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Purpose This paper aims to explore the effect of employees’ state mindfulness, a short period of mindful presence, on the quality of the service they provide in a service encounter. Design/methodology/approach Three studies are conducted. A pilot study explores the relationship between state mindfulness and service encounter quality. Experiment 1 examines whether a 15-min mindfulness exercise results in an increase in service employees’ state mindfulness. Experiment 2 tests whether induced state mindfulness produces higher service quality and whether a reminding technique can prolong state mindfulness between service encounters. Findings The results demonstrate the following. First, that more mindful employees provide better service quality. Second, that a short, easily implemented, mindfulness exercise can reliably increase employees’ state mindfulness. Third, induced mindfulness has an impact on subsequent service quality in terms of reliability, assurance, empathy and responsiveness. These effects persist regardless of the service encounter structure (high vs low structure) or the degree of emotional labor involved (high vs low emotionally charged). Finally, the reminding technique developed as part of this research suggests that state mindfulness can be maintained between service encounters. Research limitations/implications As simulated (programmed) customers are used, independent evaluators to assess service quality are used. Service providers in this study are college students; future field studies should consider a wider range of service providers. The research focuses on state mindfulness; exploration of trait mindfulness offers future research opportunities. Originality/value To the best of the authors’ knowledge, this research is the first to empirically examine the link between mindfulness and service quality. It shows that mindfulness can be induced, and through a reminding technique be maintained, and improve service quality across service interactions. This is a powerful finding for marketing managers, for it offers a new method to enhance service provision. Moreover, this research implies that the increase in service quality is likely to be accompanied by reduced job burnout: a double win for employees, employers and customers.

Have you ever watched as care providers, be they student nurses or staff nurses, display behaviors that seem to indicate that they are becoming overwhelmed by situations in the acute care setting? Have you also observed other providers who seem to thrive on the "challenges" presented by these same situations? The same situation stimulates responses that reflect opposite ends of a continuum, the continuum of tolerance of ambiguity. The nurse educator needs to develop a greater understanding of the elements in the clinical situation (the ambiguities) that have stimulated the behavioral responses, and how an individual's level of tolerance of ambiguity influences reactions to the ambiguous situations. These understandings provide the nurse educator with the foundation for developing teaching strategies to facilitate effective management of ambiguous situations in clinical settings.

Recently published consensus statements and conference proceedings from the Cystic Fibrosis Foundation provide new direction with regard to the etiology, diagnosis, and treatment of the adult patient with cystic fibrosis (CF). Survival has improved through early diagnosis and improved treatment, and aggressive management of complications. The current state of knowledge, the most recent evidence-based treatment options, and essentials of nursing care for the adult patient with CF are outlined.

Since the advent of medical treatments for HIV, the promotion of adherence to these difficult treatment regimens has proven critical to disease management. Three Connecticut state-funded HIV medication adherence programs were evaluated.1 The purpose of this process evaluation was to explore and compare the goals and modality of each adherence program, assess client and staff satisfaction, and provide recommendations for the improvement of these programs. Focus group interviews with clients and individual interviews with staff were conducted at each of the programs. Interviews were transcribed, coded and analyzed with a code and retrieve method of theme identification. Focus group themes included the importance of social support on medication adherence and the "lifesaving" effect the program has had. The staff expressed that although complete adherence should be the long-term objective, more intermediate objectives should be considered (e.g., behavioral changes to increase clients' ability, self-esteem, and self-efficacy to take medications).

The periodized resistance-training model has not been well documented in the literature. Further research is needed to determine if periodized resistance training in conjunction with creatine supplementation can cause changes in strength, performance, total body weight, girth, and lean muscle mass. Therefore, the purpose of this investigation was to determine the effects of periodized resistance training in conjunction with low-dose (LD) and high-dose (HD) creatine supplementation on strength, body composition, and anaerobic muscular endurance. Subjects were divided into 3 groups: LD, HD, and placebo (P). Testing took place pre-, mid-, and postsupplementation for the following: weight, body composition (fat-free mass and fat mass), 1 repetition maximum squat, and anaerobic muscular endurance testing. Results revealed no significant differences in either creatine group when compared with the P group. However, significant differences were noted over time. These data suggest that 10 weeks of periodized resistance training was effective for causing changes in strength, body composition, and anaerobic muscular endurance.

This study was designed to evaluate maximum length sequences-auditory brainstem responses (MLS-ABR) in children with auditory processing disorders and to compare these results with a normal control group matched for age, intelligence, and gender. Although each waveform was analyzed for the presence of waves I, III, and V, the primary focus was wave V. Although absolute latency measures for wave V were obtained from all subjects, waves I and III were not always identified. Although the results showed latency increases for all waveforms in both groups, the only significant difference noted was an increase in wave V latency for both the left and right ears in the clinical group. These results suggest that the MLS-ABR may be useful in the assessment of auditory processing disorders. Implications for the potential use of the MLS-ABR in management programs are discussed.

While many studies have documented tamoxifen's benefits as an adjuvant therapy in the treatment and prevention of recurrent breast cancer in estrogen receptor positive (ER+) breast carcinoma, this beneficial effect may decrease with long-term tamoxifen use. This experimental study was designed to compare the cytotoxic responses of ER+ primary breast cancer solid tumors derived from the MCF7 cell line to experimental therapeutics, including genistein, tamoxifen, all-trans retinoic acid (ATRA) and parthenolide in the presence and absence of exogenous beta-estradiol. The results of this study suggest that the growth inhibitory effects of tamoxifen, were dependent on beta-estradiol levels. In contrast, the cytotoxic effects of the isoflavone soy derivative, genistein, were observed to be independent of exogenous estrogen. Moreover, combined therapy using tamoxifen and genistein produced enhanced cytotoxic effects also independent of beta-estradiol levels. Additional studies involving the use of the novel agents all trans retinoic acid (ATRA) and parthenolide produced notable tumor responses and combined effects that were also estrogen-independent. Overall, these preclinical research findings suggest possible clinical applications suggesting that genistein might be a useful clinical adjuvant, particularly in post-menopausal women in whom breast cancer occurs more frequently. Moreover, this research suggests that combined treatment approaches involving the use of tamoxifen in conjunction with agents that inhibit NFkappaB pathway signaling, such as parthenolide and genistein, warrant further study.

The purpose of this study was to determine the effect of supramaximal sprint interval training (SIT), body weight reduction, and a combination of both treatments on peak and average anaerobic power to weight ratio (PPOan:Wt, APOan:Wt) by manipulating peak and average anaerobic power output (PPOan, APOan) and body weight (BW) in experienced cyclists. Participants (N = 34, age = 38.0 +/- 7.1 years) were assigned to 4 groups for a 10-week study. One group performed twice-weekly SIT sessions on a cycle ergometer while maintaining body weight (SIT). A second group did not perform SIT but intentionally reduced body weight (WR). A third group simultaneously performed SIT sessions and reduced body weight (SIT+WR). A control group cycled in their normal routine and maintained body weight (CON). The 30-second Wingate Test assessed pretest and posttest POan:Wt scores. There was a significant mean increase (p < 0.05) from pretest to posttest in PPOan:Wt and APOan:Wt (W x kg(-1)) scores in both SIT (10.82 +/- 1.71 to 11.92 +/- 1.77 and 8.05 +/- 0.64 to 8.77 +/- 0.64, respectively) and WR (10.33 +/- 2.91 to 11.29 +/- 2.80 and 7.04 +/- 1.45 to 7.62 +/- 1.24, respectively). PPOan and APOan (W) increased significantly only in SIT (753.7 +/- 121.0 to 834.3 +/- 150.1 and 561.3 +/- 62.5 to 612.7 +/- 69.0, respectively). Body weight (kg) decreased significantly in WR and SIT + WR (80.3 +/- 13.7 to 75.3 +/- 11.9 and 78.9 +/- 10.8 to 73.4 +/- 10.8, respectively). The results demonstrate that cyclists can use SIT sessions and body weight reduction as singular training interventions to effect significant increases in anaerobic power to weight ratio, which has been correlated to enhanced aerobic cycling performance. However, the treatments were not effective as combined interventions, as there was no significant change in either PPOan:Wt or APOan:Wt in SIT + WR.

OBJECTIVE: Describe a multilevel model of decontamination capacity for hospitals., DESIGN: Descriptive model., SETTING: Acute care hospitals with decontamination responsibilities., PATIENTS, PARTICIPANTS: None., INTERVENTIONS: None., MAIN OUTCOME MEASURE(S): None., RESULTS: This multilevel model of defining decontamination capacity would allow more realistic assessment of current capacity, allow for fluctuating service levels depending on time of day, incorporate realistic ramp-up and ramp-down of decontamination services, allow for a defined fall-back decontamination model should decontamination processes fail, allow hospitals to define long-term decontamination service level goals, and allow better understanding of when and why to focus on low-risk/low-resource patients rather than high-risk/high-resource patients., CONCLUSIONS: This multiple-level model would allow for more realistic and effective hospital-based decontamination service models and should become part of the national decontamination paradigm.

Firm up on the facts and considerations associated with acetaminophen toxicity.

Modifying the sequence, objectives, and research-based content for a nursing interventions course in a baccalaureate curriculum resulted in improved outcomes including enhancement of the evidence bases for nursing interventions. A mixed methods research study demonstrated better student preparation for clinical experiences and improved satisfaction with course content, consistency, and sequencing. Faculty reported improved integration of theory, research, and practice. Although grades were slightly lower in the new course, the positive outcomes greatly outweighed this expected finding. A foundation for improving the evidence bases for future nursing practice is guided by the curricular modifications described in this article.

As we are all well aware, health care expenditures in the United States are out of control and growing at epic proportions. Since private industry shoulders a significant burden of paying these rising health care costs, the huge and ever increasing sum paid by these corporations continues to impact the US economy translating into higher prices of services and manufactured goods and reduced job opportunities when companies outsource jobs or locate manufacturing facilities to avoid paying health care benefits for workers. As a result, health care expenditures have become a centerpiece of an enormous public policy debate as Congress is currently working on several versions of a bill to completely revise health care from the ground up. This research project was accomplished to examine the effectiveness of one approach to control rising health care costs and contain corporate financial responsibility--the establishment of wellness and health risk screening programs to improve the health of employees. Total health care cost per insured individual was gathered through an online survey directly from health care benefit administrators. The survey also asked information about wellness and health risk screening programs and the related responses were used to determine if there were a relationship between health care costs and health prevention programs. While statistical analysis was hampered in the current study because of the small sample size, some valid conclusions were reached. The study was successful in identifying a benchmark of Average Total Health Care Cost per Individual from $5,100 to $5,800 for 2005 through 2007. This is especially interesting in light of the fact that an average of $7,026 was spent on health care per person in 2006 in the United States. The study was also able to contribute an estimate of the increase realized in these expenditures of 6 percent in 2007 over 2006, and 4 percent in 2006 over 2005, which were in fact similar to the national average. The final contribution of the study is to suggest an explanation for the costs which appear to be holding their own in terms of the national average. While this cannot be statistically verified, it does seem that the active participation of these companies in wellness programs could be a factor. Wellness programs were very popular in this sample of companies as 82 percent of the respondents answered "YES" when asked if the company funds their own employee wellness program. This is an impressive number of companies that have recognized wellness programs as a potential means to reduce employee health care costs. In regards to specific programs, at least 50 percent of respondents answered that they have smoking cessation, employee fitness, counseling, health risk screening, and bio-metric screening programs. The existence of health screening variables show an impressive 73 percent of respondents do practice some sort of health care screening, 50 percent offer biometric screening while 18 percent have onsite clinics and 23 percent run annual employee fairs.

Many undergraduate baccalaureate nursing programs incorporate clinical emersion courses at the end of the program. Nursing capstone courses have become increasingly important in facilitating student transition into practice. However, little is known regarding the overall effectiveness of this teaching model for students, nursing programs, and clinical agencies. Previous studies revealed conflicting results about the benefits of a senior level precepted clinical experience. In this multi-method study, the authors examined student learning outcomes, perceptions, employment choice and retention following implementation of a new capstone nursing course. Results of this study indicated that a capstone course does not necessarily significantly improve scores on achievement exams or NCLEX RN first time pass rates. Nevertheless, qualitative content analysis revealed the following themes: integration, autonomy, confidence, authority, and advocacy consistent with a perceived enhanced competence in the nursing role. Data indicated that graduates often seek employment and remain at their capstone site or within their capstone specialty.

The studies reviewed here reflect many important aspects of the onset, course, and outcome of schizophrenia; that is, premorbid factors, childhood and late-life onset, the positive-negative syndrome dichotomy, co-occurring substance abuse, outcome research, and theoretical issues. Unsurprisingly, heterogeneity of course and outcome emerges as a major theme., (C) Lippincott-Raven Publishers.

This paper explores narrative literature as a means of inquiry into the sense of self in depression. Described as a disease, an identity and a way of life, depression is influenced by both internal and external factors. Although brain research has provided new insight into the relationship between neurotransmitter function and depression, the symptoms are experienced by individuals whose lives are intertwined with historical and sociocultural interpretations of illness and its manifestations. At the intersection of science and the humanities, narratives aid in the interpretation of lived experiences, provide a window to that experience, and a public medium that engages writers and readers as they interpret the world. Engaging narratives to interpret both experience and medical jargon may reveal for both those experiencing depression and those engaged in their care, a way of mediating that experience. Narratives can help dissect and thus illuminate the official language of medicine and psychiatry and the personal language of depression. Such a window can enhance the opportunities for empathy and care.

: Most stars and their planets form in open clusters. Over 95 per cent of such clusters have stellar densities too low (less than a hundred stars per cubic parsec) to withstand internal and external dynamical stresses and fall apart within a few hundred million years 1. Older open clusters have survived by virtue of being richer and denser in stars (1,000 to 10,000 per cubic parsec) when they formed. Such clusters represent a stellar environment very different from the birthplace of the Sun and other planet-hosting field stars. So far more than 800 planets have been found around Sun-like stars in the field 2. The field planets are usually the size of Neptune or smaller 3,4,5. In contrast, only four planets have been found orbiting stars in open clusters 6,7,8, all with masses similar to or greater than that of Jupiter. Here we report observations of the transits of two Sun-like stars by planets smaller than Neptune in the billion-year-old open cluster NGC6811. This demonstrates that small planets can form and survive in a dense cluster environment, and implies that the frequency and properties of planets in open clusters are consistent with those of planets around field stars in the Galaxy., (C) 2013 Nature Publishing Group

Objective: The goal of the study was to evaluate the effectiveness of tympanometry and wideband reflectance (WBR) in detecting conductive hearing loss (CHL) in young infants., Methods: Type of hearing loss was determined using auditory brainstem response using air- and bone-conducted tone bursts in 84 ears from 70 infants (median age = 10 weeks). Of these 84 ears, 60 are included in the current analysis: 43 with normal hearing (NH) and 17 with CHL. Tympanometry was measured using probe tone frequencies of 226, 678, and 1000 Hz. Tympanograms were evaluated in two ways: (1) Acoustic middle ear admittance (Ya, in millimhos); and (2) two-category classification (normal/abnormal), as described by Baldwin (2006). Measures of Ya were evaluated in two ways: by admittance-magnitude tympanograms and calculated admittance magnitude from subcomponents (conductance and susceptance). WBR was measured in response to a chirp stimulus after probe calibration. WBR was analyzed into thirteen 1/3 octave bands. Tests for statistical differences for two-category classification were analyzed using Chi-squared and Ya, and WBR were analyzed using repeated-measures analyses of variances. Cohen's d and likelihood ratios were computed for comparison with statistically significant differences., Results: Ya measured with 678- and 1000 Hz probe tones was significantly different between ears with CHL and NH. Two-category classification of tympanograms using a 1000 Hz probe tone was significantly different between ears with CHL and NH. Neither two-category classification nor Ya was significantly different between ears identified with CHL and NH using a 226 Hz probe tone. WBR was significantly higher in the frequency bands 800 to 2500 Hz and in the frequency band centered at 6300 Hz in infants with CHL. Effect sizes (Cohen's d) were greater than 2 for several WBR frequency bands and Ya measured with 1000 Hz probe tones. The results were similar for calculations of Ya from admittance-magnitude and subcomponent tympanograms. Positive likelihood ratios for WBR ranged between 8.1 and 38, and those for Ya using 1000 Hz ranged between 12.5 and 32., Conclusions: CHL in young infants can be detected well with WBR or tympanometry using probe frequencies of 678 and 1000 Hz., (C) 2013 by Lippincott Williams & Wilkins