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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.

Purpose: The purpose of this study was to examine the relationship between self-transcendence and medication adherence among older adults prescribed antihypertensive medication., Design: Descriptive, correlational research design., Method: Forty-six older adults who were prescribed antihypertensive medications from an independent living facility participated in this study. Participants were given a survey that included a demographic questionnaire, the Morisky Medication Adherence Scale, and Reed's Self-Transcendence Scale., Findings: No significant relationship was found between medication adherence and self-transcendence (r = -.20, p = .18). Ninety percent of the participants however, admitted to cutting back or stopping their medication without notifying their providers., Conclusion: Continued investigation is needed to identify reasons why older adults fail to adhere to taking prescribed hypertension medications in order to improve health outcomes in this population., (C)2014Sage Publications

: 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

A cross-sector collaboration among a community-based organization, a prison arts program, and state departments of Public Health, Education, and Correction was established to address critical health education prevention efforts for at-risk high school-aged youth. The Tell Me What You See initiative utilizes artwork and poetry created by incarcerated youth to promote sexually transmitted disease (STD), HIV, and hepatitis prevention with students in public high schools and juvenile justice facilities. This innovative intervention integrates functional health knowledge and skills-based education through an art-based interdisciplinary approach reaching various populations of youth in multiple settings across a state. Evaluation results indicated that the materials effectively engage youth and open up a critical dialogue among peers and adults by addressing the role personal behavior can have in the prevention of STDs, hepatitis, and HIV. Lessons learned and recommendations are provided., (C)2021Sage Publications

Background: Adolescents with obesity are less likely to flourish and be academically engaged in comparison to their healthy weight peers. However, it is unknown how participation in physical activity influences flourishing and academic engagement in adolescents with obesity. The current study examined engagement in varying levels of physical activity and the likelihood of flourishing and academic engagement in adolescents with obesity. Methods: Analyses included 26 764 adolescents, ages 10–17 years, from the parent-reported, combined 2016–2017 National Survey of Children's Health. Participants were grouped by physical activity levels (none, low, moderate, daily). Outcome variables included flourishing (finishing tasks, staying calm when faced with a challenge and showing interest in new things) and academic engagement (completing all required homework and caring about doing well in school). Logistic regression models, adjusted for age, sex, race, household income, highest level of education in the household, behavioural conduct problems and depression assessed the likelihood of each outcome comparing physical activity levels among adolescents with obesity. Results: Adolescents with obesity who participated in any amount of physical activity (low, moderate and daily) or sports had significantly greater likelihood of flourishing and academic engagement compared those that did not engage in any physical activity (p's ¡ 0.05). Conclusions: Participation in even low amounts of physical activity or participation in sports increases the likelihood of flourishing and academic engagement in adolescents with obesity, which expands on previous findings that adolescents with obesity are less likely to flourish and be academically engaged in comparison to their healthy weight peers. © 2021 World Obesity Federation

Humans are rapidly transforming the structural configuration of the planet's ecosystems, but these changes and their ecological consequences remain poorly quantified in underwater habitats. Here, we show that the loss of forest-forming seaweeds and the rise of ground-covering 'turfs' across four continents consistently resulted in the miniaturization of underwater habitat structure, with seascapes converging towards flattened habitats with smaller habitable spaces. Globally, turf seascapes occupied a smaller architectural trait space and were structurally more similar across regions than marine forests, evidencing habitat homogenization. Surprisingly, such habitat convergence occurred despite turf seascapes consisting of vastly different species richness and with different taxa providing habitat architecture, as well as across disparate drivers of marine forest decline. Turf seascapes contained high sediment loads, with the miniaturization of habitat across 100s of km in mid-Western Australia resulting in reefs retaining an additional ~242 million tons of sediment (four orders of magnitude more than the sediments delivered fluvially annually). Together, this work demonstrates that the replacement of marine forests by turfs is a generalizable phenomenon that has profound consequences for the ecology of temperate reefs., (C) 2021 John Wiley & Sons, Ltd

Due to steep declines in charitable support and reduced demand for traditional hospital services, economic goals are increasingly important to not-for-profit hospitals. Effects of efficient management and effective pursuit of not-for-profit status (for example, levels of Medicare, indigent patients, and unprofitable services) on financial viability are explored. While previous research compared hospitals of different ownership status, not-for-profit hospital operations before acquisition by for-profit hospital chains are investigated--"neutral ground" relative to ownership. Results suggest minor links between efficiency and long-term profitability despite effectiveness in pursuit of non taxable status.

Over the last decade, investor-owned hospital corporations have grown primarily by acquiring other for-profit hospital chains or stand-alone for-profit institutions. Between 1990 and 1995, however, these corporations also acquired nearly 50 not-for-profit hospitals and converted them to for-profit status. An examination of the long-term financial condition of 39 not-for-profit hospitals acquired by various investor-owned hospital corporations between 1992 and 1996 was conducted using free-cash-flow accounting valuation. The results suggest that, initially, only not-for-profit hospitals in dire financial straits were candidates for acquisition and conversion to for-profit status. More recent acquisitions increasingly have involved more successful not-for-profit hospitals.

This paper will discuss Internet based data collection and analysis utilizing a Windows 95 and a UNIX hosted system. Forms on the World Wide Web (WWW) that illustrate the use of this technology in medical research, conference registration, and. patient care will be highlighted. Some of the details involved with creating data collection forms will be presented. The paper concludes with the recommendation that the Health Telematics curricula should include a unit on creating Internet based data collection forms.