrosis and steatosis. The first half of the workshop focused on the theory and practice of pathway development; the second on liver disease and the two prototype pathways. Participants agreed pathway development is extremely useful for organizing information and found that focusing the theoretical discussion on a specific AOP is extremely helpful. In addition, it is important to include several perspectives during pathway development, including information specialists, pathologists, human health and environmental risk assessors, and chemical and product manufacturers, to ensure the biology is well captured and end use is considered.

  13. Oncology Advanced Practitioners Bring Advanced Community Oncology Care.

    PubMed

    Vogel, Wendy H

    2016-01-01

    Oncology care is becoming increasingly complex. The interprofessional team concept of care is necessary to meet projected oncology professional shortages, as well as to provide superior oncology care. The oncology advanced practitioner (AP) is a licensed health care professional who has completed advanced training in nursing or pharmacy or has completed training as a physician assistant. Oncology APs increase practice productivity and efficiency. Proven to be cost effective, APs may perform varied roles in an oncology practice. Integrating an AP into an oncology practice requires forethought given to the type of collaborative model desired, role expectations, scheduling, training, and mentoring.

  14. Perceptions of the benefits and challenges of the role of advanced practice nurses in nurse-led out-of-hours care in Hong Kong: a questionnaire study.

    PubMed

    Christiansen, Angela; Vernon, Veronica; Jinks, Annette

    2013-04-01

    The aim of the study was to identify the factors that nurses perceive may facilitate or hinder the development of advanced practice nurse roles in Hong Kong. Advanced practice nurses are increasingly prominent in nurse-led out-of-hours care in Hong Kong in response to changes to junior doctors' hours of work. Three five-day workshops for Hong Kong-based advanced practice nurses were offered in partnership with UK clinicians. The aim of the workshops was to share UK experiences of implementation of the 'Hospital at Night' model of care delivery. The questionnaire study undertaken was not part of the workshop programme. However, the workshops gave the authors a unique opportunity to access relatively large numbers of Hong Kong-based advanced practice nurses. The workshops were attended by experienced nurses who had been or were about to be appointed as advanced practice nurses. All nurses who attended one of the three workshops (n=120) agreed to participate in the study. Responses to two open questions posed in the questionnaire were the subject of a content analysis. A prominent finding of the study was that respondents viewed the benefits of introducing advanced practice nurse roles in Hong Kong as outweighing any challenges. One of the main features of the perceived benefits relates to improving the quality and safety of patient care. The greatest challenges associated with the role related to acceptance of the role by other healthcare professionals, and difficulties associated with the general public's traditional attitudes to healthcare provision in Hong Kong. Education of the public concerning the implementation of such roles is of crucial importance. Findings from this study enhance understanding of the factors that hinder or facilitate advanced practice roles in out-of-hours care in Hong Kong. © 2012 Blackwell Publishing Ltd.

  15. Findings: Sector-Leading and Innovative Practice in Advancing Equality and Diversity. Report to HEFCE by the Equality Challenge Unit

    ERIC Educational Resources Information Center

    Higher Education Funding Council for England, 2017

    2017-01-01

    Following our "Call for evidence of sector-leading and innovative practice in advancing equality and diversity" (HEFCE Circular letter 16/2016), HEFCE commissioned the Equality Challenge Unit (ECU) to report back on the range of equality and diversity practice undertaken across the higher education sector. Of 120 submissions received,…

  16. Phytoplasma infection of a tropical root crop triggers bottom-up cascades by favoring generalist over specialist herbivores

    PubMed Central

    Graziosi, Ignazio; Burra, Dharani Dhar; Walter, Abigail Jan

    2017-01-01

    Global interest on plant-microbe-insect interactions is rapidly growing, revealing the multiple ways in which microorganisms mediate plant-herbivore interactions. Phytopathogens regularly alter whole repertoires of plant phenotypic traits, and bring about shifts in key chemical or morphological characteristics of plant hosts. Pathogens can also cause cascading effects on higher trophic levels, and eventually shape entire plant-associated arthropod communities. We tested the hypothesis that a Candidatus Phytoplasma causing cassava witches’ broom (CWB) on cassava (Manihot esculenta Grantz) is altering species composition of invasive herbivores and their associated parasitic hymenopterans. We conducted observational studies in cassava fields in eastern Cambodia to assess the effect of CWB infection on abundance of specialist and generalist mealybugs (Homoptera: Pseudococcidae), and associated primary and hyper-parasitoid species. CWB infection positively affects overall mealybug abundance and species richness at a plant- and field-level, and disproportionately favors a generalist mealybug over a specialist feeder. CWB phytoplasma infection led to increased parasitoid richness and diversity, with richness of ‘comparative’ specialist taxa being the most significantly affected. Parasitism rate did not differ among infected and uninfected plants, and mealybug host suppression was not impacted. CWB phytoplasma modifies host plant quality for sap-feeding homopterans, differentially affects success rates of two invasive species, and generates niche opportunities for higher trophic orders. By doing so, a Candidatus phytoplasma affects broader food web structure and functioning, and assumes the role of an ecosystem engineer. Our work unveils key facets of phytoplasma ecology, and sheds light upon complex multi-trophic interactions mediated by an emerging phytopathogen. These findings have further implications for invasion ecology and management. PMID:28813469

  17. Achieving Full Scope of Practice Readiness Using Evidence for Psychotherapy Teaching in Web and Hybrid Approaches in Psychiatric Mental Health Advanced Practice Nursing Education.

    PubMed

    McCoy, Kathleen T

    2018-01-01

    Radical changes in role, education, and practice have affected how education of advance practice nurses and practice deliverables occur. This article examines the effects of distance education upon the teaching/learning of psychotherapy in integrating Web-based technology and platforms. With the advent and proliferation of online programs of study, the question begs: How do distance-linked programs successfully introduce, practice, and supervise one-to-one and group psychotherapy training? By employing evidence-based education strategies, technology, and strong interpersonal skills and evidence-based therapies, a charter Psychiatric Mental Health Nurse Practitioner Doctor of Nursing Practice program paved an innovative and successful path. In that program, they prepared their students for full scope of practice, upon graduation, inclusive of psychotherapy as well as the other highly demanding and compressed requirements of the 3-year program. This article explores that journey and its recommendations for application derived from this 2010 cohort. © 2017 Wiley Periodicals, Inc.

  18. Advancing research and practice: the revised APA Division 30 definition of hypnosis.

    PubMed

    Elkins, Gary R; Barabasz, Arreed F; Council, James R; Spiegel, David

    2015-01-01

    This article describes the history, rationale, and guidelines for developing a new definition of hypnosis by the Society of Psychological Hypnosis, Division 30 of the American Psychological Association. The definition was developed with the aim of being concise, heuristic, and allowing for alternative theories of the mechanisms (to be determined in empirical scientific study). The definition of hypnosis is presented as well as definitions of the following related terms: hypnotic induction, hypnotizability, and hypnotherapy. The implications for advancing research and practice are discussed. The definitions are presented within the article.

  19. Advancing Research and Practice: The Revised APA Division 30 Definition of Hypnosis.

    PubMed

    Elkins, Gary R; Barabasz, Arreed F; Council, James R; Spiegel, David

    2015-04-01

    This article describes the history, rationale, and guidelines for developing a new definition of hypnosis by the Society of Psychological Hypnosis, Division 30 of the American Psychological Association. The definition was developed with the aim of being concise, being heuristic, and allowing for alternative theories of the mechanisms (to be determined in empirical scientific study). The definition of hypnosis is presented as well as definitions of the following related terms: hypnotic induction, hypnotizability, and hypnotherapy. The implications for advancing research and practice are discussed. The definitions are presented within the article.

  20. The role of physician oversight on advanced practice nurses' professional autonomy and empowerment.

    PubMed

    Petersen, Polly A; Way, Sandra M

    2017-05-01

    Little is known about the effects of physician oversight on advanced practice registered nurses (APRNs). Examination of these relationships provides insight into the strength of independent practice. The purpose of this study was to examine whether APRNs' perceptions of autonomy and empowerment varied according to type of physician oversight, whether facilitative or restrictive. A cross-sectional survey design was used to examine whether APRNs' perceptions of autonomy and empowerment varied according to physician oversight, geographical location, and practice setting. Five hundred questionnaires were mailed in March 2013 with 274 returned. Participants were asked about autonomy, empowerment, demographics, physician oversight, geographical location, and practice setting. Among surveyed respondents, physician oversight was related to increased empowerment, regardless of whether the oversight was defined in facilitative or restrictive terms; both had similar positive effects on empowerment. If APRNs are to be part of the solution to the growing problem of healthcare access, it is important to study factors that contribute to their success. We speculate that increasing opportunities for collaboration and interaction with physicians, and possibly other healthcare professionals, could facilitate APRN empowerment, optimizing their contribution. ©2017 American Association of Nurse Practitioners.

  1. Current Practices in Global/International Advanced Pharmacy Practice Experiences: Home/Host Country or Site/Institution Considerations

    PubMed Central

    Dakkuri, Adnan; Abrons, Jeanine P.; Williams, Dennis; Ombengi, David N.; Zheng, HaiAn; Al-Dahir, Sara; Tofade, Toyin; Gim, Suzanna; O’Connell, Mary Beth; Ratka, Anna; Dornblaser, Emily

    2016-01-01

    International outreach by schools and colleges of pharmacy is increasing. In this paper, we provide current practice guidelines to establish and maintain successful global/international advanced pharmacy practice experiences (G/I APPEs) with specific recommendations for home/host country and host site/institution. The paper is based on a literature review (2000-2014) in databases and Internet searches with specific keywords or terms. Educational documents such as syllabi and memoranda of understanding (MoUs) from pharmacy programs were also examined. In addition, a preliminary draft was developed and the findings and recommendations were reviewed in a 90-minute roundtable discussion at the 2014 American Association of Colleges of Pharmacy Annual Meeting. Recommendations for the host country include travel considerations (eg, passport, visa, air travel), safety, housing, transportation, travel alerts and warnings, health issues, and financial considerations. For the home country, considerations for establishment of G/I APPE site (eg, vetting process, MoU, site expectations) are described. The paper is a resource for development of new G/I APPEs and provides guidance for continuous quality improvement of partnerships focusing on G/I pharmacy education. PMID:27170809

  2. Current Practices in Global/International Advanced Pharmacy Practice Experiences: Home/Host Country or Site/Institution Considerations.

    PubMed

    Alsharif, Naser Z; Dakkuri, Adnan; Abrons, Jeanine P; Williams, Dennis; Ombengi, David N; Zheng, HaiAn; Al-Dahir, Sara; Tofade, Toyin; Gim, Suzanna; O'Connell, Mary Beth; Ratka, Anna; Dornblaser, Emily

    2016-04-25

    International outreach by schools and colleges of pharmacy is increasing. In this paper, we provide current practice guidelines to establish and maintain successful global/international advanced pharmacy practice experiences (G/I APPEs) with specific recommendations for home/host country and host site/institution. The paper is based on a literature review (2000-2014) in databases and Internet searches with specific keywords or terms. Educational documents such as syllabi and memoranda of understanding (MoUs) from pharmacy programs were also examined. In addition, a preliminary draft was developed and the findings and recommendations were reviewed in a 90-minute roundtable discussion at the 2014 American Association of Colleges of Pharmacy Annual Meeting. Recommendations for the host country include travel considerations (eg, passport, visa, air travel), safety, housing, transportation, travel alerts and warnings, health issues, and financial considerations. For the home country, considerations for establishment of G/I APPE site (eg, vetting process, MoU, site expectations) are described. The paper is a resource for development of new G/I APPEs and provides guidance for continuous quality improvement of partnerships focusing on G/I pharmacy education.

  3. A Generalist Herbivore Copes with Specialized Plant Defence: the Effects of Induction and Feeding by Helicoverpa armigera (Lepidoptera: Noctuidae) Larvae on Intact Arabidopsis thaliana (Brassicales) Plants.

    PubMed

    Zalucki, M P; Zalucki, J M; Perkins, L E; Schramm, K; Vassão, D G; Gershenzon, J; Heckel, D G

    2017-06-01

    Plants of the Brassicaceae are defended from feeding by generalist insects by constitutively-expressed and herbivory-induced glucosinolates (GS). We induced Arabidopsis plants 1, 16 and 24 h prior to allowing neonate larvae of the generalist Helicoverpa armigera to feed on whole plants for 72 h. These plants were subsequently retested with another group of neonates for a further 72 h. We used wild-type A. thaliana Col-0, and mutant lines lacking indolic GS, aliphatic GS or all GS. We hypothesized that larvae would not grow well on defended plants (WT) compared to those lacking GS, and would not grow well if plants had been primed or fed on for longer, due to the expected induced GS. There was survivorship on all lines suggesting H. armigera is a suitable generalist for these experiments. Larvae performed less well on wild-type and no indolic lines than on no aliphatic and no GS lines. Larvae distributed feeding damage extensively in all lines, more so on wild type and no-indolic lines. Contrary to expectations, larvae grew better on plants that had been induced for 1 to 16 h than on un-induced plants suggesting they moved to and selected less toxic plant parts within a heterogeneously defended plant. Performance declined on all lines if plants had been induced for 24 h, or had been fed upon for a further 72 h. However, contrary to expectation, individual and total GS did not increase after these two treatments. This suggests that Arabidopsis plants induce additional (not GS) defenses after longer induction periods.

  4. Advanced Practice Nursing in Pediatric Urology: experience report in the Federal District.

    PubMed

    Souza, Bruna Marcela Lima de; Salviano, Cristiane Feitosa; Martins, Gisele

    2018-01-01

    To describe the creation and implementation of the extension program Advanced Practice Nursing in Pediatric Urology, developed in the outpatient clinic of a teaching hospital in the Federal District. This is an experience report regarding the implementation of an outpatient service aimed at children and adolescents with symptoms of bladder and bowel dysfunction. Because it is an extension program linked to the university, it follows a different model of care, valuing empowerment, informed and shared decision making, which results in a stronger bond between patients, family and the Pediatric Urology nursing team. It has also become a privileged space for the production and use of scientific knowledge, associated with the principles of evidence-based practice. This project shows a different performance of the nurse-specialist-professor-researcher in Pediatric Urology Nursing, and it has become a reference in the Federal District, mainly for undergraduate and graduate nursing students.

  5. Patient acceptability and practical implications of pharmacokinetic studies in patients with advanced cancer.

    PubMed

    Dobbs, N A; Twelves, C J; Ramirez, A J; Towlson, K E; Gregory, W M; Richards, M A

    1993-01-01

    We have studied the practical implications and acceptability to patients of pharmacokinetic studies in 34 women receiving anthracyclines for advanced breast cancer. The following parameters were recorded: age, ECOG performance status, psychological state (Rotterdam Symptom Checklist), cytotoxic drug and dose, number of venepunctures for treatment and sampling, and time when the sampling cannula was removed. Immediately after finishing pharmacokinetic sampling, patients completed a questionnaire which revealed that (i) all patients understood sampling was for research, (ii) 35% of patients experienced problems with sampling, (iii) benefits from participation were perceived by 56% of patients. Of 20 patients later questioned after completion of their treatment course, 40% recalled difficulties with blood sampling. Factors identifying in advance those patients who tolerate pharmacokinetic studies poorly were not identified but the number of venepunctures should be minimised. Patients may also perceive benefits from 'non-therapeutic' research.

  6. Geographic Medical History: Advances in Geospatial Technology Present New Potentials in Medical Practice

    NASA Astrophysics Data System (ADS)

    Faruque, F. S.; Finley, R. W.

    2016-06-01

    Genes, behaviour, and the environment are known to be the major risk factors for common diseases. When the patient visits a physician, typical questions include family history (genes) and lifestyle of the patient (behaviour), but questions concerning environmental risk factors often remain unasked. It is ironic that 25 centuries ago Hippocrates, known as the father of medicine, noted the importance of environmental exposure in medical investigation as documented in his classic work, "Airs, Waters, Places", yet the practice of routinely incorporating environmental risk factors is still not in place. Modern epigenetic studies have found that unhealthy lifestyle and environmental factors can cause changes to our genes that can increase disease risk factors. Therefore, attempting to solve the puzzle of diseases using heredity and lifestyle alone will be incomplete without accounting for the environmental exposures. The primary reason why environmental exposure has not yet been a routine part of the patient's medical history is mostly due to our inability to provide clinicians useful measures of environmental exposures suitable for their clinical practices. This presentation will discuss advances in geospatial technology that show the potential to catalyse a paradigm shift in medical practice and health research by allowing environmental risk factors to be documented as the patient's "Geographic Medical History". In order to accomplish this we need information on: a) relevant spatiotemporal environmental variables, and b) location of the individual in that person's dynamic environment. Common environmental agents that are known to interact with genetic make-up include air pollutants, mold spores, pesticides, etc. Until recently, the other component, location of an individual was limited to a static representation such as residential or workplace location. Now, with the development of mobile technology, changes in an individual's location can be tracked in real time if

  7. Building Shared Experience to Advance Practical Application of Pathway-Based Toxicology: Liver Toxicity Mode-of-Action

    PubMed Central

    Willett, Catherine; Rae, Jessica Caverly; Goyak, Katy O.; Minsavage, Gary; Westmoreland, Carl; Andersen, Melvin; Avigan, Mark; Duché, Daniel; Harris, Georgina; Hartung, Thomas; Jaeschke, Hartmut; Kleensang, Andre; Landesmann, Brigitte; Martos, Suzanne; Matevia, Marilyn; Toole, Colleen; Rowan, Andrew; Schultz, Terry; Seed, Jennifer; Senior, John; Shah, Imran; Subramanian, Kalyanasundaram; Vinken, Mathieu; Watkins, Paul

    2016-01-01

    Summary A workshop sponsored by the Human Toxicology Project Consortium (HTPC), “Building Shared Experience to Advance Practical Application of Pathway-Based Toxicology: Liver Toxicity Mode-of-Action” brought together experts from a wide range of perspectives to inform the process of pathway development and to advance two prototype pathways initially developed by the European Commission Joint Research Center (JRC): liver-specific fibrosis and steatosis. The first half of the workshop focused on the theory and practice of pathway development; the second on liver disease and the two prototype pathways. Participants agreed pathway development is extremely useful for organizing information and found that focusing the theoretical discussion on a specific AOP is helpful. It is important to include several perspectives during pathway development, including information specialists, pathologists, human health and environmental risk assessors, and chemical and product manufacturers, to ensure the biology is well captured and end use is considered. PMID:24535319

  8. Current Practices in Global/International Advanced Pharmacy Practice Experiences: Preceptor and Student Considerations.

    PubMed

    Dornblaser, Emily K; Ratka, Anna; Gleason, Shaun E; Ombengi, David N; Tofade, Toyin; Wigle, Patricia R; Zapantis, Antonia; Ryan, Melody; Connor, Sharon; Jonkman, Lauren J; Ochs, Leslie; Jungnickel, Paul W; Abrons, Jeanine P; Alsharif, Naser Z

    2016-04-25

    The objective of this article is to describe the key areas of consideration for global/international advanced pharmacy practice experience (G/I APPE) preceptors, students and learning objectives. At the 2013 Annual Meeting of the American Association of Colleges of Pharmacy (AACP), the GPE SIG prepared and presented an initial report on the G/IAPPE initiatives. Round table discussions were conducted at the 2014 AACP Annual Meeting to document GPE SIG member input on key areas in the report. Literature search of PubMed, Google Scholar and EMBASE with keywords was conducted to expand this report. In this paper, considerations related to preceptors and students and learning outcomes are described. Preceptors for G/I APPEs may vary based on the learning outcomes of the experience. Student learning outcomes for G/I APPEs may vary based on the type of experiential site. Recommendations and future directions for development of G/IAPPEs are presented. Development of a successful G/I APPE requires significant planning and consideration of appropriate qualifications for preceptors and students.

  9. Optimizing Music Learning: Exploring How Blocked and Interleaved Practice Schedules Affect Advanced Performance.

    PubMed

    Carter, Christine E; Grahn, Jessica A

    2016-01-01

    Repetition is the most commonly used practice strategy by musicians. Although blocks of repetition continue to be suggested in the pedagogical literature, work in the field of cognitive psychology suggests that repeated events receive less processing, thereby reducing the potential for long-term learning. Motor skill learning and sport psychology research offer an alternative. Instead of using a blocked practice schedule, with practice completed on one task before moving on to the next task, an interleaved schedule can be used, in which practice is frequently alternated between tasks. This frequent alternation involves more effortful processing, resulting in increased long-term learning. The finding that practicing in an interleaved schedule leads to better retention than practicing in a blocked schedule has been labeled the "contextual interference effect." While the effect has been observed across a wide variety of fields, few studies have researched this phenomenon in a music-learning context, despite the broad potential for application to music practice. This study compared the effects of blocked and interleaved practice schedules on advanced clarinet performance in an ecologically valid context. Ten clarinetists were given one concerto exposition and one technical excerpt to practice in a blocked schedule (12 min per piece) and a second concerto exposition and technical excerpt to practice in an interleaved schedule (3 min per piece, alternating until a total of 12 min of practice were completed on each piece). Participants sight-read the four pieces prior to practice and performed them at the end of practice and again one day later. The sight-reading and two performance run-throughs of each piece were recorded and given to three professional clarinetists to rate using a percentage scale. Overall, whenever there was a ratings difference between the conditions, pieces practiced in the interleaved schedule were rated better than those in the blocked schedule

  10. Optimizing Music Learning: Exploring How Blocked and Interleaved Practice Schedules Affect Advanced Performance

    PubMed Central

    Carter, Christine E.; Grahn, Jessica A.

    2016-01-01

    Repetition is the most commonly used practice strategy by musicians. Although blocks of repetition continue to be suggested in the pedagogical literature, work in the field of cognitive psychology suggests that repeated events receive less processing, thereby reducing the potential for long-term learning. Motor skill learning and sport psychology research offer an alternative. Instead of using a blocked practice schedule, with practice completed on one task before moving on to the next task, an interleaved schedule can be used, in which practice is frequently alternated between tasks. This frequent alternation involves more effortful processing, resulting in increased long-term learning. The finding that practicing in an interleaved schedule leads to better retention than practicing in a blocked schedule has been labeled the “contextual interference effect.” While the effect has been observed across a wide variety of fields, few studies have researched this phenomenon in a music-learning context, despite the broad potential for application to music practice. This study compared the effects of blocked and interleaved practice schedules on advanced clarinet performance in an ecologically valid context. Ten clarinetists were given one concerto exposition and one technical excerpt to practice in a blocked schedule (12 min per piece) and a second concerto exposition and technical excerpt to practice in an interleaved schedule (3 min per piece, alternating until a total of 12 min of practice were completed on each piece). Participants sight-read the four pieces prior to practice and performed them at the end of practice and again one day later. The sight-reading and two performance run-throughs of each piece were recorded and given to three professional clarinetists to rate using a percentage scale. Overall, whenever there was a ratings difference between the conditions, pieces practiced in the interleaved schedule were rated better than those in the blocked schedule

  11. Infaunal Benthic Communities from the Inner Shelf off Southwestern Africa Are Characterised by Generalist Species

    PubMed Central

    Steffani, Nina; Sedick, Safiyya; Rogers, John; Gibbons, Mark John

    2015-01-01

    Infaunal communities of benthic macro-organisms (≥ 1mm length) were studied from 81 samples collected across nine sites to the north and south of the Orange River in the Benguela upwelling ecosystem in 2003, with a view to describing communities and understanding the drivers of regional community structure, as well as to document diversity and to examine geographic affinities. Although the fauna was dominated by polychaetes and peracarid crustaceans, patterns in community structure could only weakly be explained by the measured environment (~35%). This is attributed to the generalist nature of the species recovered, which were widely distributed amongst different sediments, water-depths and latitudes. The fauna is dominated by species that enjoy a widespread regional and global distribution and is characterised by relatively low diversity, which is discussed. PMID:26618477

  12. Generalists and Specialists: A New View of How MHC Class I Molecules Fight Infectious Pathogens.

    PubMed

    Kaufman, Jim

    2018-05-01

    In comparison with the major histocompatibility complexes (MHCs) of typical mammals, the chicken MHC is simple and compact with a single dominantly expressed class I molecule that can determine the immune response. In addition to providing useful information for the poultry industry and allowing insights into the evolution of the adaptive immune system, the simplicity of the chicken MHC has allowed the discovery of phenomena that are more difficult to discern in the more complicated mammalian systems. This review discusses the new concept that poorly expressed promiscuous class I alleles act as generalists to protect against a wide variety of infectious pathogens, while highly expressed fastidious class I alleles can act as specialists to protect against new and dangerous pathogens. Copyright © 2018 The Author. Published by Elsevier Ltd.. All rights reserved.

  13. [Challenges and opportunities: contributions of the Advanced Practice Nurse in the chronicity. Learning from experiences].

    PubMed

    Appleby, Christine; Camacho-Bejarano, Rafaela

    2014-01-01

    Undoubtedly, our society is facing new economic, political, demographic, social and cultural challenges that require healthcare services able to meet the growing health needs of the population, especially in dealing with chronic conditions. In this new context, some countries such as the United Kingdom have made a firm commitment to develop new models for chronic patients care based on the introduction of new figures of Advanced Practice Nurses, which includes 4 cornerstones of professional practice: advanced clinical skills, clinical management, teaching and research. The implementation of this new figures implies a redefinition of professional competencies and has its own accreditation system and a specific catalogue of services adapted to the population requirements, in order to provide chronic care support from Primary Care settings. This trajectory allows us analysing the process of design and implementation of these new models and the organizational structure where it is integrated. In Spain, there are already experiences in some regions such as Andalucia and the Basque Country, focused on the creation of new advanced nursing roles. At present, it is necessary to consider suitable strategic proposals for the complete development of these models and to achieve the best results in terms of overall health and quality of life of patients with chronic conditions, improving the quality of services and cost-effectiveness through a greater cohesion and performance of healthcare teams towards the sustainability of healthcare services and patient satisfaction. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  14. Assessment of Prey Preference by the Generalist Predator, Mallada basalis (Walker), When Offered Two Species of Spider Mites, Tetranychus kanzawai Kishida and Panonychus citri (McGregor) on Papaya

    USDA-ARS?s Scientific Manuscript database

    We investigated potential prey preference of the generalist predator Mallada basalis (Walker) when offered two mites, Tetranychus kanzawai Kishida and Panonychus citri (McGregor), both important pests on papaya. Laboratory choice tests revealed that none of the three larval instars of M. basalis sho...

  15. Palliative radiation therapy practice for advanced esophageal carcinoma in Africa.

    PubMed

    Sharma, V; Gaye, P M; Wahab, S A; Ndlovu, N; Ngoma, T; Vanderpuye, V; Sowuhami, A; Dawotola, D A; Kigula-Mugambe, J; Jeremic, B

    2010-04-01

    While numerous surveys of pattern of practices of palliative radiotherapy (RT) in advanced esophageal cancers have been published in developed countries, there is no such survey in African countries. During and after a regional training course by the International Atomic Energy Agency (IAEA) in palliative cancer care, a questionnaire was distributed to African RT centers to gather information about infrastructure and human resources available, and the pattern of practice of palliative RT for esophageal cancers. Twenty-four of the 35 centers (60%) completed the questionnaire. Twenty out of 23 (87%) centers treat patients with esophageal cancer presenting with dysphagia using external beam RT (16 centers external beam RT alone and 4 centers also use brachytherapy as a boost). Twelve (60%) centers prescribe RT doses of 30 Gy in 10 fractions and 2 centers 20 Gy in 5 fractions. Eighteen centers (78%) have low dose rate (LDR) brachytherapy, and 9 (39%) centers have high dose rate (HDR) brachytherapy. One center only used HDR brachytherapy alone to a dose of 16 Gy in 2 fractions over 8 days. RT remains a major component of treatment of patients with esophageal cancers in African countries. Still, there is a great variety among centers in both indications for RT and its characteristics for a treatment indication.

  16. Variables Affecting Pharmacy Students’ Patient Care Interventions during Advanced Pharmacy Practice Experiences

    PubMed Central

    Patterson, Brandon J.; Sen, Sanchita; Bingham, Angela L.; Bowen, Jane F.; Ereshefsky, Benjamin; Siemianowski, Laura A.

    2016-01-01

    Objective. To identify the temporal effect and factors associated with student pharmacist self-initiation of interventions during acute patient care advanced pharmacy practice experiences (APPE). Methods. During the APPE, student pharmacists at an academic medical center recorded their therapeutic interventions and who initiated the intervention throughout clinical rotations. At the end of the APPE student pharmacists completed a demographic survey. Results. Sixty-two student pharmacists were included. Factors associated with lower rates of self-initiated interventions were infectious diseases and pediatrics APPEs and an intention to pursue a postgraduate residency. Timing of the APPE, previous specialty elective course completion, and previous hospital experience did not result in any significant difference in self-initiated recommendations. Conclusion. Preceptors should not base practice experience expectations for self-initiated interventions on previous student experience or future intentions. Additionally, factors leading to lower rates of self-initiated interventions on infectious diseases or pediatrics APPEs should be explored. PMID:27756924

  17. Advances and Best Practices in Airborne Gravimetry from the U.S. GRAV-D Project

    NASA Astrophysics Data System (ADS)

    Diehl, Theresa; Childers, Vicki; Preaux, Sandra; Holmes, Simon; Weil, Carly

    2013-04-01

    The Gravity for the Redefinition of the American Vertical Datum (GRAV-D) project, an official policy of the U.S. National Geodetic Survey as of 2007, is working to survey the entire U.S. and its holdings with high-altitude airborne gravimetry. The goal of the project is to provide a consistent, high-quality gravity dataset that will become the cornerstone of a new gravimetric geoid and national vertical datum in 2022. Over the last five years, the GRAV-D project has surveyed more than 25% of the country, accomplishing almost 500 flights on six different aircraft platforms and producing more than 3.7 Million square km of data thus far. This wealth of experience has led to advances in the collection, processing, and evaluation of high-altitude (20,000 - 35,000 ft) airborne gravity data. This presentation will highlight the most important practical and theoretical advances of the GRAV-D project, giving an introduction to each. Examples of innovation include: 1. Use of navigation grade inertial measurement unit data and precise lever arm measurements for positioning; 2. New quality control tests and software for near real-time analysis of data in the field; 3. Increased accuracy of gravity post-processing by reexamining assumptions and simplifications that were inconsistent with a goal of 1 mGal precision; and 4. Better final data evaluation through crossovers, additional statistics, and inclusion of airborne data into harmonic models that use EGM08 as a base model. The increases in data quality that resulted from implementation of the above advances (and others) will be shown with a case study of the GRAV-D 2008 southern Alaska survey near Anchorage, over Cook Inlet. The case study's statistics and comparisons to global models illustrate the impact that these advances have had on the final airborne gravity data quality. Finally, the presentation will summarize the best practices identified by the project from its last five years of experience.

  18. HMO penetration and the geographic mobility of practicing physicians.

    PubMed

    Polsky, D; Kletke, P R; Wozniak, G D; Escarce, J J

    2000-09-01

    In this study, we assessed the influence of changes in health maintenance organization (HMO) penetration on the probability that established patient care physicians relocated their practices or left patient care altogether. For physicians who relocated their practices, we also assessed the impact of HMO penetration on their destination choices. We found that larger increases in HMO penetration decreased the probability that medical/surgical specialists in early career stayed in patient care in the same market, but had no impact on generalists, hospital-based specialists, or mid career medical/surgical specialists. We also found that physicians who relocated their practices were much more likely to choose destination markets with the same level of HMO penetration or lower HMO penetration compared with their origin markets than they were to choose destination markets with higher HMO penetration. The largely negligible impact of changes in HMO penetration on established physicians' decisions to relocate their practices or leave patient care is consistent with high relocation and switching costs. Relocating physicians' attraction to destination markets with the same level of HMO penetration as their origin markets suggests that, while physicians' styles of medical practice may adapt to changes in market conditions, learning new practice styles is costly.

  19. Optimal utilization of a breast care advanced practice clinician.

    PubMed

    Russell, Katie W; Mone, Mary C; Serpico, Victoria J; Ward, Cori; Lynch, Joanna; Neumayer, Leigh A; Nelson, Edward W

    2014-12-01

    Incorporation of "lean" business philosophy within health care has the goal of adding value by reducing cost and improving quality. Applying these principles to the role of Advance Practice Clinicians (APCs) is relevant because they have become essential members of the healthcare team. An independent surgical breast care clinic directed by an APC was created with measurements of success to include the following: time to obtain an appointment, financial viability, and patient/APC/MD satisfaction. During the study period, there was a trend toward a decreased median time to obtain an appointment. Monthly APC charges increased from $388 to $30,800. The mean provider satisfaction score by Press Ganey was 96% for the APC and 95.8% for the surgeon. Both clinicians expressed significant satisfaction with clinic development. Overall, initiation of an APC breast clinic met the proposed goals of success. The use of lean philosophy demonstrates that implementation of change can result in added value in patient care. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. Care Coordination for Children with Complex Special Health Care Needs: The Value of the Advanced Practice Nurse’s Enhanced Scope of Knowledge and Practice

    PubMed Central

    Looman, Wendy S.; Presler, Elizabeth; Erickson, Mary M.; Garwick, Ann E.; Cady, Rhonda G.; Kelly, Anne M.; Finkelstein, Stanley M.

    2012-01-01

    Efficiency and effectiveness of care coordination depends on a match between the needs of the population and the skills, scope of practice, and intensity of services provided by the care coordinator. There is limited existing literature that addresses the relevance of the APN role as a fit for coordination of care for children with SHCN. The objective of this paper is to describe the value of the advanced practice nurse’s (APN’s) enhanced scope of knowledge and practice for relationship-based care coordination in healthcare homes that serve children with complex special health care needs (SHCN). The TeleFamilies project is provided as an example of the integration of an APN care coordinator in a healthcare home for children with SHCN. PMID:22560803

  1. The role of the nurse executive in fostering and empowering the advanced practice registered nurse.

    PubMed

    Talbert, Tukea L

    2012-06-01

    The nurse executive plays a critical role in the design, oversight, and outcomes of the delivery of care and a key role in the success of the integration of advanced practice registered nurses (APRNs) into an organization. The critical areas that nurse executives must consider to foster and empower APRNs are: (1) knowledge and self preparation, especially of political initiatives that affect the role, (2) visionary leadership and development of clear role expectations and appropriate credentialing, (3) strategies to reduce disconnection between the APRN and their practice setting, and (4) appropriate education and marketing of the role to stakeholders. Copyright © 2012 Elsevier Inc. All rights reserved.

  2. [Burnout syndrome among generalist medical doctors of Douala region (Cameroon): Can physical activities be a protective factor?

    PubMed

    Mandengue, S H; Owona Manga, L J; Lobè-Tanga, M Y; Assomo-Ndemba, P B; Nsongan-Bahebege, S; Bika-Lélé, C; Ngo Sack, F; Njamnshi, A K; Etoundi-Ngoa, S L

    2017-01-01

    This study aimed to evaluate and document the importance of Burnout syndrome among generalist medical doctors (GMD) since no investigation have been carried in Cameroon. Cross-sectional study including 85 GMD using a self-administered questionnaire on socio-demographic characteristics, socioprofessional conditions, Maslach Burnout Inventory - Human Services Survey (MBI-HSS) to evaluate burnout, and Ricci-Gagnon physical activities level metrics. 77 GMD (90.6 %) reported having never heard about burnout. Mean age was 29 years (range 24-42 years). The MBI-HSS revealed that 36 GMD (42.4 %) were victims of burnout, with 27 (31.8 %) at a low level, 8 (9.4 %) moderate and one (1.2 %) severe. Burnout was associated with distance from home to job place (p ⟨ 0.05), strenuous job (p = 0.04), number of children in charge (p = 0.007), number of hospital attended (p = 0.003), number of hours of labor per day (p = 0.0001), conflicts with the hierarchy (p = 0.01), number of guards per month (p = 0.01). Physical activities practice did not showed significant preventive effect on burnout (p = 0.3) (Odds-ratio = 1.45, IC 95 % 0.6, 3.45). Burnout syndrome is not well known among GMD in Douala, though having a high prevalence. Various socio-demographic and socio-professional factors are associated and contribute to increase the level of affect. Burnout seems to be a vicious somato-psycho-somatic disorder. This study did not found a protective or preventive effect of physical activities on burnout.

  3. Some Misconceptions in Meiosis Shown by Students Responding to an Advanced Level Practical Examination Question in Biology.

    ERIC Educational Resources Information Center

    Brown, C. R.

    1990-01-01

    Discussed are problems revealed in student responses to a practical task which formed part of an advanced level examination. The frequencies with which some misconceptions about cell reproduction and genetics occurred are presented. The nature of these misconceptions is analyzed and their implications discussed. (CW)

  4. Pediatric generalists and subspecialists: determinants of career satisfaction.

    PubMed

    Shugerman, R; Linzer, M; Nelson, K; Douglas, J; Williams, R; Konrad, R

    2001-09-01

    To evaluate the work life and job satisfaction of pediatric generalists and subspecialists in comparison to each other and to a group of general internists and internal medicine subspecialists. Data were collected by survey of a national sample of 5704 general pediatricians, subspecialty pediatricians, general internists, internal medicine subspecialists, and family physicians who were selected randomly from the American Medical Association Masterfile using stratified sampling with disproportionate weighting to ensure ethnic diversity and representation of high managed care areas. Surveys were mailed up to 4 times and contained 150 items that reflected 10 facets of physician job satisfaction as well as an assessment of individual and practice demographic information. This study reports data from all groups except for family medicine. The adjusted response rate was 58% for general pediatricians (n = 590), 67% for specialty pediatricians (n = 345), and 52% (n = 1823) for the entire pool. In comparison with general internists, general pediatricians were more likely to be female (44% vs 24%); to work part time (20% vs 12%); to have lower annual income ($125 679 vs $143 875); and to report significantly higher levels of job, career, and specialty satisfaction on a 5-point scale (3.81 vs 3.52, 3.80 vs 3.55, and 3.76 vs 3.17 respectively). In comparison with internal medicine subspecialists, pediatric subspecialists were more likely to be female (42% vs 22%); to work in academically affiliated settings (35% vs 17%); to have lower incomes ($156 284 vs $192 006); to receive significantly less time for a complete history and physical examination (39 minutes vs 51 minutes); and to report similar levels of job, career, and specialty satisfaction (3.69 vs 3.71, 3.74 vs 3.78, and 3.60 vs 3.47 respectively). Of all 4 physician groups, general pediatricians worked the fewest hours (50/week), spent the greatest percentage of time in the office and the lowest percentage in the

  5. Understanding the foundation: the state of generalist search education in library schools as related to the needs of expert searchers in medical libraries.

    PubMed

    Nicholson, Scott

    2005-01-01

    The paper explores the current state of generalist search education in library schools and considers that foundation in respect to the Medical Library Association's statement on expert searching. Syllabi from courses with significant searching components were examined from ten of the top library schools, as determined by the U.S. News & World Report rankings. Mixed methods were used, but primarily quantitative bibliometric methods were used. The educational focus in these searching components was on understanding the generalist searching resources and typical users and on performing a reflective search through application of search strategies, controlled vocabulary, and logic appropriate to the search tool. There is a growing emphasis on Web-based search tools and a movement away from traditional set-based searching and toward free-text search strategies. While a core set of authors is used in these courses, no core set of readings is used. While library schools provide a strong foundation, future medical librarians still need to take courses that introduce them to the resources, settings, and users associated with medical libraries. In addition, as more emphasis is placed on Web-based search tools and free-text searching, instructors of the specialist medical informatics courses will need to focus on teaching traditional search methods appropriate for common tools in the medical domain.

  6. Advances in endodontics: Potential applications in clinical practice

    PubMed Central

    Kishen, Anil; Peters, Ove A.; Zehnder, Matthias; Diogenes, Anibal R.; Nair, Madhu K.

    2016-01-01

    Contemporary endodontics has seen an unprecedented advance in technology and materials. This article aimed to review some of the challenges and advances in the following sections: (1) endodontic imaging, (2) root canal preparation, (3) root canal disinfection, (4) root canal filling, and (4) regenerative endodontic procedures (REPs). Jointly, these advances are aimed at improving the state of the art and science of root canal treatment. PMID:27217630

  7. A qualitative analysis of an advanced practice nurse-directed transitional care model intervention.

    PubMed

    Bradway, Christine; Trotta, Rebecca; Bixby, M Brian; McPartland, Ellen; Wollman, M Catherine; Kapustka, Heidi; McCauley, Kathleen; Naylor, Mary D

    2012-06-01

    The purpose of this study was to describe barriers and facilitators to implementing a transitional care intervention for cognitively impaired older adults and their caregivers lead by advanced practice nurses (APNs). APNs implemented an evidence-based protocol to optimize transitions from hospital to home. An exploratory, qualitative directed content analysis examined 15 narrative case summaries written by APNs and fieldnotes from biweekly case conferences. Three central themes emerged: patients and caregivers having the necessary information and knowledge, care coordination, and the caregiver experience. An additional category was also identified, APNs going above and beyond. APNs implemented individualized approaches and provided care that exceeds the type of care typically staffed and reimbursed in the American health care system by applying a Transitional Care Model, advanced clinical judgment, and doing whatever was necessary to prevent negative outcomes. Reimbursement reform as well as more formalized support systems and resources are necessary for APNs to consistently provide such care to patients and their caregivers during this vulnerable time of transition.

  8. Oncology Gold Standard™ practical consensus recommendations 2016 for treatment of advanced clear cell renal cell carcinoma.

    PubMed

    Batra, U; Parikh, P M; Prabhash, K; Tongaonkar, H B; Chibber, P; Dabkara, D; Deshmukh, C; Ghadyalpatil, N; Hingmire, S; Joshi, A; Raghunath, S K; Rajappa, S; Rajendranath, R; Rawal, S K; Singh, Manisha; Singh, R; Somashekhar, S P; Sood, R

    2016-01-01

    The Oncology Gold Standard (OGS) Expert Group on renal cell carcinoma (RCC) developed the consensus statement to provide community oncologists practical guidelines on the management of advanced clear cell (cc) RCC using published evidence, practical experience of experts in real life management, and results of a nationwide survey involving 144 health-care professionals. Six broad question categories containing 33 unique questions cover major situations in the routine management of RCC. This document serves as a ready guide for the standard of care to optimize outcome. The table of "Take Home Messages" at the end is a convenient tool for busy practitioners.

  9. Advanced access appointments

    PubMed Central

    Hudec, John C.; MacDougall, Steven; Rankin, Elaine

    2010-01-01

    ABSTRACT OBJECTIVE To examine the effects of advanced access (same-day physician appointments) on patient and provider satisfaction and to determine its association with other variables such as physician income and patient emergency department use. DESIGN Patient satisfaction survey and semistructured interviews with physicians and support staff; analysis of physician medical insurance billings and patient emergency department visits. SETTING Cape Breton, NS. PARTICIPANTS Patients, physicians, and support staff of 3 comparable family physician practices that had not implemented advanced access and an established advanced access practice. MAIN OUTCOME MEASURES Self-reported provider and patient satisfaction, physician office income, and patients’ emergency department use. RESULTS The key benefits of implementation of advanced access were an increase in provider and patient satisfaction levels, same or greater physician office income, and fewer less urgent (triage level 4) and nonurgent (triage level 5) emergency department visits by patients. CONCLUSION Currently within the Central Cape Breton Region, 33% of patients wait 4 or more days for urgent appointments. Findings from this study can be used to enhance primary care physician practice redesign. This research supports many benefits of transitioning to an advanced access model of patient booking. PMID:20944024

  10. A comparison of diagnostic imaging ordering patterns between advanced practice clinicians and primary care physicians following office-based evaluation and management visits.

    PubMed

    Hughes, Danny R; Jiang, Miao; Duszak, Richard

    2015-01-01

    Little is known about the use of diagnostic testing, such as medical imaging, by advanced practice clinicians (APCs), specifically, nurse practitioners and physician assistants. To examine the use of diagnostic imaging ordered by APCs relative to that of primary care physicians (PCPs) following office-based encounters. Using 2010-2011 Medicare claims for a 5% sample of beneficiaries, we compared diagnostic imaging ordering between APC and PCP episodes of care, controlling for geographic variation, patient demographics, and Charlson Comorbidity Index scores. Provider specialty codes were used to identify PCPs and APCs (general practice, family practice, or internal medicine for PCP; nurse practitioner or physician assistant for APC). Episodes were constructed using evaluation and management (E&M) office visits without any claims 30 days prior to the index visit and (1) no claims at all within the subsequent 30 days; (2) no claims within the subsequent 30 days other than a single imaging event; or (3) claims for any nonimaging services in that subsequent 30-day period. The primary outcome was whether an imaging event followed a qualifying E&M visit. Advanced practice clinicians and PCPs ordered imaging in 2.8% and 1.9% episodes of care, respectively. In adjusted estimates and across all patient groups and imaging services, APCs were associated with more imaging than PCPs (odds ratio [OR], 1.34 [95% CI, 1.27-1.42]), ordering 0.3% more images per episode. Advanced practice clinicians were associated with increased radiography orders on both new (OR, 1.36 [95% CI, 1.13-1.66]) and established (OR, 1.33 [95% CI, 1.24-1.43]) patients, ordering 0.3% and 0.2% more images per episode of care, respectively. For advanced imaging, APCs were associated with increased imaging on established patients (OR, 1.28 [95% CI, 1.14-1.44]), ordering 0.1% more images, but were not significantly different from PCPs ordering imaging on new patients. Advanced practice clinicians are associated

  11. Promoting addiction medicine teaching through functional mentoring by co-training generalist chief residents with faculty mentors.

    PubMed

    Alford, Daniel P; Carney, Brittany L; Jackson, Angela H; Brett, Belle; Bridden, Carly; Winter, Michael; Samet, Jeffrey H

    2018-02-16

    Generalist physicians should play a vital role in identifying and managing individuals with substance use but are inadequately trained to do so. This 5-year (2008-2012) controlled educational study assessed whether internal medicine and family medicine chief residents' (CRs) addiction medicine teaching increased by co-training with faculty mentors at a Chief Resident Immersion Training (CRIT) program in addiction medicine. All CRIT CR attendees identified a residency program faculty mentor to support addiction medicine teaching after CRIT through functional mentoring with a focus on developing and implementing an Addiction Medicine Teaching Project ("Teaching Project"). Approximately half of the CRs attended CRIT with their mentor (co-trained) and half without their mentor (solo-trained). Addiction medicine teaching outcomes were compared between groups using 6- and 11-month questionnaires and 4 bimonthly teaching logs. Of co-trained CRs, mentor characteristics that positively influenced addiction medicine teaching outcomes were identified. One hundred CRs from 74 residency programs attended CRIT from 2008 to 2012; 47 co-trained with their mentors and 53 solo-trained without their mentors. At 6-month follow-up, the co-trained CRs were more likely to meet at least monthly with their mentor (22.7% vs. 9.6%, P < .01) and more likely to identify their mentor as a facilitator for Teaching Project implementation (82.2% vs. 38.5%, P < .01). At 11-month follow-up, a higher percentage of co-trained CRs had completed their Teaching Project (34.0% vs. 15.1%, P < .05). Both CR groups had similarly large increases in other addiction medicine teaching outcomes. Mentors with more experience, including years of teaching, was associated with better CR Teaching Project outcomes. Co-training generalist chief residents with a faculty mentor appeared to facilitate functional mentoring-driven Teaching Project implementation but did not further increase already high levels of other

  12. Prime movers: Advanced practice professionals in the role of stroke coordinator.

    PubMed

    Rattray, Nicholas A; Damush, Teresa M; Luckhurst, Cherie; Bauer-Martinez, Catherine J; Homoya, Barbara J; Miech, Edward J

    2017-07-01

    Following a stroke quality improvement clustered randomized trial and a national acute ischemic stroke (AIS) directive in the Veterans Health Administration in 2011, this comparative case study examined the role of advanced practice professionals (APPs) in quality improvement activities among stroke teams. Semistructured interviews were conducted at 11 Veterans Affairs medical centers annually over a 3-year period. A multidisciplinary team analyzed interviews from clinical providers through a mixed-methods, data matrix approach linking APPs (nurse practitioners and physician assistants) with Consolidated Framework for Implementation Research constructs and a group organization measure. Five of 11 facilities independently chose to staff stroke coordinator positions with APPs. Analysis indicated that APPs emerged as boundary spanners across services and disciplines who played an important role in coordinating evidence-based, facility-level approaches to AIS care. The presence of APPs was related to engaging in group-based evaluation of performance data, implementing stroke protocols, monitoring care through data audit, convening interprofessional meetings involving planning activities, and providing direct care. The presence of APPs appears to be an influential feature of local context crucial in developing an advanced, facility-wide approach to stroke care because of their boundary spanning capabilities. ©2017 American Association of Nurse Practitioners.

  13. Pembrolizumab Utilization and Outcomes for Advanced Melanoma in US Community Oncology Practices

    PubMed Central

    Liu, Frank Xiaoqing; Black-Shinn, Jenny; Stevinson, Kendall; Boyd, Marley; Frytak, Jennifer R.; Ebbinghaus, Scot W.

    2018-01-01

    The programmed death-1 inhibitor pembrolizumab has demonstrated efficacy and safety in clinical trials for treating advanced (unresectable/metastatic) melanoma. We investigated the real-world utilization of pembrolizumab and associated patient outcomes for advanced melanoma in US community oncology practices. This retrospective, observational study used deidentified data from electronic health records for adult patients with advanced melanoma who received pembrolizumab at The US Oncology Network sites from September 2014 through December 2015, with follow-up through September 2016. Patients enrolled in clinical trials were excluded. Overall survival (OS) and physician-stated progression-free survival (PFS) were analyzed from pembrolizumab initiation using Kaplan-Meier, and associations between pembrolizumab therapy and OS/PFS, using multivariable Cox regression. Of 168 patients studied, 110 (65%) were male; the median age was 66 years (range, 26–over 90). Pembrolizumab was prescribed as first-line, second-line, and third-line/later for 39 (23%), 87 (52%), and 42 (25%) patients, respectively. In total, 41 patients (24%) had brain metastases. At pembrolizumab initiation, 21/129 (16%) had Eastern Cooperative Oncology Group performance status (ECOG PS) >1; 51/116 (44%) had elevated lactate dehydrogenase. Median follow-up was 10.5 months (range, 0–25.1); median OS was 19.4 months (95% confidence interval, 14.0–not reached); median PFS was 4.2 months (95% confidence interval, 2.9–5.3). Brain metastases, ECOG PS>1, elevated lactate dehydrogenase, and third-line/later (vs. first-line) pembrolizumab were significant predictors (P<0.01) of decreased survival. Treatment-related toxicity was a discontinuation reason for 25% (29/117) of patients, and for 10 of these 29 patients (6% of the full-study cohort) treatment-related toxicity was the only reported reason. The real-world effectiveness and safety of pembrolizumab for advanced melanoma are consistent with clinical

  14. Assessing the Spread and Uptake of a Framework for Introducing and Evaluating Advanced Practice Nursing Roles.

    PubMed

    Boyko, Jennifer A; Carter, Nancy; Bryant-Lukosius, Denise

    2016-08-01

    Health system researchers must ensure that the products of their work meet the needs of various stakeholder groups (e.g., patients, practitioners, and policy makers). Evidence-based frameworks can support the uptake and spread of research evidence; however, their existence as knowledge translation tools does not ensure their uptake and it is difficult to ascertain their spread into research, practice, and policy using existing methods. The purpose of this article is to report results of a study on the spread and uptake of an evidence-based framework (i.e., the participatory, evidence-based, patient-focused process for advanced practice nursing [PEPPA] framework) into research, practice, and policies relevant to the introduction and evaluation of advanced practice nursing roles. We also reflect on the utility of using a modified citation methodology to evaluate knowledge translation efforts. We searched four databases for literature published between 2004 and 2014 citing the original paper in which the PEPPA framework was published, and carried out an Internet search for grey literature using keywords. Relevant data were extracted from sources and organized using NVivo software. We analysed results descriptively. Our search yielded 164 unique sources of which 69.5% were from published literature and the majority (83.4%) of these were published in nursing journals. Most frequently (71.5%), the framework was used by researchers and students in research studies. A smaller number of citations (11.3%) reflected use of the PEPPA framework in practice settings with a focus on role development, implementation, evaluation, or a combination of these. This study demonstrates that the PEPPA framework has been used to varying degrees as intended, and provides guidance on how to evaluate the spread and uptake of research outputs (e.g., theoretical frameworks). Further research is needed about ways to determine whether evidence-informed research tools such as frameworks have been

  15. A Narrative Review of How Sleep-Related Breathing Disorders and Cardiovascular Diseases Are Linked: An Update for Advanced Practice Registered Nurses.

    PubMed

    Moon, Chooza; Phelan, Cynthia H; Lauver, Diane R; Bratzke, Lisa C

    Sleep-related breathing disorders (SRBDs), including obstructive sleep apnea and central sleep apnea, are common among patients with cardiovascular disease (CVD), but clinicians often do not pay enough attention to SRBDs. The purpose of this narrative review is to update advanced practice registered nurses on the literature focusing on the relationship between SRBDs and CVD (eg, hypertension, heart failure, coronary artery disease, arrhythmias, and stroke) and on treatments that can improve SRBDs in patients with CVD. We conducted an electronic search of the literature published between 1980 and 2016 from PubMed, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Academic Search Premier, and related health resource Web sites to address the aims of this study. Fifty-six primary research articles (42 observational studies and 14 experimental and quasi-experimental studies) were selected based on our study aims and inclusion criteria. The studies revealed that individuals with CVD are at a greater risk for SRBDs and that SRBDs can worsen CVD. The findings from the studies also suggest that positive airway treatment could improve both SRBDs and CVD. This review found a close relationship between SRBDs and CVD. Advanced practice registered nurses are in key positions to identify and help patients manage SRBDs. In particular, advanced practice registered nurses can educate staff and establish standards of practice to improve outcomes for patients with CVD.

  16. Integrating aesthetics into advanced practice mental health nursing: commercial film as a suggested modality.

    PubMed

    Raingruber, Bonnie

    2003-01-01

    The purpose of this study was to explore the advantages and disadvantages of using feature films in teaching advanced practice mental health nursing. A phenomenological investigation was conducted of 11 master's student perspectives regarding the use of movies in an on-line course. According to the students, the disadvantages of movies were that films are time consuming to watch and often more dramatic than real-life situations. The advantages of using movies were that films are effective in promoting reflection and enhancing empathy. Students noted that movies poignantly portray emotional issues and are engaging in addition to being a good way both to present educational content and introduce ethical dilemmas. Using movies also may be effective with select clients as a once-removed way to introduce therapeutic discussions in outpatient practice.

  17. Diet quality affects warning coloration indirectly: excretion costs in a generalist herbivore.

    PubMed

    Lindstedt, Carita; Talsma, Joanneke Hendrika Reudler; Ihalainen, Eira; Lindström, Leena; Mappes, Johanna

    2010-01-01

    Aposematic herbivores are under selection pressure from their host plants and predators. Although many aposematic herbivores exploit plant toxins in their own secondary defense, dealing with these harmful compounds might underlay costs. We studied whether the allocation of energy to detoxification and/or sequestration of host plant defense chemicals trades off with warning signal expression. We used a generalist aposematic herbivore Parasemia plantaginis (Arctiidae), whose adults and larvae show extensive phenotypic and genetic variation in coloration. We reared larvae from selection lines for small and large larval warning signals on Plantago lanceolata with either low or high concentration of iridoid glycosides (IGs). Larvae disposed of IGs effectively; their body IG content was low irrespective of their diet. Detoxification was costly as individuals reared on the high IG diet produced fewer offspring. The IG concentration of the diet did not affect larval coloration (no trade-off) but the wings of females were lighter orange (vs. dark red) when reared on the high IG diet. Thus, the difference in plant secondary chemicals did not induce variation in the chemical defense efficacy of aposematic individuals but caused variation in reproductive output and warning signals of females.

  18. Cryptic speciation and host-race formation in a purportedly generalist tumbling flower beetle.

    PubMed

    Blair, Catherine P; Abrahamson, Warren G; Jackman, John A; Tyrrell, Lynn

    2005-02-01

    Host-race formation remains controversial as a source of herbivorous insect diversity, and examples of host races are still fairly scarce. In this study, analysis of five enzyme loci in the ostensibly generalist tumbling flower beetle Mordellistena convicta (Coleoptera: Mordellidae) revealed hidden host-plant and plant-organ related genetic differentiation. Mordellistena convicta turned out to be a complex of cryptomorphic species, each with fewer hosts than the nominal species. These cryptic species, in turn, were divided into taxa that showed host-race characteristics: samples from different host plants and organs exhibited (1) genetic indications of partial reproductive isolation, (2) differences in size and emergence timing that suggested divergent host-related selection, and (3) among-host selective differences in mortality from parasitoids. Host-race formation in M. convicta, which has a somewhat different life history from the well-studied host races, enlarges the group of insects considered likely to undergo this process. The widespread sympatry of the M. convicta species complex, along with its spectrum of host-correlated genetic differentiation, suggests that these host specialist taxa developed in sympatry.

  19. Variation in the diet composition of a generalist predator, the red fox, in relation to season and density of main prey

    NASA Astrophysics Data System (ADS)

    Dell'Arte, Graziella Lucia; Laaksonen, Toni; Norrdahl, Kai; Korpimäki, Erkki

    2007-05-01

    Diet composition of a generalist predator, the red fox ( Vulpes vulpes) in relation to season (winter or summer) and abundance of multi-annually cyclic voles was studied in western Finland from 1983 to 1995. The proportion of scats (PS; a total of 58 scats) including each food category was calculated for each prey group. Microtus voles (the field vole M. agrestis and the sibling vole M. rossiaemeridionalis) were the main prey group of foxes (PS = 0.55) and they frequently occurred in the scats both in the winter and summer (PSs 0.50 and 0.62, respectively). There was a positive correlation between the PSs of Microtus voles in the winter diet of foxes and the density indices of these voles in the previous autumn. Other microtine rodents (the bank vole Clethrionomys glareolus, the water vole Arvicola terrestris and the muskrat Ondatra zibethicus) were consumed more in winter than in summer. The unusually high small mustelid predation by red foxes (PS = approx. 0.10) in our study area gives qualitative support for the hypothesis on the limiting impact of mammalian predators on least weasel and stoat populations. None of the important prey groups was preyed upon more at low than at high densities of main prey ( Microtus voles). This is consistent with the notion that red foxes are generalist predators that tend to opportunistically subsist on many prey groups. Among these prey groups, particularly hares and birds (including grouse), were frequently used as food by foxes.

  20. Spatial variation in selection on corolla shape in a generalist plant is promoted by the preference patterns of its local pollinators.

    PubMed

    Gómez, José M; Bosch, Jordi; Perfectti, Francisco; Fernández, J D; Abdelaziz, Mohamed; Camacho, J P M

    2008-10-07

    An adaptive role of corolla shape has been often asserted without an empirical demonstration of how natural selection acts on this trait. In generalist plants, in which flowers are visited by diverse pollinator fauna that commonly vary spatially, detecting pollinator-mediated selection on corolla shape is even more difficult. In this study, we explore the mechanisms promoting selection on corolla shape in the generalist crucifer Erysimum mediohispanicum Polatschek (Brassicaceae). We found that the main pollinators of E. mediohispanicum (large bees, small bees and bee flies) discriminate between different corolla shapes when offered artificial flowers without reward. Importantly, different pollinators prefer different shapes: bees prefer flowers with narrow petals, whereas bee flies prefer flowers with rounded overlapping petals. We also found that flowers with narrow petals (those preferred by bees) produce both more pollen and nectar than those with rounded petals. Finally, different plant populations were visited by different faunas. As a result, we found spatial variation in the selection acting on corolla shape. Selection favoured flowers with narrow petals in the populations where large or small bees are the most abundant pollinator groups. Our study suggests that pollinators, by preferring flowers with high reward, exert strong selection on the E. mediohispanicum corolla shape. The geographical variation in the pollinator-mediated selection on E. mediohispanicum corolla shape suggests that phenotypic evolution and diversification can occur in this complex floral trait even without specialization.

  1. Provision of NHS generalist and specialist services to care homes in England: review of surveys.

    PubMed

    Iliffe, Steve; Davies, Susan L; Gordon, Adam L; Schneider, Justine; Dening, Tom; Bowman, Clive; Gage, Heather; Martin, Finbarr C; Gladman, John R F; Victor, Christina; Meyer, Julienne; Goodman, Claire

    2016-03-01

    The number of beds in care homes (with and without nurses) in the United Kingdom is three times greater than the number of beds in National Health Service (NHS) hospitals. Care homes are predominantly owned by a range of commercial, not-for-profit or charitable providers and their residents have high levels of disability, frailty and co-morbidity. NHS support for care home residents is very variable, and it is unclear what models of clinical support work and are cost-effective. To critically evaluate how the NHS works with care homes. A review of surveys of NHS services provided to care homes that had been completed since 2008. It included published national surveys, local surveys commissioned by Primary Care organisations, studies from charities and academic centres, grey literature identified across the nine government regions, and information from care home, primary care and other research networks. Data extraction captured forms of NHS service provision for care homes in England in terms of frequency, location, focus and purpose. Five surveys focused primarily on general practitioner services, and 10 on specialist services to care home. Working relationships between the NHS and care homes lack structure and purpose and have generally evolved locally. There are wide variations in provision of both generalist and specialist healthcare services to care homes. Larger care home chains may take a systematic approach to both organising access to NHS generalist and specialist services, and to supplementing gaps with in-house provision. Access to dental care for care home residents appears to be particularly deficient. Historical differences in innovation and provision of NHS services, the complexities of collaborating across different sectors (private and public, health and social care, general and mental health), and variable levels of organisation of care homes, all lead to persistent and embedded inequity in the distribution of NHS resources to this population

  2. Toward Advancing Nano-Object Count Metrology: A Best Practice Framework

    PubMed Central

    Boyko, Volodymyr; Meyers, Greg; Voetz, Matthias; Wohlleben, Wendel

    2013-01-01

    Background: A movement among international agencies and policy makers to classify industrial materials by their number content of sub–100-nm particles could have broad implications for the development of sustainable nanotechnologies. Objectives: Here we highlight current particle size metrology challenges faced by the chemical industry due to these emerging number percent content thresholds, provide a suggested best-practice framework for nano-object identification, and identify research needs as a path forward. Discussion: Harmonized methods for identifying nanomaterials by size and count for many real-world samples do not currently exist. Although particle size remains the sole discriminating factor for classifying a material as “nano,” inconsistencies in size metrology will continue to confound policy and decision making. Moreover, there are concerns that the casting of a wide net with still-unproven metrology methods may stifle the development and judicious implementation of sustainable nanotechnologies. Based on the current state of the art, we propose a tiered approach for evaluating materials. To enable future risk-based refinements of these emerging definitions, we recommend that this framework also be considered in environmental and human health research involving the implications of nanomaterials. Conclusion: Substantial scientific scrutiny is needed in the area of nanomaterial metrology to establish best practices and to develop suitable methods before implementing definitions based solely on number percent nano-object content for regulatory purposes. Strong cooperation between industry, academia, and research institutions will be required to fully develop and implement detailed frameworks for nanomaterial identification with respect to emerging count-based metrics. Citation: Brown SC, Boyko V, Meyers G, Voetz M, Wohlleben W. 2013. Toward advancing nano-object count metrology: a best practice framework. Environ Health Perspect 121:1282–1291;

  3. Economic benefits of less restrictive regulation of advanced practice nurses in North Carolina.

    PubMed

    Conover, Chris; Richards, Robert

    2015-01-01

    With looming provider shortages and increased demand for health care, many states are looking for low-cost ways to alleviate the shortages. The purpose of this study was to assess the economic impact of less restrictive regulations for advanced practice registered nurses (APRNs) in North Carolina. We use economic impact analysis to demonstrate the economic impacts of making state scope-of-practice regulations on APRNs less restrictive in North Carolina. Outcomes include economic output, value-added, payroll compensation, employment, and tax revenue for North Carolina and for various subregions. If North Carolina adopted the same approach to APRN regulation as the least restrictive states, its economy will benefit from substantial increases in economic output and employment. The state will also see increases in tax revenue. In addition to substantially shrinking the size of projected physician shortages, allowing full scope-of-practice for APRNs will bring significant economic benefits to the state of North Carolina. Our analysis should be helpful to policy makers considering ways to deal with provider shortages. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Recognizing the Importance of Aging Skills and Knowledge in Generalist Social Work Practice: Effective Strategies for MSW Students

    ERIC Educational Resources Information Center

    Bonifas, Robin P.; Fredriksen-Goldsen, Karen I.; Bailey, Kathleen A.

    2009-01-01

    This article examines the impact of a curricular infusion strategy aimed at integrating gerontological practice issues into social work education. Findings (N = 83) illustrate that student interest, knowledge, and skills in aging practice increased immediately following implementation of a three-tiered infusion approach; however, ongoing exposure…

  5. Feeding Tube Placement in Patients with Advanced Dementia: The Beliefs and Practice Patterns of Speech-Language Pathologists

    ERIC Educational Resources Information Center

    Sharp, Helen M.; Shega, Joseph W.

    2009-01-01

    Purpose: To describe the beliefs and practices of speech-language pathologists (SLPs) about the use of percutaneous endoscopic gastrostomy (PEG) among patients with advanced dementia and dysphagia. Method: A survey was mailed to a geographically stratified random sample of 1,050 medical SLPs. Results: The response rate was 57%, and 326 surveys met…

  6. Oncology Gold Standard™ practical consensus recommendations 2016 for treatment of advanced clear cell renal cell carcinoma

    PubMed Central

    Batra, U; Parikh, PM; Prabhash, K; Tongaonkar, HB; Chibber, P; Dabkara, D; Deshmukh, C; Ghadyalpatil, N; Hingmire, S; Joshi, A; Raghunath, SK; Rajappa, S; Rajendranath, R; Rawal, SK; Singh, Manisha; Singh, R; Somashekhar, SP; Sood, R

    2016-01-01

    The Oncology Gold Standard (OGS) Expert Group on renal cell carcinoma (RCC) developed the consensus statement to provide community oncologists practical guidelines on the management of advanced clear cell (cc) RCC using published evidence, practical experience of experts in real life management, and results of a nationwide survey involving 144 health-care professionals. Six broad question categories containing 33 unique questions cover major situations in the routine management of RCC. This document serves as a ready guide for the standard of care to optimize outcome. The table of “Take Home Messages” at the end is a convenient tool for busy practitioners. PMID:28032079

  7. WE-F-201-00: Practical Guidelines for Commissioning Advanced Brachytherapy Dose Calculation Algorithms

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    NONE

    2015-06-15

    With the recent introduction of heterogeneity correction algorithms for brachytherapy, the AAPM community is still unclear on how to commission and implement these into clinical practice. The recently-published AAPM TG-186 report discusses important issues for clinical implementation of these algorithms. A charge of the AAPM-ESTRO-ABG Working Group on MBDCA in Brachytherapy (WGMBDCA) is the development of a set of well-defined test case plans, available as references in the software commissioning process to be performed by clinical end-users. In this practical medical physics course, specific examples on how to perform the commissioning process are presented, as well as descriptions of themore » clinical impact from recent literature reporting comparisons of TG-43 and heterogeneity-based dosimetry. Learning Objectives: Identify key clinical applications needing advanced dose calculation in brachytherapy. Review TG-186 and WGMBDCA guidelines, commission process, and dosimetry benchmarks. Evaluate clinical cases using commercially available systems and compare to TG-43 dosimetry.« less

  8. Research for the advancement of green chemistry practice: Studies in atmospheric and educational chemistry

    NASA Astrophysics Data System (ADS)

    Cullipher, Steven Gene

    Green chemistry is a philosophy of chemistry that emphasizes a decreasing dependence on limited non-renewable resources and an increasing focus on preventing pollution byproducts of the chemical industry. In short, it is the discipline of chemistry practiced through the lens of environmental stewardship. In an effort to advance the practice of green chemistry, three studies will be described that have ramifications for the practice. The first study examines the atmospheric oxidation of a hydrofluorinated ether, a third-generation CFC replacement compound with primarily unknown atmospheric degradation products. Determination of these products has the potential to impact decisions on refrigerant usage in the future. The second study examines chemistry students' development of understanding benefits-costs-risks analysis when presented with two real-world scenarios: refrigerant choice and fuel choice. By studying how benefits-costs-risks thinking develops, curricular materials and instructional approaches can be designed to better foster the development of an ability that is both necessary for green chemists and important in daily decision-making for non-chemists. The final study uses eye tracking technology to examine students' abilities to interpret molecular properties from structural information in the context of global warming. Such abilities are fundamental if chemists are to appropriately assess risks and hazards of chemistry practice.

  9. Focused development of advanced practice nurse roles for specific patient groups in a Swiss university hospital

    PubMed

    Spichiger, Elisabeth; Zumstein-Shaha, Maya; Schubert, Maria; Herrmann, Luzia

    2018-02-01

    Background: To cover future health care needs of the population, new care models are necessary. The development of advanced nursing practice (ANP) offers the opportunity to meet these challenges with novel services. At the Inselspital, Bern University Hospital, ANP services and corresponding advanced practice nurse (APN) roles have been developed since 2011. Purpose: The aim is to develop innovative and evidence based ANP services to supplement health care for specific patient groups and their family members with the goal to improve safety and achieve better outcomes. Methods: Project-based ANP services are developed in close collaboration of clinical departments and the Nursing Development Unit (NDU) of the Directorate of Nursing. Structure, process and outcome data are collected for evaluation. Findings: Currently, five ANP services are established and running, eight more are in the developmental phase. Most services address the long term care of patients with chronic illnesses and their family members. Ten APNs work between 10 % and 80 %, three are leading an ANP-team. APNs work over 50 % in direct clinical practice, primarily in counselling. An ANP network connects APNs and NDU, promoting synergy and exchange. Conclusions: The available resources often constitute a challenge for the development of ANP services. Vital for the long-term success are an adequate extent of the position, the support by department directorate, the conceptual framework that is implemented across the whole hospital, and the development within project structures.

  10. Management of advanced pancreatic cancer with gemcitabine plus erlotinib: efficacy and safety results in clinical practice.

    PubMed

    Diaz Beveridge, Robert; Alcolea, Vicent; Aparicio, Jorge; Segura, Ángel; García, Jose; Corbellas, Miguel; Fonfría, María; Giménez, Alejandra; Montalar, Joaquin

    2014-01-10

    The combination of gemcitabine and erlotinib is a standard first-line treatment for unresectable, locally advanced or metastatic pancreatic cancer. We reviewed our single centre experience to assess its efficacy and toxicity in clinical practice. Clinical records of patients with unresectable, locally advanced or metastatic pancreatic cancer who were treated with the combination of gemcitabine and erlotinib were reviewed. Univariate survival analysis and multivariate analysis were carried out to indentify independent predictors factors of overall survival. Our series included 55 patients. Overall disease control rate was 47%: 5% of patients presented complete response, 20% partial response and 22% stable disease. Median overall survival was 8.3 months). Cox regression analysis indicated that performance status and locally advanced versus metastatic disease were independent factors of overall survival. Patients who developed acne-like rash toxicity, related to erlotinib administration, presented a higher survival than those patients who did not develop this toxicity. Gemcitabine plus erlotinib doublet is active in our series of patients with advanced pancreatic cancer. This study provides efficacy and safety results similar to those of the pivotal phase III clinical trial that tested the same combination.

  11. Understanding the foundation: the state of generalist search education in library schools as related to the needs of expert searchers in medical libraries

    PubMed Central

    Nicholson, Scott

    2005-01-01

    Purpose: The paper explores the current state of generalist search education in library schools and considers that foundation in respect to the Medical Library Association's statement on expert searching. Setting/Subjects: Syllabi from courses with significant searching components were examined from ten of the top library schools, as determined by the U.S. News & World Report rankings. Methodology: Mixed methods were used, but primarily quantitative bibliometric methods were used. Results: The educational focus in these searching components was on understanding the generalist searching resources and typical users and on performing a reflective search through application of search strategies, controlled vocabulary, and logic appropriate to the search tool. There is a growing emphasis on Web-based search tools and a movement away from traditional set-based searching and toward free-text search strategies. While a core set of authors is used in these courses, no core set of readings is used. Discussion/Conclusion: While library schools provide a strong foundation, future medical librarians still need to take courses that introduce them to the resources, settings, and users associated with medical libraries. In addition, as more emphasis is placed on Web-based search tools and free-text searching, instructors of the specialist medical informatics courses will need to focus on teaching traditional search methods appropriate for common tools in the medical domain. PMID:15685276

  12. Family presence during cardiopulmonary resuscitation: using evidence-based knowledge to guide the advanced practice nurse in developing formal policy and practice guidelines.

    PubMed

    Doolin, Christopher T; Quinn, Lisa D; Bryant, Lesley G; Lyons, Ann A; Kleinpell, Ruth M

    2011-01-01

    To provide advanced practice nurses (APNs) with the best available evidence for implementation of policies and procedures to allow family presence during cardiopulmonary resuscitation (CPR) in the acute care environment. A comprehensive review of research-based articles from Ebsco Host, CINAHL, Pre-CINAHL, and Medline Plus, as well as statement alerts from nursing credentialing bodies, and practice guidelines were reviewed. Kolcaba's Theory of Comfort and Lewin's Three Step Change Theory provide a framework for implementation of formal policies and procedures. Best available evidence showed more support in favor of allowing families at the bedside during CPR. Implementation of policies and procedures allowing family presence enables facilities to change and grow in a holistic and family-oriented atmosphere. With this evidence-based knowledge the APN will be able to disseminate information to facilitate collaborative change in current practices surrounding staff education, decision making, and self-governance. The APN can then address controversial changes when developing formal policies and procedures, which will increase patient satisfaction and outcomes. ©2010 The Author Journal compilation ©2010 American Academy of Nurse Practitioners.

  13. Landscape structure affects specialists but not generalists in naturally fragmented grasslands

    USGS Publications Warehouse

    Miller, Jesse E.D.; Damschen, Ellen Ingman; Harrison, Susan P.; Grace, James B.

    2015-01-01

    Understanding how biotic communities respond to landscape spatial structure is critically important for conservation management as natural landscapes become increasingly fragmented. However, empirical studies of the effects of spatial structure on plant species richness have found inconsistent results, suggesting that more comprehensive approaches are needed. In this study, we asked how landscape structure affects total plant species richness and the richness of a guild of specialized plants in a multivariate context. We sampled herbaceous plant communities at 56 dolomite glades (insular, fire-adapted grasslands) across the Missouri Ozarks, and used structural equation modeling (SEM) to analyze the relative importance of landscape structure, soil resource availability, and fire history for plant communities. We found that landscape spatial structure-defined as the area-weighted proximity of glade habitat surrounding study sites (proximity index)-had a significant effect on total plant species richness, but only after we controlled for environmental covariates. Richness of specialist species, but not generalists, was positively related to landscape spatial structure. Our results highlight that local environmental filters must be considered to understand the influence of landscape structure on communities, and that unique species guilds may respond differently to landscape structure than the community as a whole. These findings suggest that both local environment and landscape context should be considered when developing management strategies for species of conservation concern in fragmented habitats.

  14. [Practice of Internal Medicine in Latin America. Role of the internist].

    PubMed

    Varela, Nacor

    2002-01-01

    This article explores the causes of the crisis in the role of internists. As in the United States, the progressive specialization of internists lead to a dehumanized, expensive and technical practice of medicine. Aiming to better incomes and prestige, more than 60% of internists practice as specialists. Primary care physicians, with a very low rate of problem solving, cover 75% of consultations. Specialists, with increasing costs, cover the rest of consultations. Patients, medical schools and health organizations are claiming the return of the general internal medicine specialist. To increase the interest for general internal medicine, several strategies are applicable. Medical students interested in general internal medicine could receive a focused training, provided by these specialists. A greater emphasis should be put on primary care. More independent, secondary care diagnostic and treatment centers, should be created. Continuous medical education should be done with periodical re certification of physicians. The public health system should increase its wages and the generalist view should be maintained by physicians when practicing at their private offices.

  15. A model to advance nursing science in trauma practice and injury outcomes research.

    PubMed

    Richmond, Therese S; Aitken, Leanne M

    2011-12-01

    This discussion paper reports development of a model to advance nursing science and practice in trauma care based on an analysis of the literature and expert opinion. The continuum of clinical care provided to trauma patients extends from the time of injury through to long-term recovery and final outcomes. Nurses bring a unique expertise to meet the complex physical and psychosocial needs of trauma patients and their families to influence outcomes across this entire continuum. Literature was obtained by searching CINAHL, PubMed and OvidMedline databases for 1990-2010. Search terms included trauma, nursing, scope of practice and role, with results restricted to those published in English. Manual searches of relevant journals and websites were undertaken. Core concepts in this trauma outcomes model include environment, person/family, structured care settings, long-term outcomes and nursing interventions. The relationships between each of these concepts extend across all phases of care. Intermediate outcomes are achieved in each phase of care and influence and have congruence with long-term outcomes. Implications for policy and practice.  This model is intended to provide a framework to assist trauma nurses and researchers to consider the injured person in the context of the social, economic, cultural and physical environment from which they come and the long-term goals that each person has during recovery. The entire model requires testing in research and assessment of its practical contribution to practice. Planning and integrating care across the trauma continuum and recognition of the role of the injured person's background, family and resources will lead to improved long-term outcomes. © 2011 Blackwell Publishing Ltd.

  16. Advanced Energy Retrofit Guide: Practical Ways to Improve Energy Performance, K-12 Schools (Book)

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Not Available

    The U.S. Department of Energy developed the K-12 Advanced Energy Retrofit Guide to provide specific methodologies, information, and guidance to help energy managers and other stakeholders plan and execute energy efficiency improvements. We emphasize actionable information, practical methodologies, diverse case studies, and unbiased evaluation of the most promising retrofit measure for each building type. K-12 schools were selected as one of the highest priority building sectors, because schools affect the lives of most Americans. They also represent approximately 8% of the energy use and 10% of the floor area in commercial buildings.

  17. Seminar for High School Students “Practice on Manufacturing Technology by Advanced Machine Tools”

    NASA Astrophysics Data System (ADS)

    Marui, Etsuo; Yamawaki, Masao; Taga, Yuken; Omoto, Ken'ichi; Miyaji, Reiji; Ogura, Takahiro; Tsubata, Yoko; Sakai, Toshimasa

    The seminar ‘Practice on Manufacturing Technology by Advanced Machine Tools’ for high school students was held at the supporting center for technology education of Gifu University, under the sponsorship of the Japan Society of Mechanical Engineers. This seminar was held, hoping that many students become interested in manufacturing through the experience of the seminar. Operating CNC milling machine and CNC wire-cut electric discharge machine, they made original nameplates. Participants made the program to control CNC machine tools themselves. In this report, some valuable results obtained through such experience are explained.

  18. Listening Instruction and Practice for Advanced ESL Students.

    ERIC Educational Resources Information Center

    Godfrey, Dennis

    This paper attempts to enact Rivers' (1971 and 1972) urgings to base ESL listening instruction on both psychological and linguistic findings and contends that advanced ESL students' listening needs call for improvement in processing spoken English discourse. Psychological data on memory span is cited to demonstrate that advanced ESL students…

  19. Host generalists and specialists emerging side by side: an analysis of evolutionary patterns in the cosmopolitan chewing louse genus Menacanthus.

    PubMed

    Martinů, Jana; Sychra, Oldřich; Literák, Ivan; Čapek, Miroslav; Gustafsson, Daniel L; Štefka, Jan

    2015-01-01

    Parasites with wide host spectra provide opportunities to study the ecological parameters of speciation, as well as the process of the evolution of host specificity. The speciose and cosmopolitan louse genus Menacanthus comprises both multi-host and specialised species, allowing exploration of the ecological and historical factors affecting the evolution of parasites using a comparative approach. We used phylogenetic analysis to reconstruct evolutionary relationships in 14 species of Menacanthus based on the sequences of one mitochondrial and one nuclear gene. The results allowed us to validate species identification based on morphology, as well as to explore host distribution by assumed generalist and specialist species. Our analyses confirmed a narrow host use for several species, however in some cases, the supposed host specialists had a wider host spectrum than anticipated. In one case a host generalist (Menacanthus eurysternus) was clustered terminally on a clade almost exclusively containing host specialists. Such a clade topology indicates that the process of host specialisation may not be irreversible in parasite evolution. Finally, we compared patterns of population genetic structure, geographic distribution and host spectra between two selected species, M. eurysternus and Menacanthus camelinus, using haplotype networks. Menacanthus camelinus showed limited geographical distribution in combination with monoxenous host use, whereas M. eurysternus showed a global distribution and lack of host specificity. It is suggested that frequent host switching maintains gene flow between M. eurysternus populations on unrelated hosts in local populations. However, gene flow between geographically distant localities was restricted, suggesting that geography rather than host-specificity is the main factor defining the global genetic diversity of M. eurysternus. Copyright © 2014 Australian Society for Parasitology Inc. Published by Elsevier Ltd. All rights reserved.

  20. Habitat generalists and specialists in microbial communities across a terrestrial-freshwater gradient

    NASA Astrophysics Data System (ADS)

    Monard, C.; Gantner, S.; Bertilsson, S.; Hallin, S.; Stenlid, J.

    2016-11-01

    Observations of distributions of microorganisms and their differences in community composition across habitats provide evidence of biogeographical patterns. However, little is known about the processes controlling transfers across habitat gradients. By analysing the overall microbial community composition (bacteria, fungi, archaea) across a terrestrial-freshwater gradient, the aim of this study was to understand the spatial distribution patterns of populations and identify taxa capable of crossing biome borders. Barcoded 454 pyrosequencing of taxonomic gene markers was used to describe the microbial communities in adjacent soil, freshwater and sediment samples and study the role of biotic and spatial factors in shaping their composition. Few habitat generalists but a high number of specialists were detected indicating that microbial community composition was mainly regulated by species sorting and niche partitioning. Biotic interactions within microbial groups based on an association network underlined the importance of Actinobacteria, Sordariomycetes, Agaricomycetes and Nitrososphaerales in connecting among biomes. Even if dispersion seemed limited, the shore of the lake represented a transition area, allowing populations to cross the biome boundaries. In finding few broadly distributed populations, our study points to biome specialization within microbial communities with limited potential for dispersal and colonization of new habitats along the terrestrial-freshwater continuum.

  1. Culture care theory: a major contribution to advance transcultural nursing knowledge and practices.

    PubMed

    Leininger, Madeleine

    2002-07-01

    This article is focused on the major features of the Culture Care Diversity and Universality theory as a central contributing theory to advance transcultural nursing knowledge and to use the findings in teaching, research, practice, and consultation. It remains one of the oldest, most holistic, and most comprehensive theories to generate knowledge of diverse and similar cultures worldwide. The theory has been a powerful means to discover largely unknown knowledge in nursing and the health fields. It provides a new mode to assure culturally competent, safe, and congruent transcultural nursing care. The purpose, goal, assumptive premises, ethnonursing research method, criteria, and some findings are highlighted.

  2. Sandia National Laboratories Advanced Simulation and Computing (ASC) software quality plan. Part 1: ASC software quality engineering practices, Version 2.0.

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Sturtevant, Judith E.; Heaphy, Robert; Hodges, Ann Louise

    2006-09-01

    The purpose of the Sandia National Laboratories Advanced Simulation and Computing (ASC) Software Quality Plan is to clearly identify the practices that are the basis for continually improving the quality of ASC software products. The plan defines the ASC program software quality practices and provides mappings of these practices to Sandia Corporate Requirements CPR 1.3.2 and 1.3.6 and to a Department of Energy document, ASCI Software Quality Engineering: Goals, Principles, and Guidelines. This document also identifies ASC management and software project teams responsibilities in implementing the software quality practices and in assessing progress towards achieving their software quality goals.

  3. Habitat-related specialization of lateral-line system morphology in a habitat-generalist and a habitat-specialist New Zealand eleotrid.

    PubMed

    Vanderpham, J P; Nakagawa, S; Senior, A M; Closs, G P

    2016-04-01

    An investigation of intraspecific habitat-related patterns of variation in oculoscapular lateral-line superficial neuromasts (SN) identified a decrease in the ratio of total SNs to pores, and a trend towards decreased asymmetry in SNs in the habitat-generalist common bully Gobiomorphus cotidianus from fluvial habitats compared to lacustrine habitats, suggesting habitat-related phenotypic variability. A greater ratio of pores to SNs, as well as less variation in the total number and asymmetry of SNs observed in the fluvial habitat-specialist redfin bully Gobiomorphus huttoni may provide further evidence of variations in the oculoscapular lateral-line morphology of fluvial habitat G. cotidianus individuals serving as adaptations to more turbulent environments. © 2016 The Fisheries Society of the British Isles.

  4. Establishment and Implementation of a Required Medication Therapy Management Advanced Pharmacy Practice Experience

    PubMed Central

    Gilliam, Eric; Thompson, Megan; Vande Griend, Joseph

    2017-01-01

    Objective. To develop a community pharmacy-based medication therapy management (MTM) advanced pharmacy practice experience (APPE) that provides students with skills and knowledge to deliver entry-level pharmacy MTM services. Design. The University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences (SSPPS) partnered with three community pharmacy chains to establish this three-week, required MTM APPE. Students completed the American Pharmacists Association MTM Certificate Course prior to entering the APPE. Students were expected to spend 90% or more of their time at this experience working on MTM interventions, using store MTM platforms. Assessment. All 151 students successfully completed this MTM APPE, and each received a passing evaluation from their preceptor. Preceptor evaluations of students averaged above four (entry-level practice) on a five-point Likert scale. The majority of students reported engagement in MTM services for more than 80% of the time on site. Students’ self-reporting of their ability to perform MTM interventions improved after participation in the APPE. Conclusion. The SSPPS successfully implemented a required MTM APPE, preparing students for entry-level delivery of MTM services. PMID:28381896

  5. Collaboratively reframing mental health for integration of HIV care in Ethiopia†

    PubMed Central

    Wissow, Lawrence S.; Tegegn, Teketel; Asheber, Kassahun; McNabb, Marion; Weldegebreal, Teklu; Jerene, Degu; Ruff, Andrea

    2015-01-01

    Background Integrating mental health with general medical care can increase access to mental health services, but requires helping generalists acquire a range of unfamiliar knowledge and master potentially complex diagnostic and treatment processes. Method We describe a model for integrating complex specialty care with generalist/primary care, using as an illustration the integration of mental health into hospital-based HIV treatment services in Ethiopia. Generalists and specialists collaboratively developed mental health treatments to fit the knowledge, skills and resources of the generalists. The model recognizes commonalities between mental health and general medical care, focusing on practical interventions acceptable to patients. It was developed through a process of literature review, interviews, observing clinical practice, pilot trainings and expert consultation. Preliminary evaluation results were obtained by debriefing generalist trainees after their return to their clinical sites. Results In planning interviews, generalists reported discomfort making mental health diagnoses but recognition of symptom groups including low mood, anxiety, thought problems, poor child behaviour, seizures and substance use. Diagnostic and treatment algorithms were developed for these groups and tailored to the setting by including possible medical causes and burdens of living with HIV. First-line treatment included modalities familiar to generalists: empathetic patient–provider interactions, psychoeducation, cognitive reframing, referral to community supports and elements of symptom-specific evidence-informed counselling. Training introduced basic skills, with evolving expertise supported by job aides and ongoing support from mental health nurses cross-trained in HIV testing. Feedback from trainees suggested the programme fit well with generalists’ settings and clinical goals. Conclusions An integration model based on collaboratively developing processes that fit the

  6. Randomized Clinical Trial of the Effectiveness of a Home-Based Advanced Practice Psychiatric Nurse Intervention: Outcomes for Individuals with Serious Mental Illness and HIV

    PubMed Central

    Hanrahan, Nancy P.; Wu, Evan; Kelly, Deena; Aiken, Linda H.; Blank, Michael B.

    2011-01-01

    Individuals with serious mental illness have greater risk for contracting HIV, multiple morbidities, and die 25 years younger than the general population. This high need and high cost subgroup face unique barriers to accessing required health care in the current health care system. The effectiveness of an advanced practice nurse model of care management was assessed in a four-year random controlled trial. Results are reported in this paper. In a four-year random controlled trial, a total of 238 community-dwelling individuals with HIV and serious mental illness (SMI) were randomly assigned to an intervention group (n=128) or to a control group (n=110). Over 12 months, the intervention group received care management from advanced practice psychiatric nurse, and the control group received usual care. The intervention group showed significant improvement in depression (P=.012) and the physical component of health-related quality of life (P=.03) from baseline to 12 months. The advanced practice psychiatric nurse intervention is a model of care that holds promise for a higher quality of care and outcomes for this vulnerable population. PMID:21935499

  7. Practical Advances in Petroleum Processing

    NASA Astrophysics Data System (ADS)

    Hsu, Chang S.; Robinson, Paul R.

    "This comprehensive book by Robinson and Hsu will certainly become the standard text book for the oil refining business...[A] must read for all who are associated with oil refining." - Dr. Walter Fritsch, Senior Vice President Refining, OMV "This book covers a very advanced horizon of petroleum processing technology. For all refiners facing regional and global environmental concerns, and for those who seek a more sophisticated understanding of the refining of petroleum resources, this book has been long in coming." - Mr. Naomasa Kondo, Cosmo Oil Company, Ltd.

  8. Relative Binding Free Energy Calculations in Drug Discovery: Recent Advances and Practical Considerations.

    PubMed

    Cournia, Zoe; Allen, Bryce; Sherman, Woody

    2017-12-26

    Accurate in silico prediction of protein-ligand binding affinities has been a primary objective of structure-based drug design for decades due to the putative value it would bring to the drug discovery process. However, computational methods have historically failed to deliver value in real-world drug discovery applications due to a variety of scientific, technical, and practical challenges. Recently, a family of approaches commonly referred to as relative binding free energy (RBFE) calculations, which rely on physics-based molecular simulations and statistical mechanics, have shown promise in reliably generating accurate predictions in the context of drug discovery projects. This advance arises from accumulating developments in the underlying scientific methods (decades of research on force fields and sampling algorithms) coupled with vast increases in computational resources (graphics processing units and cloud infrastructures). Mounting evidence from retrospective validation studies, blind challenge predictions, and prospective applications suggests that RBFE simulations can now predict the affinity differences for congeneric ligands with sufficient accuracy and throughput to deliver considerable value in hit-to-lead and lead optimization efforts. Here, we present an overview of current RBFE implementations, highlighting recent advances and remaining challenges, along with examples that emphasize practical considerations for obtaining reliable RBFE results. We focus specifically on relative binding free energies because the calculations are less computationally intensive than absolute binding free energy (ABFE) calculations and map directly onto the hit-to-lead and lead optimization processes, where the prediction of relative binding energies between a reference molecule and new ideas (virtual molecules) can be used to prioritize molecules for synthesis. We describe the critical aspects of running RBFE calculations, from both theoretical and applied perspectives

  9. Special populations: telehealth advance practice nursing: the lived experiences of individuals with acute infections transitioning in the home.

    PubMed

    Marineau, Michelle L

    2007-01-01

    This paper aims to describe the "lived experience" of individuals with acute infections transitioning in the home with support by an advance practice nurse using telehealth. The use of telehealth in individuals' homes in the United States is increasing in an effort to cut cost by limiting admissions to hospitals and/or reducing length of stay. This increase has not been driven by conclusive research findings in support of this technology; furthermore, the majority of research conducted has been in the area of chronic disease management. A qualitative approach was used to describe the essential structure of the lived experience as told during taped interviews by individuals who had been enrolled in a pilot quantitative telehealth study over the past 2 years. Major findings consisted of three theme categories: Initial response, Engaging in care, and Experiencing the downside. The transition that occurred when an individual with an acute infection was discharged from the hospital to the home supported by telehealth technology revealed an overall positive experience from the 10 participants. There was one negative experience in a participant who had two separate telehealth enrollments. The findings add valuable insight for advanced practice nurses into the experience of participants with acute illness who are receiving telehealth as they transition from hospital care to home care. The findings highlighted the importance of the participants having a sense of control when recovering from their illness, which could be achieved at home with a family member acting as a substitute nurse. The participants shared that the hospital environment may not be optimal for recovering from an illness. This provides the advanced practice nurse with information on risk and benefits of telehealth from the individuals' perspective.

  10. Can the Institute of Medicine trump the dominant logic of nursing? Leading change in advanced practice education.

    PubMed

    Dreher, Melanie C; Clinton, Patricia; Sperhac, Arlene

    2014-01-01

    The Institute of Medicine (IOM; 2010) has called for a transformation of the nursing profession to lead the redesign of health care in the United States. It acknowledges the need for profound change in nursing education, particularly advanced practice education, to produce the next generation of leaders in sufficient quantity to expand access, improve quality, and reduce cost. Although the IOM provides welcome validation of nursing's significant role, most of the recommendations are not new and have been advocated by nurse educators for decades. What has prevented us from creating the nimble and responsive educational programs that would ensure a sufficient corpus of advanced practice nurses with the relevant knowledge and skill to transform our ailing health system? Conceptualizing nursing as a complex, adaptive system (J.W. Begun and K. White, 1997), this article explores three examples of the dominant logic, grounded in a historical legacy that has kept the nursing profession from realizing its promise as a potent force: (a) the continuing preference for experience over education, (b) the belief that only nurses can teach nurses, and (c) the hegemony of the research doctorate. © 2014.

  11. Nurses self-performing and teaching others breast self-examination: implications for advanced practice nurses.

    PubMed

    Devine, S K; Frank, D I

    2000-07-01

    Although there is evidence to suggest that breast self-examination (BSE) aids in the early detection of breast cancer, the underuse of this prevention behavior continues to exist. The purpose of this study was to explore the personal behaviors and professional practices of nurses in the use of BSE and to discuss implications for the advanced practice nurse (APN). The sample (N = 300) consisted of nurses and student nurses. While almost all nurses had performed BSE at least once, fewer than half did this monthly. The majority believed it was the nurse's role to teach BSE, but almost three fourths of the sample taught it only occasionally or rarely. Not thinking of it and not knowing when or how to teach were reasons identified for not teaching. The roles of the APN as an educator, leader, consultant, direct care provider, and researcher are examined in light of these findings to promote nurses' performing and teaching BSE.

  12. Innovative Practice in Advancement of Academic Nurse Educator Careers: Developing Scholarship From Program Grants.

    PubMed

    Eddy, Linda L; Hoeksel, Renee; Fitzgerald, Cindy; Doutrich, Dawn

    We describe an innovative practice in advancing careers of academic nurse educators: demonstrating scholarly productivity from program grants. Scholarly productivity is often narrowly defined, especially in research-intensive institutions. The expectation may be a career trajectory based on the traditional scholarship of discovery. However, nurse educators, especially at the associate and full professor ranks, are often involved in leadership activities that include writing and managing program grants. We encourage the academy to value and support the development of program grants that include significant scholarly components, and we offer exemplars of associate and full professor scholarship derived from these projects.

  13. Determinants in the development of advanced nursing practice: a case study of primary-care settings in Hong Kong.

    PubMed

    Twinn, Sheila; Thompson, David R; Lopez, Violeta; Lee, Diana T F; Shiu, Ann T Y

    2005-01-01

    Different factors have been shown to influence the development of models of advanced nursing practice (ANP) in primary-care settings. Although ANP is being developed in hospitals in Hong Kong, China, it remains undeveloped in primary care and little is known about the factors determining the development of such a model. The aims of the present study were to investigate the contribution of different models of nursing practice to the care provided in primary-care settings in Hong Kong, and to examine the determinants influencing the development of a model of ANP in such settings. A multiple case study design was selected using both qualitative and quantitative methods of data collection. Sampling methods reflected the population groups and stage of the case study. Sampling included a total population of 41 nurses from whom a secondary volunteer sample was drawn for face-to-face interviews. In each case study, a convenience sample of 70 patients were recruited, from whom 10 were selected purposively for a semi-structured telephone interview. An opportunistic sample of healthcare professionals was also selected. The within-case and cross-case analysis demonstrated four major determinants influencing the development of ANP: (1) current models of nursing practice; (2) the use of skills mix; (3) the perceived contribution of ANP to patient care; and (4) patients' expectations of care. The level of autonomy of individual nurses was considered particularly important. These determinants were used to develop a model of ANP for a primary-care setting. In conclusion, although the findings highlight the complexity determining the development and implementation of ANP in primary care, the proposed model suggests that definitions of advanced practice are appropriate to a range of practice models and cultural settings. However, the findings highlight the importance of assessing the effectiveness of such models in terms of cost and long-term patient outcomes.

  14. Collaboratively reframing mental health for integration of HIV care in Ethiopia.

    PubMed

    Wissow, Lawrence S; Tegegn, Teketel; Asheber, Kassahun; McNabb, Marion; Weldegebreal, Teklu; Jerene, Degu; Ruff, Andrea

    2015-07-01

    Integrating mental health with general medical care can increase access to mental health services, but requires helping generalists acquire a range of unfamiliar knowledge and master potentially complex diagnostic and treatment processes. We describe a model for integrating complex specialty care with generalist/primary care, using as an illustration the integration of mental health into hospital-based HIV treatment services in Ethiopia. Generalists and specialists collaboratively developed mental health treatments to fit the knowledge, skills and resources of the generalists. The model recognizes commonalities between mental health and general medical care, focusing on practical interventions acceptable to patients. It was developed through a process of literature review, interviews, observing clinical practice, pilot trainings and expert consultation. Preliminary evaluation results were obtained by debriefing generalist trainees after their return to their clinical sites. In planning interviews, generalists reported discomfort making mental health diagnoses but recognition of symptom groups including low mood, anxiety, thought problems, poor child behaviour, seizures and substance use. Diagnostic and treatment algorithms were developed for these groups and tailored to the setting by including possible medical causes and burdens of living with HIV. First-line treatment included modalities familiar to generalists: empathetic patient-provider interactions, psychoeducation, cognitive reframing, referral to community supports and elements of symptom-specific evidence-informed counselling. Training introduced basic skills, with evolving expertise supported by job aides and ongoing support from mental health nurses cross-trained in HIV testing. Feedback from trainees suggested the programme fit well with generalists' settings and clinical goals. An integration model based on collaboratively developing processes that fit the generalist setting shows promise as a method

  15. Use of stable isotopes to identify dietary differences across subpopulations and sex for a free-ranging generalist herbivore.

    PubMed

    Walter, W David

    2014-01-01

    Carbon and nitrogen isotopes in tissues can be used to understand plants consumed by various taxa, but can they provide additional information about consumers? Values of δ(13)C and δ(15)N were assessed from tissue of free-ranging elk (Cervus elaphus) occupying disparate habitats of mixed prairie-oak savannah that contained C3 agricultural crops in a C4-dominated landscape and in key plants consumed by elk. Muscle and hoof samples were collected from female and male elk in two subpopulations (forested land and grassland) from private land and one subpopulation from the Wichita Mountains Wildlife Refuge (refuge) in 2001-2006. Previous research identified differences between mean muscle δ(13)C and δ(15)N and mean hoof δ(13)C and δ(15)N indicating that isotopes differed between tissues of varying metabolic activity. Mean δ(13)C in hoof of elk on forested land and grassland were lower than hoof δ(13)C from elk in the refuge indicating greater long-term consumption of C3 plants by elk on forested land and grassland subpopulations. The δ(15)N in hoof was greater for elk outside the refuge than that for elk in the refuge. Interaction of sex and subpopulation only occurred for hoof δ(15)N suggesting that factors such as tissue type, sex, and habitat need to be considered to understand free-ranging ecology of generalist herbivores using stable isotopes. Availability of C3 agricultural crops high in percent nitrogen on a nearly annual basis in a C4-dominated landscape was likely driving differences in tissue δ(13)C and δ(15)N among subpopulations of free-ranging elk. An increase in tissue δ(15)N resulted from an increase in the consumption of higher δ(15)N in forage for sexes and subpopulations of a free-ranging ungulate in North America but δ(15)N should be further evaluated as an index of nutrition for subpopulations of generalist herbivores.

  16. Empirical and pragmatic adequacy of grounded theory: Advancing nurse empowerment theory for nurses' practice.

    PubMed

    Udod, Sonia A; Racine, Louise

    2017-12-01

    To draw on the findings of a grounded theory study aimed at exploring how power is exercised in nurse-manager relationships in the hospital setting, this paper examines the empirical and pragmatic adequacy of grounded theory as a methodology to advance the concept of empowerment in the area of nursing leadership and management. The evidence on staff nurse empowerment has highlighted the magnitude of individual and organisational outcomes, but has not fully explicated the micro-level processes underlying how power is exercised, shared or created within the nurse-manager relationship. Although grounded theory is a widely adopted nursing research methodology, it remains less used in nursing leadership because of the dominance of quantitative approaches to research. Grounded theory methodology provides the empirical and pragmatic relevance to inform nursing practice and policy. Grounded theory is a relevant qualitative approach to use in leadership research as it provides a fine and detailed analysis of the process underlying complexity and bureaucracy. Discursive paper. A critical examination of the empirical and pragmatic relevance of grounded theory by (Corbin & Strauss, , ) as a method for analysing and solving problems in nurses' practice is provided. This paper provides evidence to support the empirical and pragmatic adequacy of grounded theory methodology. Although the application of the ontological, epistemological and methodological assumptions of grounded theory is challenging, this methodology is useful to address real-life problems in nursing practice by developing theoretical explanations of nurse empowerment, or lack thereof, in the workplace. Grounded theory represents a relevant methodology to inform nursing leadership research. Grounded theory is anchored in the reality of practice. The strength of grounded theory is to provide results that can be readily applied to clinical practice and policy as they arise from problems that affect practice and that

  17. Sandia National Laboratories Advanced Simulation and Computing (ASC) software quality plan : ASC software quality engineering practices Version 3.0.

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Turgeon, Jennifer L.; Minana, Molly A.; Hackney, Patricia

    2009-01-01

    The purpose of the Sandia National Laboratories (SNL) Advanced Simulation and Computing (ASC) Software Quality Plan is to clearly identify the practices that are the basis for continually improving the quality of ASC software products. Quality is defined in the US Department of Energy/National Nuclear Security Agency (DOE/NNSA) Quality Criteria, Revision 10 (QC-1) as 'conformance to customer requirements and expectations'. This quality plan defines the SNL ASC Program software quality engineering (SQE) practices and provides a mapping of these practices to the SNL Corporate Process Requirement (CPR) 001.3.6; 'Corporate Software Engineering Excellence'. This plan also identifies ASC management's and themore » software project teams responsibilities in implementing the software quality practices and in assessing progress towards achieving their software quality goals. This SNL ASC Software Quality Plan establishes the signatories commitments to improving software products by applying cost-effective SQE practices. This plan enumerates the SQE practices that comprise the development of SNL ASC's software products and explains the project teams opportunities for tailoring and implementing the practices.« less

  18. Effect of qualitative and quantitative variation in allelochemicals on a generalist insect: Iridoid glycosides and the southern armyworm.

    PubMed

    Puttick, G M; Bowers, M D

    1988-01-01

    The behavioral and physiological effects of plant allelochemicals have been difficult to demonstrate; it is not often clear whether the compounds are deterrent, toxic, or both. In this study, we compared the qualitative and quantitative effects of several iridoid glycosides on a generalist lepidopteran herbivore,Spodoptera eridania (Noctuidae). Larval growth and survivorship and larval preference or avoidance were measured on artificial diets containing different iridoid glycosides at different concentrations. We also tested the toxicity/deterrence of these compounds. We found that iridoid glycosides retarded larval growth significantly at relatively low concentrations and that they were usually avoided in preference tests. The toxicity/ deterrence test did not always reflect the results of these other tests. The merits of using a variety of methods for determining deterrence and/or toxicity of plant allelochemicals are discussed.

  19. Seasonal and algal diet-driven patterns of the digestive microbiota of the European abalone Haliotis tuberculata, a generalist marine herbivore.

    PubMed

    Gobet, Angélique; Mest, Laëtitia; Perennou, Morgan; Dittami, Simon M; Caralp, Claire; Coulombet, Céline; Huchette, Sylvain; Roussel, Sabine; Michel, Gurvan; Leblanc, Catherine

    2018-03-27

    Holobionts have a digestive microbiota with catabolic abilities allowing the degradation of complex dietary compounds for the host. In terrestrial herbivores, the digestive microbiota is known to degrade complex polysaccharides from land plants while in marine herbivores, the digestive microbiota is poorly characterized. Most of the latter are generalists and consume red, green, and brown macroalgae, three distinct lineages characterized by a specific composition in complex polysaccharides, which represent half of their biomass. Subsequently, each macroalga features a specific epiphytic microbiota, and the digestive microbiota of marine herbivores is expected to vary with a monospecific algal diet. We investigated the effect of four monospecific diets (Palmaria palmata, Ulva lactuca, Saccharina latissima, Laminaria digitata) on the composition and specificity of the digestive microbiota of a generalist marine herbivore, the abalone, farmed in a temperate coastal area over a year. The microbiota from the abalone digestive gland was sampled every 2 months and explored using metabarcoding. Diversity and multivariate analyses showed that patterns of the microbiota were significantly linked to seasonal variations of contextual parameters but not directly to a specific algal diet. Three core genera: Psychrilyobacter, Mycoplasma, and Vibrio constantly dominated the microbiota in the abalone digestive gland. Additionally, a less abundant and diet-specific core microbiota featured genera representing aerobic primary degraders of algal polysaccharides. This study highlights the establishment of a persistent core microbiota in the digestive gland of the abalone since its juvenile state and the presence of a less abundant and diet-specific core community. While composed of different microbial taxa compared to terrestrial herbivores, the digestive gland constitutes a particular niche in the abalone holobiont, where bacteria (i) may cooperate to degrade algal polysaccharides to

  20. The roles of geography and founder effects in promoting host-associated differentiation in the generalist bogus yucca moth Prodoxus decipiens.

    PubMed

    Darwell, C T; Fox, K A; Althoff, D M

    2014-12-01

    There is ample evidence that host shifts in plant-feeding insects have been instrumental in generating the enormous diversity of insects. Changes in host use can cause host-associated differentiation (HAD) among populations that may lead to reproductive isolation and eventual speciation. The importance of geography in facilitating this process remains controversial. We examined the geographic context of HAD in the wide-ranging generalist yucca moth Prodoxus decipiens. Previous work demonstrated HAD among sympatric moth populations feeding on two different Yucca species occurring on the barrier islands of North Carolina, USA. We assessed the genetic structure of P. decipiens across its entire geographic and host range to determine whether HAD is widespread in this generalist herbivore. Population genetic analyses of microsatellite and mtDNA sequence data across the entire range showed genetic structuring with respect to host use and geography. In particular, genetic differentiation was relatively strong between mainland populations and those on the barrier islands of North Carolina. Finer scale analyses, however, among sympatric populations using different host plant species only showed significant clustering based on host use for populations on the barrier islands. Mainland populations did not form population clusters based on host plant use. Reduced genetic diversity in the barrier island populations, especially on the derived host, suggests that founder effects may have been instrumental in facilitating HAD. In general, results suggest that the interplay of local adaptation, geography and demography can determine the tempo of HAD. We argue that future studies should include comprehensive surveys across a wide range of environmental and geographic conditions to elucidate the contribution of various processes to HAD. © 2014 European Society For Evolutionary Biology. Journal of Evolutionary Biology © 2014 European Society For Evolutionary Biology.