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Burnout among nurses negatively impacts patient care experiences and safety. Inpatient pediatric nurses are high-risk for burnout due to high patient volumes, inadequate staffing, and needing to balance the demands of patients, families and team members. We examined the associations of inpatient pediatric nurse burnout with their perspectives on the importance of quality at the hospital, patient experience measurement, quality improvement (QI), unit culture, and staffing.We conducted a cross-sectional study at an urban children's hospital. We surveyed pediatric nurses about their perspectives including the single-item Maslach Burnout Inventory. We fit separate regression models, controlling for role, location and unit, predicting outcome measures from the dichotomized burnout scale.Twenty-seven percent of pediatric nurses reported burnout. Nurses who had more confidence in patient experience measurement, received frequent patient experience performance reports, felt included in QI, and experienced QI efforts as integrated into patient care reported not being burned out (compared to those reporting burnout; all p-values0.05). More open communication among nurses (e.g., about possible problems with care) and unit-level teamwork were also associated with not being burned out, whereas a larger QI workload was associated with burnout (p-values0.05).Open communication among nurses and nurses being more involved and valued in QI efforts were related to not being burned out. Research is needed to further examine aspects of QI involvement that reduce burnout.Supporting open communication among pediatric nurses, engaging them in QI and integrating QI into patient care while minimizing QI workload may decrease burnout.

Summary Background In many countries, healthcare-associated infections (HAIs) are problematic in long-term aged care living facilities. In the United States (US), HAIs occur frequently in nursing homes (NHs). Identifying effective practices for state Departments of Health (DOHs) to help NHs improve infection prevention and control and reduce HAIs is necessary. Aim As a first step, the objective was to systematically examine and catalogue the variations in state intentions and activities related to HAI prevention in NHs. Methods An environmental scan of state DOH websites, HAI plans, and HAI state infographics was conducted. Data were collected on 16 items across three domains: (1) intentions to reduce HAIs in NHs, (2) actions to reduce HAIs in NHs, and (3) website usability. Findings State infection control support for NHs varied widely. Most states (92%) mentioned NHs in their HAI plans and 76% included NHs in their infographic. Half has an HAI prevention advisory council, while one-third had a state HAI prevention collaborative. Only 57% of HAI plans that mentioned NHs included training materials on HAI reduction. The most common training available was on antibiotic stewardship. Conclusion Many US states have room for improvement in the support they provide NHs regarding infection prevention and control. Specific areas of improvement include: (1) increased provision of training materials on HAI reduction, (2) focusing training materials on common HAIs, and (3) NH engagement in collaboratives aimed at HAI reduction. More research is needed linking DOH activities to resident outcomes.

A growing body of human literature implicates KIBRA in memory and neurodevelopmental disorders. Memory and the cellular substrates supporting adaptive cognition change across development. Using an inducible KIBRA knockout mouse, we demonstrate that adult-onset deletion of KIBRA in forebrain neurons impairs long-term spatial memory and long-term potentiation (LTP). These LTP deficits correlate with adult-selective decreases in extrasynaptic AMPA receptors under basal conditions, and we identify a role for KIBRA in LTP-induced AMPAR upregulation. In contrast, juvenile-onset deletion of KIBRA in forebrain neurons did not affect LTP and had minimal effects on basal AMPAR expression. LTP did not increase AMPAR protein expression in juvenile WT mice, providing a potential explanation for juvenile resilience to KIBRA deletion. These data suggest that KIBRA serves a unique role in adult hippocampal function through regulation of basal and activity-dependent AMPAR proteostasis that supports synaptic plasticity.

Patient-centered, multidisciplinary interventions offer one of the most promising strategies to improve blood pressure (BP) control, yet effectiveness trials in underserved real-world settings are limited. We used a multidisciplinary strategy to improve hypertension control in an underserved urban practice. We collected 1007 surveys to monitor medication adherence and used weighted generalized estimating equations to examine trends in BP control. We examined 13,404 visits from patients with hypertension between August 2010 and February 2014. Overall, BP control rates increased from 51.0% to 67.4% (adjusted odds ratio, 1.58; 95% confidence interval, 1.44-1.74) by the end of the intervention phase and were maintained during the postintervention phase (adjusted odds ratio, 1.60; 95% confidence interval, 1.41-1.82). Medication adherence scores increased across the intervention (5.9-6.6; P < .001), but were not sustained at the conclusion of the study (5.9-6.2; P = .16). A multidisciplinary team approach involving registered nurses, pharmacists, and physicians resulted in substantial improvements in hypertension control in a real-world underserved setting.

The aim of this study was to determine the potential modulatory effects of diets supplemented with spray-dried animal plasma (SDAP) or immunoglobulin concentrates (IC) on the immune response of rats challenged with Staphylococcus aureus enterotoxin B (SEB). Lewis rats were fed diets containing 80 g of SDAP/kg diet, 22.7 g of IC/kg diet, or milk proteins (Control diet) from postnatal d 21 (weaning) for 14 d. On d 30 and 33, rats were given SEB (0.5 mg/kg body weight; i.p.). Organized gut-associated lymphoid tissue (GALT) populations, intestinal secretion, mucosal and serum immunoglobulin concentrations, and neutrophil infiltration were studied. On d 35, blood was collected under anesthesia and samples of intestinal mucosa, Peyer's patches, mesenteric lymph nodes (MLN), and spleen were taken. SEB increased the water content of feces, which was prevented by diets containing either SDAP (P < 0.002) or IC (P < 0.001), indicating that plasma protein–supplemented diets can reverse the SEB-induced secretory response. In Peyer's patches, the diet containing SDAP partially prevented the SEB-induced increase in T lymphocytes (P < 0.1) and reduced the percentage of activated T helper cells (P < 0.05). In MLN, activated T lymphocytes were increased by SEB but they were not affected by diet. No effects of SEB or dietary supplementation on mucosal IgA and serum IgA and IgG were observed. The effects of SDAP supplementation on the lymphocyte populations of GALT in rats challenged with SEB support the view that SDAP can modulate the immune response and suggest that plasma protein supplementation can prevent GALT from possible activation by luminal bacterial superantigens.

Reactive oxygen species derived from dopamine metabolism can induce oxidative stress and thus may contribute to Parkinson's disease (PD) pathogenesis. The quinone oxidoreductases, nicotinamide adenine dinucleotide (phosphate) (NAD[P]H): quinone oxidoreductase 1 (NQO1) and dihydronicotinamide riboside (NRH): quinone oxidoreductase 2 (NQO2) detoxify quinones and quinonoid compounds. We investigated associations of genetic polymorphisms of NQO1 (C609T) and NQO2 (I/D, 29 base pairs) with PD in a population-based case-control study of 190 idiopathic PD cases and 305 unrelated controls matched on age and sex. No associations were detected for either gene variant or for any allele combinations.

1. 1.Esophageal temperature [Tes (18.0 ± 6.1 min)] and pill temperature [Thti (25.3 ± 9.1 min)] reached steady state faster (P V O 2 ) than rectal temperature [Tre (37.3 ± 4.6 min)] at Ta = 29°C, Tdp = 11°C. Steady-state exercise temperatures were lower for Tes = 37.18 ± 0.18°C andThti = 37.20 ± 0.32°C than Tre = 37.46 ± 0.15°C (P 2. 2.During moderate exercise the change in core temperature per time (slope) was greater (P 3. 3.Overall, Thti tracked dynamic changes in core temperature significantly faster than Tre, although Thti did not track dynamic changes as well or as consistently as Tes. The concept of using a temperature sensor in a pill may be useful clinically, but mobility of the pill makes this temperature measurement less suitable for research than esophageal or rectal temperature measurements.

© 2015 Elsevier Inc. Background: Palpitations are a common emergency department (ED) complaint, yet relatively little research exists on this topic from an emergency care perspective. Objectives: We sought to describe the perceptions and clinical decision-making processes of emergency physicians (EP) surrounding patients with palpitations. Methods: We conducted 21 semistructured interviews with a convenience sample of EPs. We recruited participants from academic and community practice settings from four regions of the United States. The transcribed interviews were analyzed using a combination of structural coding and grounded theory approaches with ATLAS.ti, a qualitative data analysis software program (version 7; Atlas.ti Scientific Software Development GmbH, Berlin, Germany). Results: EPs perceive palpitations to be a common but generally benign chief complaint. EPs' clinical approach to palpitations, with regards to testing, treatment, and ED management, can be classified as relating to one or more of the following themes: 1) risk stratification, 2) diagnostic categorization, 3) algorithmic management, and 4) case-specific gestalt. With regard to disposition decisions, four main themes emerged: 1) presence of a serious diagnosis, 2) perceived need for further cardiac testing/monitoring, 3) presence of key associated symptoms, 4) request of other physician or patient desire. The interrater reliability exercise yielded a Fleiss' kappa measure of 0.69, indicating substantial agreement between coders. Conclusion: EPs perceive palpitations to be a common but generally benign chief complaint. EPs rely on one or more of four main clinical approaches to manage these patients. These findings could help guide future efforts at developing risk-stratification tools and clinical algorithms for patients with palpitations.

Context Increasing interest in end-of-life care has resulted in many tools to measure the quality of care. An important outcome measure of end-of-life care is the family members' or caregivers' experiences of care. Objectives To evaluate the instruments currently in use to inform next steps for research and policy in this area. Methods We conducted a systematic review of PubMed, PsycINFO, and PsycTESTS ® for all English-language articles published after 1990 using instruments to measure adult patient, family, or informal caregiver experiences with end-of-life care. Survey items were abstracted and categorized into content areas identified through an iterative method using three independent reviewers. We also abstracted information from the most frequently used surveys about the identification of proxy respondents for after-death surveys, the timing and method of survey administration, and the health care setting being assessed. Results We identified 88 articles containing 51 unique surveys with available content. We characterized 14 content areas variably present across the 51 surveys. Information and care planning, provider care, symptom management, and overall experience were the most frequent areas addressed. There was also considerable variation across the surveys in the identification of proxy respondents, the timing of survey administration, and in the health care settings and services being evaluated. Conclusion This review identified several comprehensive surveys aimed at measuring the experiences of end-of-life care, covering a variety of content areas and practical issues for survey administration. Future work should focus on standardizing surveys and administration methods so that experiences of care can be reliably measured and compared across care settings.

AS POINTED out by Quigley (1944), commercial poultrymen have in some instances associated blue comb or pullet disease with wheat feeds. It has also been pointed out by Quigley (1944), that there is a significant difference in germination between wheats associated with the appearance of pullet disease and wheats which were found to be not associated with the appearance of the disease. Wheat samples regarded as positive for the appearance of pullet disease had a mean germination of 68.3 percent, and those regarded as negative had a mean germination of 89.4 percent. The purpose of this paper is to present evidence that wheats being fed to flocks when blue comb developed have a different microflora from wheats not associated with blue comb. The association of feed stuffs with certain animal diseases is not new, and it is necessary to call attention to only one outstanding and pertinent case—that concerning . . .

THE heavy feeding of wheat in many sections of the country and the continued incidence of “pullet disease” or “blue comb” in widespread areas would seem to justify an interim report and discussion of a limited number of field observations and experimental work conducted by the author at the Maryland Agricultural Experiment Station. The condition known as pullet disease (also termed X disease, blue comb, new wheat disease) was first described by Beaudette (1929) but despite the efforts of several investigators to transmit the condition from bird to bird, none appears to have succeeded. The possible exception is Waller (1942) who announced the isolation of a virus from acute cases which was not capable of producing death, hence he was unable to identify the virus as the sole etiological agent in pullet disease. Other investigators have proceeded without success along similar lines, and to the present time it is considered . . .

THE reported success of the chemical dichloro-diphenyl-trichlorethane, hereinafter known as DDT, as an insecticide, and its possible use around poultry houses and hatcheries, prompted an investigation as to its safety and effectiveness. It was observed early in the investigation that DDT was effective against lice, so attempts were made to develop a satisfactory method of flock treatment for these parasites. This work was started in August 1944. Since it is known that mammals and fish show substantial variability to the toxic effects of DDT, it was considered necessary in this work to study its toxicity to poultry, to hatching eggs or developing embryos, but above all to study the usefulness and limitations of DDT, and to acquire experience in its application to practical poultry problems. No experiments were conducted with solutions of DDT in oil and no recommendations are made for the use of this type of material. All data . . .

THE rapid changes in the poultry industry are evident to all who are engaged in it, but they are especially apparent to those whose experience spans 10, 15, 25 or more years. The operation of poultry production and the distribution of our products, is undergoing the same change apparent in most of agriculture,—indeed in almost all kinds of business, and we find fewer units, but larger ones. Both vertical and horizontal integration is coming into the poultry picture very rapidly, and the advent of the contract system of producing turkeys, broilers and eggs has been described as nothing short of revolutionary in agricultural history. The changes which we see are producing concentrations of capital, administrative responsibility, and expenditures for advertising and promotion, which are large and substantial. This is true both within the poultry industry, and in closely allied contributing industries, as feed, equipment, and drugs. In turn this . . .

RESISTANCE to disease is a variable factor. Operating together with changes in organism virulence, it is responsible for the severity of any given disease attack. Experimental evidence bringing more light to bear upon the conditions under which pullorum resistance varies may prove a valuable aid to brooding and flock management. Rettger, Kirkpatrick, and Stoneburn showed that pullorum resistance varies with age. Roberts and Card demonstrated the variation of pullorum resistance caused by genetic factors. These authors determined, among other things, that “Selection was effective in producing strains of domestic fowl more resistant than . . . unselected stocks in respect to infection by Salmonella pullora.” The same investigators also noted an increase of resistance under natural conditions in the presence of infection. They reported that among flocks of the Chia Gi variety in the vicinity of Peiping, China, pullorum reactors were present while no evidence of pullorum infection could be . . .

IN TEACHING, as in research, government, business, and other activities of man, a progressive society must constantly appraise educational techniques, procedures, and policies. Such is the price of progress. One area where appraisal and re-evaluation is in order is the well known procedure known as live poultry judging. Since there can be more than one interpretation of the scope of judging, we will limit our discussion to comparative consideration of evidence of health, productivity of meat or eggs, together with minimum breed requirements to keep our breeds intact. Included are all visible economic factors; excluded are many of the details known generally as belonging peculiarly to “fancy” poultry. The objection to judging that one may hear is that its importance in relation to breeding and genetics has declined, hence by implication, training in judging is a waste of student time and energy. We regret that to us this viewpoint represents …

It does not seem to be recognized sufficiently among operators of incubators and other precision temperature equipment that the flexible gas wafer thermostat is affected by barometric pressure as well as by temperature changes. An increase in barometric pressure has the effect of compressing the wafer slightly, this compression acting the same as a decrease in temperature; consequently, the machine responds by building up heat to compensate for the increase in pressure upon the control wafer. This resulting change in the temperature of the incubator is therefore an additional variation to the normal lag between the “make” and “break” of the control mechanism. PROCEDURE The observations herein recorded were made upon a standard, well-known incubator in good mechanical condition. The thermometer used was a number 19245-B made by the Central Scientific Company, and was graduated in 1/10°C. increments, but could be read fairly easily to 1/100°C. increments by means of . . .

Need was experienced for an individual feed hopper suitable for experimental work in laying cages to permit accurate, frequent, and convenient measurement of feed consumption. The hopper (Figures 1 and 2) shown was designed to accomplish these objectives, and it has proven satisfactory in practice. It has high flares on both ends to prevent birds from reaching around or over same to eat from their neighbor's trough. When filled to a level that minimizes feed wastage, its capacity is about 500 gms. The over all length (8″ in our design) must be such as to prevent a bird from reaching between the cage partition and the feeder. The design shown is for the “Hart-ford” laying cage. Other small changes in design might be necessary for other makes, including adjustment of height to permit eggs to roll past the feeder. *

The work of Hoffman (1961), Sherman and Ross (1960, 1961, 1962), Dorough et al. (1961), Furman et al. (1962), outlines the possibility of using systemic insecticides for poultry, but the principal benefit was in the control of larvae of the housefly, Musca domestica L. An exception was Sherman and Ross (1962). A systemic effect, resulting in the death of a mite species was shown for Sevin by Furman and Pieper (1962). Hoffman (1961) reported a partial control of lice after administering Ruelene in a single dose. In the foregoing, comparatively large single doses were used, or when continuous feeding was employed, comparatively high levels of the insecticide were used. Some toxicity was occasionally shown. There would therefore seem to be room for an insecticide to be fed for longer periods of time at lower levels. Certainly there seemed to be a need for knowledge of the control of other species…

The shape of the spur of the capon is in general described as differing somewhat from the cock, notably in being longer and more pointed. Spur growth also is favored in absence of the gonads, see, for example, Goodale (1918), Domm (1927). Goodale considers the larger body size of the capon as due to continued growth of the bones and associated structures and as reflecting the persistence of certain juvenile qualities: this would suggest a prolongation of the growth period rather than accelerations within it. Observations to this effect specifically regarding the spur have not been noted in the literature. The measurements recorded in the present brief communication were planned to compare spur length in the cockerel, slip, and capon at successive ages and also to outline changes of shape developing in the spurs of the three groups at these same periods. For this purpose, in addition to spur length, . . .

The onset of an attack of “bluecomb” or “pullet disease” in a flock of New Hampshires at the Poultry Experimental Farm of the University of Maryland, and the statements of Jungherr (1942) and Beaudette (1942) that poultrymen in their areas may call this trouble “wheat disease” or “new wheat disease,” and a similar and firm conviction in the minds of certain Maryland commercial poultrymen, promoted this preliminary study of the role of wheat in the development of this disease. At the outset it was realized that the elements of an experiment were partially lacking since the condition had been developing in the flock for several weeks before it was definitely diagnosed, therefore, in the affected New Hampshires the comparative effect of wheat versus corn can only be interpreted during the typically long recovery phase of the trouble. The flocks reported are two in number, pen 7 with 99 pullets and . . .

A field report requested information on the effects of Malathion an organic phosphate insecticide, on egg quality. Harding and Quigley (1956) applied Malathion dust to litter at various rates and found that it did not affect hatchability and residues were not detected in eggs. Gaafar and Turk (1956) dusted three-week-old chicks for four successive weeks with this same compound and they found it did not affect feed intake and no signs of toxicity were observed. The literature does not reveal any investigations on the effect of this insecticide on egg quality. Therefore, it appears that information in this area is pertinent before any conclusions can be drawn on test results. Eight pens, each with a total area of 63 sq. ft., were selected for this study, four of which were treated with 4% Malathion. Each pen contained 15 White Leghorn hens on an all-mash diet. The insecticide was carefully applied . . .