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Dopamine transmission in the striatum is a critical mediator of the rewarding and reinforcing effects of commonly misused psychoactive drugs. G protein-coupled receptors (GPCRs) that bind a variety of neuromodulators including dopamine, endocannabinoids, acetylcholine, and endogenous opioid peptides regulate dopamine release by acting on several components of dopaminergic circuitry. Striatal dopamine release can be driven by both somatic action potential firing and local mechanisms that depend on acetylcholine released from striatal cholinergic interneurons. GPCRs that primarily regulate somatic firing of dopamine neurons via direct effects or modulation of synaptic inputs are likely to impact distinct aspects of behavior and psychoactive drug actions compared with GPCRs that primarily regulate local acetylcholine-dependent dopamine release in striatal regions. This review will highlight mechanisms by which GPCRs modulate dopaminergic transmission and the relevance of these findings to psychoactive drugs involved in substance use disorders.

The health care settings of today are rapidly evolving in form and function, challenging nurse executives to adopt, adapt, and develop new ways to lead and find professional fulfillment in their roles. The organizational design of many health care settings has changed from a functional to a matrix structure to facilitate more effective and efficient operations. While the structures and reporting relationship of contemporary nurse executives may have changed significantly, the primary responsibility of championing the advancement of the profession of nursing remains essential. The mastery of change management methods is critical for the nurse executive to successfully lead in today's dynamic health care settings. A well-developed and actualized nursing professional practice model is a foundational tool for the nurse executive to employ to advance the profession of nursing in any health care setting or structure. This article describes how a nurse executive used change management methods and principles to lead the development of a new network-wide unifying nursing professional practice model in a highly matrixed health care setting.

When a patient is admitted to a hospital, admission assessments are completed in the electronic medical record. There is minimal information about who the person is, what they liked to be called, favorite activity, and or past occupation to view. A communication board is visible to all caring for the patient. This pre-post design evaluated whether using "All About Me Board" (AAMB) could change workplace climate perception among 25 registered nurses (RN)s in a 28 bed medical surgical unit. RNs were asked to participate in a Person Centered Climate Questionnaire and were provided education about purpose and use of the AAMB, which were placed in each patient's room. Having the AAMB placed and visible in patient rooms provided healthcare providers personal information to assist in planning care with patients and family. Survey results were favorable in supporting a workplace environment where patients were empowered to participate in planning their care.

Introduction Reminiscence therapy has been shown to improve mental health and quality of life in dementia; however, reminiscence therapy is often delivered by therapists instead of being technology-enabled. This study evaluated the preliminary efficacy of Memory Matters (MM), an iPad reminiscence game on mood, social interaction, quality of life, and behavioral and psychological symptoms of dementia. Methods This pilot study used an experimental design where participants were randomized on a 2:2:1 ratio to three arms: individual MM (one-on-one with an interventionist), group MM (2–3 participants per session), or waitlist control. MM was delivered for 30 minutes a session, twice a week for six weeks, followed by six-week self-play. Outcomes were assessed at the baseline, six weeks, and 12 weeks by data collectors blinded to group allocation. Data were analyzed using intention-to-treat analysis and analysis of covariance. Results The sample (n = 80) was 82.1 ± 7.8 years in age with 58% female, 15.3 ± 3.3 years of education. Mood did not differ, except for apathetic mood between group MM and control arm at 12 weeks (P = .051). Social interaction improved for individual MM compared with group MM (t = 2.38, P = .017) and control (t = 2.84, P = .005) at six weeks, but not 12 weeks. Other outcomes did not differ. Discussion MM improved social interaction and possibly mood. Future studies are needed to evaluate the efficacy of MM with a sufficient sample size.

Background Optimizing early education in gynecological procedures utilizing an Enhanced Recovery after Surgery (ERAS) program and a bundle concept may optimize patient outcomes after surgery. Purpose Evaluate whether an ERAS bundle compared to standard education can affect length of stay, 30 day readmission, and patient satisfaction among patients undergoing gynecologic surgery. Design Prospective, comparative, randomized design Setting 28 bed Medical Surgical Unit Sample/Intervention 50 patients undergoing hysterectomy, 25 who received post-operative evidence based bundle/standard education, and 25 who received standard education packet. Bundle components included 1) early mobilization, 2) early transition to oral pain medication, 3) early feeding, and 4) chewing gum. A follow-up phone call was made in two to three days following discharge for both groups utilizing teach-back. Results 84% (n = 21) patients in the bundle group were discharged in one day. There were no 30 day readmissions for both groups. Twenty two (88%) participants met the bundle components 100% of the time. For the indicator “walking helped with recovery” 100% (n = 25) responded “very good to excellent” for bundle group and 96% (n = 24) responded “very good to excellent” for standard group. Twenty three (92%) of the bundle group felt that that overall nursing care received was very good to excellent and 24 (96%) of the general group felt that overall nursing care received was very good to excellent. Conclusion Optimizing peri-operative education using a bundle approach to provide evidence based interventions can minimize risk and enhance early recovery for females undergoing gynecological surgery.

Agrobacterium-mediated transformation of canola (Brassica napus) via hypocotyl segments has been a commonly used method for the past 30 years. While the hypocotyl-based method is well-established, it is not readily adapted to elite germplasm and the prolonged process is not ideal for a production transformation setting. We developed an Agrobacterium-mediated transformation method based on epicotyl and higher stem (internodal) segments that is efficient, rapid and amenable for high-throughput transformation and genome editing. The method has been successfully implemented in multiple canola genotypes. The method appears to be genotype-independent, with varying transformation efficiencies. Internodal segment transformation was used to generate transgenic events as well as CRISPR-Cas9-mediated frameshift gene knockouts.

Background Workplace stress can affect nurse satisfaction. Aroma therapy as a therapeutic use of essential oil can be beneficial in reducing stress. Purpose Assess perceived stress pre-post introduction of Essential Oil Lavender among registered nurses, charge nurses, and patient care technicians in a trauma intensive care unit, surgical specialty care unit and an orthopedic trauma unit. Methods Pre-post intervention with a quasi-experimental design. After a pre-survey, Essential Oil Lavender was diffused 24 h per day over 30 days in a designated nursing area that all nurses were not required to enter on each unit. Results Dependent sample t-test for “how often do nurses feel stressed a work in a typical week” revealed pre-survey mean 2.97 (SD = 0.99) which was significantly higher than post-survey mean 2.70 (SD = 0.92) with significance, t(69) = 2.36, p = 0.021, suggesting a difference in how often staff felt stressed at work in a typical week, trending down from “feeling stressed half of time” to “once in a while”. There were no statistically significant differences in pre-post survey scores for TICU, TOU, or SSC as separate units. Relevance Use of essential oils to decrease work-related stress among nursing staff may improve retention, workplace environment, and increase nurse satisfaction.

Among freshwater systems, coldwater habitats are among the most threatened by climate change. Examining the impacts of increasing water temperature requires the use of both traditional biomonitoring efforts and measures of ecosystem function and structure. We examined fish and macroinvertebrate communities, leaf decomposition rates, periphyton production, and ecosystem metabolism to compare two branches of a trout stream in Minnesota with differing thermal regimes. The cooler South Branch had more coldwater fish, a higher index of biological integrity for fish but a lower index for macroinvertebrates. There were no differences in leaf decomposition rates between branches, although non-native buckthorn leaves decomposed faster than native black cherry leaves. Periphyton production was higher in the North Branch than the South Branch. Both branches had high nitrogen but low phosphorus levels. Nutrient enrichment with phosphorus enhanced periphyton production in both branches. Measures of stream meta...

Purpose Evaluate music listening for delirium prevention among patients admitted to a Trauma Intensive Care and Trauma Orthopaedic Unit. The Roy Adaptation Model provided the theoretical framework focusing on modifying contextual stimuli. Methods Randomised controlled trial, 40 patients aged 55 and older. Intervention Participants randomly assigned to receive music listening or usual care for 60 minutes, twice a day, over three days. Pre-recorded self-selected music using an iPod and headsets, with slow tempo, low pitch and simple repetitive rhythms to alter physiologic responses. Outcomes Heart rate, respiratory rate, systolic and diastolic blood pressure, confusion assessment method. Results Repeated measures ANOVA, F(4, 134) = 4.75, p = .001, suggested statistically significant differences in heart rate pre/post music listening, and F(1, 37) = 10.44, p = .003 in systolic blood pressure pre/post music listening. Post-hoc analysis reported changes at three time periods of statistical significance; (p = .010), (p = .005) and (p = .039) and a change in systolic blood pressure pre/post music listening; (p = .001) of statistical significance. All participants screened negative for delirium. Conclusion Music addresses pathophysiologic mechanisms that contribute to delirium; neurotransmitter imbalance, inflammation and acute physiologic stressors. Music to prevent delirium is one of few that provide support in a critical care setting.

Objective. The objective of the current project was to determine the feasibility of using 3D printed technology to facilitate reminiscence-related activities for persons with memory loss (PWMLs). Methods. A parallel convergent mixed methods design was used. Fifteen PWMLs, 13 family members, and six staff from two residential long-term care facilities participated. Participants were observed and interviewed initially, during a 2-week reminiscence session, and again during a 1-month reminiscence session. Staff participants also completed a 1-month focus group, and staff and family members were administered a 3D printing review checklist at 1-month. Results. The integrated qualitative and quantitative data strongly suggested that PWMLs enjoyed using the 3D objects, were engaged while doing so and appeared to value the objects due to their personalized nature. The use of 3D printed objects also appeared to encourage family involvement as well as family and staff interactions with PWMLs. Barriers to use included memory impairment and behavioral issues. Conclusions. The use of 3D printed objects could provide an easy-to-use, well-received, person-centered approach that augments current reminiscence strategies for PWMLs.

Mechanically ventilated patients can be at risk for functional decline (Cameron et al., 2015). Early mobilisation of mechanically ventilated patients can improve outcomes after critical illness to prevent this decline. Although registered nurses understand the importance of early mobilisation there are nurses who are unwilling to mobilise patients. Aim The aim of this study is to examine whether nurses’ attitudes and beliefs are barriers for early mobilisation and evaluate whether an education intervention can improve early mobilisation. Method Pre-test, post-test intervention with registered nurses and charge nurses in a 22 bed trauma intensive care setting. Procedure Pre-test, post-test survey assessed perceived barriers in knowledge, attitudes, and behaviours followed by targeted education. Results Dependent Sample T-test revealed a statistically significant increase in post-test responses for the subscales knowledge, attitudes, and behaviours with early mobilisation. This over-all increase in post-test results support that understanding barriers can improve patient outcomes. Conclusion Use of structured surveys to identify barriers for early mobilisation among nursing can assist in providing targeted education that address nurse’s perception. The education intervention appeared to have a positive impact on attitudes but it is unknown if the difference was sustained over time or affected participants practice or patient outcomes.

Summary Objective Evaluate change in practice and beliefs regarding delirium among nurses, pharmacists, respiratory therapists and physicians in a trauma intensive care unit. Methodology/design/setting Descriptive pre and post-design at a Level One Trauma Center. Education on causes of delirium, risk factors, strategies to prevent delirium and routine screening. Outcome measures Change in practice and beliefs regarding delirium. Results McNemars test measured the differences between pre- and post-questionnaires comparing the proportion of staff changed their responses in one direction to those who went in the opposite direction. Changes in "Delirium is largely preventable", were statistically significant ( p =0.035). Haldol was the medication of choice for treating delirium, with an increase in use ( p =0.062) post-intervention. The majority of participants believed a high percentage of patients experience delirium in a trauma intensive care. The two most frequent medical complications associated with delirium pre-questionnaire was over sedation 8 (22%) and falls 9 (24%) and in post-questionnaire, over sedation 12 (26%) and falls 13 (28%). Conclusions An educational intervention emphasising the importance of screening for delirium, risk factors for delirium and approaches to decrease the incidence of delirium can improve identifying and correctly treating delirium in a critical care setting. An educational program had concrete results in respondents' knowledge about delirium.

SUMMARYElephant movement patterns in relation to surface water demonstrate that they are a water-dependent species. Thus, there has been interest in using surface water management to mitigate problems associated with localized elephant overabundance. However, the physiological mechanisms underlying the elephant's water dependence remain unclear. Although thermoregulation is likely an important driver, the relationship between thermoregulation, water use and climate has not been quantified. We measured skin surface temperature of and cutaneous water loss from 13 elephants (seven African, 3768±642 kg; six Asian, 3834±498 kg) and determined the contribution of evaporative cooling to their thermal and water budgets across a range of air temperatures (8–33°C). We also measured respiratory evaporative water loss and resting metabolic heat production on a subset of elephants (N=7). The rate of cutaneous evaporative water loss ranged between 0.31 and 8.9 g min−1 m−2 for Asian elephants and 0.26 and 6.5 g min−1 m−2 for African elephants. Simulated thermal and water budgets using climate data from Port Elizabeth, South Africa, and Okaukuejo, Namibia, suggested that the 24-h evaporative cooling water debt incurred in warm climates can be more than 4.5 times that incurred in mesic climates. This study confirms elephants are obligate evaporative coolers but suggests that classification of elephants as water dependent is insufficient given the importance of climate in determining the magnitude of this dependence. These data highlight the potential for a physiological modeling approach to predicting the utility of surface water management for specific populations.

Three captive-born (5-day-old, 8-day-old, and 4-yr-old) Asian elephants (Elephas maximus) and one captive-born 22-yr-old African elephant (Loxodonta africana) from three private elephant facilities and one zoo in the United States presented with depression, anorexia, and tachycardia as well as gastrointestinal signs of disease including abdominal distention, decreased borborygmi, tenesmus, hematochezia, or diarrhea. All elephants showed some evidence of discomfort including agitation, vocalization, or postural changes. One animal had abnormal rectal findings. Nonmotile bowel loops were seen on transabdominal ultrasound in another case. Duration of signs ranged from 6 to 36 hr. All elephants received analgesics and were given oral or rectal fluids. Other treatments included warm-water enemas or walking. One elephant underwent exploratory celiotomy. Three animals died, and the elephant taken to surgery was euthanized prior to anesthetic recovery. At necropsy, all animals had severe, strangulating intestinal lesions.

Summary Objectives Evaluate change in ventilator associated pneumonia (VAP) and nurse's attitudes, beliefs post implementation of an evidence based practice (EBP) oral hygiene protocol. Methodology/design/setting Descriptive pre and post test design in two critical care units in a Level One Trauma Community Hospital. Oral hygiene protocol data was reanalysed to examine effects in medical surgical and trauma subgroups. Outcome measures Oral care practices, attitudes and beliefs among nurses, and VAP rates according to Centers for Disease Control and Prevention guidelines. Results Trauma rates increased from 6.4% to 10.0% ( p = 0.346), and medical/surgical rates decreased from 3.3% to 1.0% ( p = 0.042). Results revealed changes in nurses’ beliefs regarding pre-admission colonisation ( p = 0.027) and having adequate training. Nurses’ perception of facility support improved, by having suitable equipment and readily available supplies. Foam swabs with moisture agents at 4 hours or less was 88.6% and toothbrush use at 12 hours or less was 71%, with significant changes in frequency of oral care post intervention. Conclusions Trauma patients present with unique characteristics which compromise oral care. Understanding risk and prognostic factors, mechanisms of transmission and systemic inflammatory response are important when implementing EBP protocols. Nurses’ attitudes, beliefs are important, and staff adherence considered when initiating EBP changes.