Changing roles of nurse educators employed in acute and chronic care settings : the impact of professional and statutory mandates in Ontario at four sites of one hospital corporation /

The role of the hospital-employed nurse educator is evolving. Factors influencing this change include the introduction of standards for nurse educators by the College of Nurses of Ontario (CNO), a change in the way nurses are educated, the emergence of nursing as a profession, and hospital restructuring as a result of budgetary constraints. Two of these influencing factors: the introduction of the updated Standards of Practice for Registered Nurses and Registered Practical Nurses (1996) and hospital restructuring occurred over the last 7 years at several hospitals in southern Ontario. Current literature as well as the Standards of Practice (1996) were utilized to examine the current roles and responsibilities of nurse educators and subsequently develop a questionnaire to study the impact of these influencing factors on the role of the nurse educator. This questionnaire was piloted and revised before its distribution at 4 hospitals in southern Ontario. Twenty-five of the 41 surveys (61%) distributed were returned for analysis. The data reflected that the Standards of Practice had a positive influence on the role of the nurse educator, while hospital restructuring had a negative impact. In addition, many of the roles and responsibilities identified in the literature were indeed part of the current role of nurse educators, as well as several responsibilities not captured in the literature. The predictions for the future of this role in its current state were not positive given the financial status of the health care system as well as the lack of clarity for the role and the current level ofjob satisfaction among practicing nurse educators. However, a list of recommendations were generated which, if implemented, could add clarity to the role and improve job satisfaction. This could enhance the retention of current nurse educators and the possibility of recruiting competent nurse educators to the role in the future.

The effect of elevated muscle fluid volume on indices of muscle damage following an acute bout of eccentric exercise

The primary purpose of the current investigation was to develop an elevated muscle fluid level using a human in-vivo model. The secondary purpose was to determine if an increased muscle fluid content could alter the acute muscle damage response following a bout of eccentric exercise. Eight healthy, recreationally active males participated in a cross-over design involving two randomly assigned trials. A hydration trial (HYD) consisting of a two hour infusion of a hypotonic (0.45%) saline at a rate of 20mL/minVl .73m"^ and a control trial (CON), separated by four weeks. Following the infusion (HYD) or rest period (CON), participants completed a single leg isokinetic eccentric exercise protocol of the quadriceps, consisting of 10 sets of 10 repetitions with a one minute rest between each set. Muscle biopsies were collected prior to the exercise, immediately following and at three hours post exercise. Muscle analysis included determination of wet-dry ratios and quantification of muscle damage using toluidine blue staining and light microscopy. Blood samples were collected prior to, immediately post, three and 24 hours post exercise to determine changes in creatine kinase (CK), lactate dehydrogenase (LD), interleukin-6 (IL-6) and Creactive protein (CRP) levels. Results demonstrated an increased muscle fluid volume in the HYD condition following the infusion when compared to the CON condition. Isometric peak torque was significantly reduced following the exercise in both the HYD and CON conditions. There were no significant differences in the number of areas of muscle damage at any of the time points in either condition, with no differences between conditions. CK levels were significantly greater 24hour post exercise compared to pre, immediately and three hours post similarly in both conditions. LD in the HYD condition followed a similar trend as CK with 24 hour levels higher than pre, immediately post and three hours post and LD levels were significantly greater 24 hours post compared to pre levels in the CON condition, with no differences between conditions. A significant main effect for time was observed for CRP (p<0.05) for time, such that CRP levels increased consistently at each subsequent time point. However, CRP and IL-6 levels were not different at any of the measured time points when comparing the two conditions. Although the current investigation was able to successfully increase muscle fluid volume and an increased CK, LD and CRP were observed, no muscle damage was observed following the eccentric exercise protocol in the CON or HYD conditions. Therefore, the hypotonic infusion used in the HYD condition proved to be a viable method to acutely increase muscle fluid content in in-vivo human skeletal muscle.

Enhancing pnemonia surveillance in acute care facilities in post SARS era : a Canadian hospital surveillance study, 2003-2004 influenza season

A retrospective study of patients hospitalized with influenza and/or pneumonia in a Niagara area community hospital for the influenza season 2003-04 was designed with the main goal of enhancing pneumonia surveillance in acute care facilities and the following specific objectives: 1) identify etiologies, factors, and clinical presentation associated with pneumonia; 2) assess the ODIN score on ICU patients to predict outcomes of severe pneumonia; 3) identify the frequency of pneumonia and influenza in a hospital setting; and 4) develop a hospital pneumonia electronic surveillance tool. A total of 172 patients' charts (50% females) were reviewed and classified into two groups: those with diagnosis of pneumonia (n=132) and those without pneumonia (n=40). The latter group consisted mainly of patients with influenza (85%). Most patients were young (<10yrs) or elderly (>71yrs). Presenting body temperature <38°C, cough symptoms, respiratory and cardiac precomorbidities were common in both groups. Pneumonia was more frequent in males (p= .032) and more likely community-acquired (98%) than nosocomial (2%). No evidence of ventilator-associated pneumonia was found. Microbiology testing in 72% of cases detected 19 different pathogens. In pneumonia patients the most common organisms were Streptococcus pneumoniae (3%), Respiratory syncytial virus (4%), and Influenza A virus (2%). Conversely, Influenza A virus was identified in 73% of non-pneumonia patients. Community-acquired influenza was more common (80%) than nosocomial influenza (20%). The ODIN score was a good predictor of mortality and the new electronic surveillance tool was an effective prototype to monitor patients in acute care, especially during influenza season. The results of this study provided baseline data on respiratory illness surveillance and demonstrated that future research, including prospective studies, is warranted in acute care facilities.

Changes in the magnitude and pattern of translocation of photoassimilated ¹CO in soybean plants following an acute exposure to gamma radiation /

Young soybean plants (Glycine ~. L. cultivar Harosoy '63), grown under controlled conditions, were exposed to gamma radiation on a single occasion. One hour following exposure to 3,750 rads, the mature trifoliate leaf of the soybean plant was isolated in a closed system and permitted to photoassimilate approximately 1-5 pCi of 14C02 for 15 minutes. After an additional 45 minute-period, the plant was sacrificed and the magnitude of translocation and distribution pattern of 14C determined. In the non-irradiated plants 18~ of the total 14C recovered was outside the fed leaf blades and of this translocated 14c, 28~ was above the node of the fed leaf, 38~ in the stem below the node, 28~ in the roots and 7~ in the petiole. As well, in the irradiated plants, a smaller per cent (6~) of the total 14 C recovered was exported out of the source leaf blades. Of this translocated 14c , a smaller per cent (20~) was found in the apical region above the node of the source leaf and a higher per cent (45~) was recovered from the stem below the node and in the petiole (11~). The per cent of exported 14 C recovered from the root was unaffected by the radiation. Replacement of the shoot apex with 20 ppm IAA immediately following irradiation, only J partially increased the magnitude of translocation but did completely restore the pattern of distribution to that observed in the non-irradiated plants. From supplementary studies showing a radiationinduced reduction of photosynthetic rates in the source leaf and a reduction of the cumulative stem and leaf lengths in the apical sink region, the observed effects of radiation on the translocation process have been correlated to damage incurred by the source and sink regions. These data suggest that the reduction in the magnitude of translocation is the result of damage to both the source and sink regions rather than the phloem conducting tissue itself, whereas the change in the pattern of translocation is probably the result of a reduced rate of 14C-assimilate movement caused by a radiation-induced decrease of sink metabolism, especially the decrease in the metabolism of the apical sink.

The acute effects of differential dietary fatty acids on PDHa activity in human skeletal muscle at the onset of exercise

Pyruvate dehydrogenase (PDH) is an important regulator of carbohydrate oxidation during exercise and its activity can be down-regulated by an increase in dietary fat. The purpose of this study was to determine the acute metabolic effects of differential dietary fatty acids on the activation of PDH in its active form (PDHa) at rest and at the onset of moderate-intensity exercise. University-aged male subjects (n=7) underwent 2 fat loading trials spaced at least 2 weeks apart. Subjects consumed saturated (SFA) or polyunsaturated (PUFA) fat over the course of 5 hours. Following this, participants cycled at 65% VO2 max for 15 min. Muscle biopsies were taken prior to and following fat loading and at 1 min exercise. Plasma free fatty acids increased from 0.15 ± 0.07 to 0.54 ± 0.19 mM over 5 hours with SFA and from 0.1 1 ± 0.04 to 0.35 ±0.13 mM with PUFA. PDHa activity was unchanged following fat loading, but increased at the onset of exercise in the SFA trial, from 1 .4 ± 0.4 to 2.2 ± 0.4 /xmol/min/kg wet wt. This effect was negated in the PUFA trial (1 .2 ± 0.3 to 1 .3 ± 0.3 pimol/min/kg wet wt.). PDH kinase (PDK) was unchanged in both trials, suggesting that the attenuation of PDHa activity with PUFA was a result of changes in the concentrations of intramitochondrial effectors, more specifically intramitochondrial NADH or Ca^*. Our findings suggest that attenuated PDHa activity participates in the preferential oxidation of PUFA during moderateintensity exercise.

Exploring the effects of change on nursing practice in acute ambulatory care settings : a qualitative study

As a result of the current changes taking place in the delivery of acute care services, the emergence of acute ambulatory care (AAC) settings is expanding. According to a literature review, the volume, acuity, and complexity of patient care in these settings is increasing while the time the patients spend under the care of nurses is decreasing. Two forces, hospital downsizing and advancing technology, are identified as the major contributors to the shift in acute care delivery. The effects that these changes are having on the clinical nursing practice of registered nurses working in AAC settings are not known. Given that AAC settings are rapidly expanding, it can be anticipated that the delivery of nursing care will continue to be compressed into a shorter time frame. Therefore, the following qualitative research question was formulated: What are the problems and issues related to clinical nursing practice in acute ambulatory settings? The purpose of this study was to explore the problems and issues associated with change and clinical nursing practice including the educational needs of nurses working in MC settings. Specific objectives of the study included the following: (a) to explore the problems and issues related to nursing practice in select AAC settings; (b) to explore the similarities and differences in perspectives related to role expectation between nurse managers, nurse educators, and staff nurses; and (c) to develop a conceptual framework that will guide the construction of an instrument needed for further research. This study used semistructured individual interviews and focus group sessions to collect data from the three categories of registered nurses. More specifically, data were collected from one nurse manager, two charge nurses, two nurse educators and fifteen staff nurses, working in three different MC settings of a major teaching hospital. Collected data were separately analyzed by the researcher and an external rater following grounded theory methodology. By using open and axial coding, the problems and issues identified by nurses were grouped into several major and minor themes. In final analysis, by using selective coding, the four core themes (intensification, moderation, frustration, and adaptation) were extracted. Each core theme was presented and discussed in relation to hospital downsizing and advancing technology. The relationships among the four core themes were discussed and depicted in a model termed the "Impact and Consequence Model on Nursing Practice in MC Settings." Implications for further research are discussed and research hypotheses, based on the research findings, are presented.

The effect of acute exercise type on body image attitudes

The current study examined the effect of two types of acute exercise (resistance and mind-body yoga) on state body image attitudes, to see which, was most effective at reducing body image concerns. I t was hypothesized that both types of exercise would lead to improvements in body image, with yoga showing the biggest benefits. Collegeaged female non/infrequent exercisers (n = 40) completed state measures of body satisfaction, social physique anxiety (SPA), and appearance orientation prior to and following participation in a single yoga and resistance class. Participation in the yoga class was associated with decreases in SPA and increases in body satisfaction. However, participation in the resistance class was associated with no changes in any of the study variables. These findings indicate participation in a single yoga class may have positive effects on body image attitudes, which may encourage non-exercisers to become more active.

The effects of an acute bout of whole-body vibration on pulse wave velocity in individuals with SCI

Cardiovascular disease is a leading cause of mortality in the spinal cord injured (SCI) population. Reduced arterial compliance is a cardiovascular risk factor and whole body vibration (WBV) has be en shown to improve arterial compliance in able-bodied individuals. The study investigated the effect of an acute session ofWBV on arterial compliance as measured by pulse wave velocity (PWV). On separate days, arm, leg and aortic PWV were measured pre- and post- a 45 minute session of passive stance (PS) and WBV. The WBV was intermittent with a set frequency of 45Hz and amplitude of O.6mm. There was no condition by time effect when comparing PWV after WBV and PS. Following WBV, aortic (928.6±127.7 vs. 901.1±96.6cm/sec), leg (1035.2±113.8 vs.l099.8±114.2cm/sec) and arm PWV (1118.9±119.8 vs. 1181.1±124.4cm/s) did not change. As such, WBV did not reduce arterial compliance, however future research with protocol modifications is recommended.

The acute effects of systemic cytokines on peripheral nerve function in humans

Cytokines have been shown to cause a reduction in nerve conduction when examined using animal models. Such effects, if shown in humans, could result in detrimental effects to physical function during periods heightened systemic cytokine concentrations. The study investigated the acute effects of cytokines on nerve conduction velocity (NCV) and functional measures. Measures were taken under both basal and elevated cytokine concentrations to determine any corresponding changes to NCV. A significant positive correlation was found between the cytokine IL-6 and NCV at 2 hours post-exercise (r=0.606, p=0.048). A significant negative correlation was found between IL-1ra and NCV at 24 hours post-exercise (r=-0.652, p=0.021). A significant positive correlation was also found between IL-1ra and endurance at 1 hour post-exercise (r=0.643, p=0.033). As such, it would seem that IL-6 may potentially act to enhance nerve function while other cytokines such as IL-1ra may have negative effects and reduce NCV.

Chronic versus acute ingestion of sodium citrate: a randomized placebo controlled cross-over trial for swimming 200 metres in well-trained swimmers age 13-17

A double-blinded, placebo controlled, cross-over design was used to investigate sodium citrate dihydrate (Na-CIT) supplementation improve 200m swimming performance. Ten well-trained, male swimmers (14.9 ± 0.4y; 63.5 ± 4kg) performed four 200m time trials: acute (ACU) supplementation (0.5g/kg), acute placebo (PLC-A), chronic (CHR) (0.1g/kg for 3 days and 0.3g/kg on the 4th day pre-trial), and chronic placebo (PLC-C). Na-CIT was administered 120min pre-trial in solution with 500mL of flavored water; placebo was flavored water. Blood lactate, base excess (BE), bicarbonate, pH, and PCO2 were analyzed at basal, 100min post-ingestion, and 3min post-trial via finger prick. Time, lactate, and rate of perceived exertion were not different between trials. BE and bicarbonate were significantly higher for the ACU and CHR trials compared to placebo. “Responders” improved by 1.03% (P=0.043) and attained significantly higher post-trial lactate concentrations in the ACU versus PLC-A trials and compared to non-responders in the ACU and CHR trials.

THE ACUTE EFFECTS OF A SINGLE SESSION OF PLYOMETRIC EXERCISE ON MARKERS OF BONE TURNOVER IN BOYS AND MEN

The study objective was to compare the response of bone markers to an exercise session consisting of high mechanical loading (144 jumps) between boys (n=12, 10.2 ± 0.4 years) and men (n=18, 22.5 ± 0.7 years). Blood samples were collected at pre-, 5, 60 minutes post-, and 24 hours post-exercise) to measure bone-specific alkaline phosphatase (BAP), amino-terminal cross-linking telopeptide (NTx), osteoprotegrin (OPG) and receptor activator of nuclear factor kb ligand (RANKL). Boys had higher BAP levels at all time points, with an increase 24 hours post-exercise. No such increase was observed in men. Likewise, NTx levels were higher in boys, with a greater increase over time than in men. OPG and RANKL levels were similar in boys and men at all times. In summary, even one session of exercise stimulates bone turnover, as reflected in the increase in both BAP and NTx, in boys (but not men) within 24 hours.

Effects of social context on endocrine function and Zif268 expression in response to an acute stressor in adolescent and adult rats

There is a paucity of studies comparing social buffering in adolescents and adults, despite their marked differences in social behaviour. I investigated whether greater effects of social buffering on plasma corticosterone concentrations and expression of Zif268 in neural regions after an acute stressor would be found in adolescent compared with adult rats. Samples were obtained before and after one hour of isolation stress and after either one or three hours of recovery back in the colony with either a familiar or unfamiliar cage partner. Adolescent and adult rats did not differ in plasma concentrations of corticosterone at any time point. Corticosterone concentrations were higher after one hour isolation than at baseline (p < 0.001), and rats with a familiar partner during the recovery phase had lower corticosterone concentrations than did rats with an unfamiliar partner (p = 0.02). Zif268 immunoreactive cell counts were higher in the arcuate nucleus in both age groups after isolation (p = 0.007) and higher in the paraventricular nucleus of adolescents compared with adults during the recovery phase irrespective of partner familiarity. There was a significant decrease in immunoreactive cell counts after one hour isolation compared to baseline in the basolateral amygdala, central nucleus of the amygdala, and in the pyramidal layer of the hippocampus (all p < 0.05). An effect of partner familiarity on Zif268 immunoreactive cell counts was found in the granule layer of the dentate gyrus irrespective of age (higher in those with a familiar partner, p = 0.03) and in the medial prefrontal cortex in adolescents (higher with an unfamiliar partner, p = 0.02). Overall, the acute stress and partner familiarity produced a similar pattern of results in adolescents and adults, with both age groups sensitive to the social context.

Changes in mitochondrial PLIN3 and PLIN5 protein content in rat skeletal muscle following acute contraction and endurance training

Surrounding lipid droplets in skeletal muscle are the perilipin (PLIN2-5) family of proteins, regulating lipid droplet metabolism. During exercise lipid droplets provide fatty acids to the mitochondria for oxidation while increasing their proximity to each other. Whether PLIN3 and PLIN5 associate with mitochondria following contraction has not been examined. To determine whether contraction altered mitochondrial PLIN3 and PLIN5 content, sedentary and endurance trained rats underwent acute contraction. The main outcomes are; 1) mitochondrial PLIN3 content is unaltered while mitochondrial PLIN5 content is increased following an acute contraction 2) mitochondrial PLIN3 content is higher in endurance trained rats when compared to sedentary and mitochondrial PLIN5 content is similar in both conditions 3) only PLIN5 mitochondrial content is increased similarly in both groups following acute contraction. This work highlights the dynamics of these two PLIN proteins, which may have roles not only on the lipid droplet but also on the mitochondria.

Acute endocrine responses to plyometrics versus resistance exercise in children

The purpose of this study was to examine the acute hormonal responses to a bout of resistance versus plyometric exercise in young male athletes. Specifically, changes in salivary cortisol, testosterone and testosterone-to-cortisol ratio from pre- to post-exercise between the two different exercise protocols were examined. Twenty-six peri-pubertal active boys participated in this cross-over study, completing two exercise sessions. During each session, participants first completed a 30 min control period, which did not include any exercise, and then was randomly assigned to perform a 45 min of either a resistance exercise or a plyometric exercise protocol. All participants crossed over to perform the other exercise protocol during their second exercise session, a week later. Four saliva samples during each protocol were taken at: baseline, pre-exercise, 5 min post-exercise and 30 min post-exercise. Significant increases in testosterone values were reported 5 min post-exercise following the resistance protocol, but not the plyometric protocol. Both exercise protocols resulted in significant cortisol decreases overtime, as well as significant testosterone-to-cortisol ratio increases. The post-exercise increases in salivary testosterone and testosterone-to-cortisol ratio followed the typical exercise induced anabolic response seen in adults. However, the post-exercise decrease in salivary cortisol was different than the typical adult response indicating an insufficient stimulus for this age group maybe due to their stage of the biological development. Thus, in the adolescent boys, exercise appears to change the anabolic to catabolic balance in favor of anabolism.

Higher PLIN5 but not PLIN3 content in isolated skeletal muscle mitochondria following acute in vivo contraction in rat hindlimb

Contraction-mediated lipolysis increases the association of lipid droplets and mitochondria, indicating an important role in the passage of fatty acids from lipid droplets to mitochondria in skeletal muscle. PLIN3 and PLIN5 are of particular interest to the lipid droplet–mitochondria interaction because PLIN3 is able to move about within cells and PLIN5 associates with skeletal muscle mitochondria. This study primarily investigated: 1) if PLIN3 is detected in skeletal muscle mitochondrial fraction; and 2) if mitochondrial protein content of PLIN3 and/or PLIN5 changes following stimulated contraction. A secondary aim was to determine if PLIN3 and PLIN5 associate and whether this changes following contraction. Male Long Evans rats (n = 21;age, 52 days; weight = 317 6 g) underwent 30 min of hindlimb stimulation (10 msec impulses, 100 Hz/3 sec at 10–20 V; train duration 100 msec). Contraction induced a ~50% reduction in intramuscular lipid content measured by oil red-O staining of red gastrocnemius muscle. Mitochondria were isolated from red gastrocnemius muscle by differential centrifugation and proteins were detected by western blotting. Mitochondrial PLIN5 content was ~1.6-fold higher following 30 min of contraction and PLIN3 content was detected in the mitochondrial fraction, and unchanged following contraction. An association between PLIN3 and PLIN5 was observed and remained unaltered following contraction. PLIN5 may play a role in mitochondria during lipolysis, which is consistent with a role in facilitating/regulating mitochondrial fatty acid oxidation. PLIN3 and PLIN5 may be working together on the lipid droplet and mitochondria during contraction-induced lipolysis.