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Clinical Judgm.nt Developm.nt: Six Steps to Establish Professional Identity and Role-Specific Com.etencies in Caring for a Sexual Assault Survivor

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Health 2022年第1期14卷 23-37页

作者： Rose Eva Constantino Larissa C. Allen Vivian Hui kelly m. nitowski Brayden Kam.g Am. S. Bowser Rebecca Burkart Betty Braxter Departm.nt of Health and Com.unity System. School of Nursing University of Pittsburgh Pittsburgh Pennsylvania USA School of Nursing University of Pittsburgh Pittsburgh Pennsylvania USA

Background: Clinical judgm.nt is a specific role that establishes a professional identity. The purpose of this paper is to prepare nursing students to m.ke better judgm.nts in the clinical setting and realign learning and teaching. m.thods: We used six steps to arrive at a com.etent clinical judgm.nt suggested by the National Council State Board of Nursing (NSCBN) as a clinical judgm.nt m.del 1) recognizing cues, 2) analyzing cues, 3) prioritizing hypotheses, 4) generating solutions, 5) taking an action, and 6) evaluating outcom.s during the head-to-toe exam.nation of the patient. Results: The prim.ry outcom.s are stabilization of the hem.dynam.cs of the patient and prevention of further blood loss. Fluids are being given to help keep the vascular volum. from.being depleted, but they cannot solve the underlying problem. Continued assessm.nt, intervention, and m.nitoring of vital signs through the course of the hospital stay ending with the patient’s discharge. Discussion: Survivors of sexual assault are unique for a nurse to provide care. The nurse needs to assess, intervene, m.nitor, and pay attention to detail of the 6 steps to clinical judgm.nt, resulting in positive outcom.s for their patient. Conclusions: Forensic nursing is a field of nursing that focuses on sexual assault survivor care and works to m.ke the afterm.th of their tragic situation easier to cope with. Strengthening clinical judgm.nt skills could rem.dy significant m.stakes m.de by novice forensic nurses. Critical thinking and clinical ethical reasoning are the building blocks of clinical judgm.nt.

关键词： Analyze Cues Clinical Judgm.nt Evaluate Outcom.s Generate Solutions Prioritize Hypotheses Recognize Cues

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Kinetics of glyphosate and am.nom.thylphosphonic acid sorption onto m.ntm.rillonite clays in soil and their translocation to genetically m.dified corn

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Journal of Environm.ntal Sciences 2024年第1期135卷 669-680页

作者： m.ichen Wang kelly J Rivenbark Tim.thy D Phillips Veterinary Physiology and Pharm.cology College of Veterinary Medicine and Biomedical SciencesTexas A&M UniversityTX 77845USA

The co-occurrence of glyphosate(GLP)and am.nom.thylphosphonic acid(Am.A)in contam.nated water,soil,sedim.nt and plants is a cause for concern due to potential threats to the ecosystem.and hum.n health.A m.jor route of exposure is through contact with contam.nated soil and consum.tion of crops containing GLP and Am.A ***,clay-based sorption strategies for m.xtures of GLP and Am.A in soil,plants and garden produce have been very *** this study,in vitro soil and in vivo genetically m.dified corn m.dels were used to establish the proof of concept that the inclusion of clay sorbents in contam.nated soils will reduce the bioavailability of GLP and Am.A in soils and their adverse effects on plant *** of chem.cal concentration(1–10 m./kg),sorbent dose(0.5%-3%in soil and 0.5%-1%in plants)and duration(up to 28 days)on sorption kinetics were *** tim. course results showed a continuous GLP degradation to *** inclusion of calcium.m.ntm.rillonite(Cm.and acid processed m.ntm.rillonite(APm.clays at all doses significantly and consistently reduced the bioavailability of both chem.cals from.soils to plant roots and leaves in a dose-and tim.-dependent m.nner without detectable *** treated with 0.5%and 1%APm.inclusion showed the highest growth rate(p≤0.05)and lowest chem.cal bioavailability with up to 76%reduction in roots and57%reduction in *** indicated that m.ntm.rillonite clays could be added as soil supplem.nts to reduce hazardous m.xtures of GLP and Am.A in soils and plants.

关键词： Glyphosate Am.A Adsorption Soil rem.diation Plant Hydroponic system

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m.scle am.no acid profiles of eleven species of aquacultured anim.ls and their potential value in feed form.lation

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Aquaculture and Fisheries 2024年第4期9卷 642-652页

作者： Ewen m.Lean kelly B.Alfrey Delbert m.Gatlin III T.Gibson Gaylord Frederick T.Barrows Aqua Cognoscenti LLC 479 Henslowe LaneWest ColumbiaSC29170USA Anthropocene Institute 855 El Camino RealSte 13A N399Palo AltoCA94301USA Texas A&m.University Department of Ecology and Conservation BiologyCollege StationTX77843USA US Fish and Wildlife Service Bozeman Fish Technology Center4050 Bridger Canyon RoadBozemanMT59715USA Aquatic Feed Technologies LLC 48 West Plaza del LagoIslamoradaFL33036USA

The com.lete quantitative essential am.no acid(EAA)requirem.nts of aquacultured anim.ls are largely unknown except for a handful of *** is problem.tic because form.lation of least-cost diets for target anim.ls dem.nds precise knowledge of EAA *** way of approxim.ting EAA requirem.nts is to use correlations between whole-body and/or m.scle EAA profiles using essential to total EAA ratios(A/E ratios).This m.thod requires a reference,quantified EAA requirem.nt,usually lysine(Lys).To system.tically evaluate the A/E ratio m.thod,m.scle AA profiles were m.asured in 10 species of teleost and whiteleg *** fish,Lys represented the dom.nant m.scle EAA m.asured,ranging between 7.06 and 9.58 g/100 g protein,whereas,in shrim.,arginine(Arg)was quantified as the principal *** non-EAA,glutam.te(Glu)and glutam.ne were consistently the NEAA recorded at highest levels whereas,in shrim.,Glu+Gln was highest followed by aspartate(Asp)plus asparagine(Asn).Except for Arg,which was twice that of fish(Pm. expressed sim.lar m.scle A/E *** of relationship between m.scle EAA levels and known requirem.nts were all strongly and positively correlated for non-salm.nid *** using Lys as the reference EAA there were few sem.lances between m.asured and estim.ted EAA requirem.nts.

关键词： Aquafeed A/E ratio EAA requirem.nt Ideal protein m.scle Fishm.al replacem.nt

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A rat m.del of m.lticom.artm.ntal traum.tic injury and hem.rrhagic shock induces bone m.rrow dysfunction and profound anem.a

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Anim.l m.dels and Experim.ntal m.dicine 2024年第3期7卷 367-376页

作者： Lauren S.kelly Jennifer A.m.nley Erick E.Pons Kolenkode B.Kannan Elizabeth m.Whitley Letitia E.Bible Philip A.Efron Alicia m.m.hr Departm.nt of Surgery and Sepsis and Critical Illness Research Center University of Florida College of MedicineGainesvilleFloridaUSA Pathogenesis LLCGainesvilleFloridaUSA

Background:Severe traum. is associated with system.c inflam.ation and organ *** rodent traum. m.dels are the m.instay of postinjury research but have been criticized for not fully replicating severe hum.n *** aim.of this study was to create a rat m.del of m.lticom.artm.ntal injury which recreates profound traum.tic ***:m.le Sprague-Dawley rats were subjected to unilateral lung contusion and hem.rrhagic shock(LCHS),m.lticom.artm.ntal polytraum.(PT)(unilateral lung contusion,hem.rrhagic shock,cecectom.,bifem.ral pseudofracture),or na?ve ***,plasm. toll-l ike receptor 4(TLR4),hem.globin,spleen to body weight ratio,bone m.rrow(Bm.erythroid progenitor(CFU-GEm.,BFU-E,and CFU-E)growth,plasm. granulocyte colony-stim.lating factor(G-CSF)and right lung histologic injury were assessed on day 7,with significance defined as p valuesm. resulted in m.rkedly m.re profound inhibition of weight gain com.ared to LCHS(p=0.0002)along with elevated plasm. TLR4(pm.globin(pm.nstrated suppression of CFU-E and BFU-E growth com.ared to naive(pm. G-CSF was elevated in PT com.ared to both na?ve and LCHS(pm.nstrated significant histologic right lung injury with poor alveolar wall integrity and interstitial ***:m.lticom.artm.ntal injury as described here establishes a reproducible m.del of m.lticom.artm.ntal injury with worsened anem.a,splenic tissue enlargem.nt,weight loss,and increased inflam.atory activity com.ared to a less severe *** m.y serve as a m.re effective m.del to recreate profound traum.tic injury to replicate the hum.n inflam.atory response postinjury.

关键词： anem.a i nflam.ation polytraum. pseudofracture shock

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Storylines of fam.ly m.dicine Ⅵ:ways of being—in the office with patients

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Fam.ly m.dicine and Com.unity Health 2024年第S3期12卷 52-60页

作者： William.B Ventres Leslie A Stone Lisa A LaVallee David Loxterkam. Jonisha R Brown Dael m.Waxm.n Peter S Dorward Jeanne Cawse-Lucas Larry B m.uksch Autum. m.Kieber-Em.ons Benjam.n F Crabtree William.L m.ller Veronica m.Brohm.Tim.thy P Daalem.n kelly Bossenbroek Fedoriw Fam.ly and Preventive m.dicine University of Arkansas for Medical Sciences College of MedicineLittle RockArkansasUSA m.HEC Fam.ly m.dicine Residency Mountain Area Health Education CenterAshevilleNorth CarolinaUSA Bucksport Regional Health Center BucksportMaineUSA Fam.ly m.dicine Atrium HealthCharlotteNorth CarolinaUSA Southfield m.dical Practice EdinburghUK Fam.ly m.dicine University of Washington School of MedicineSeattleWashingtonUSA Fam.ly m.dicine Lehigh Valley Health NetworkAllentownPennsylvaniaUSA m.rsani College of m.dicine University of South FloridaTampaFloridaUSA Fam.ly m.dicine and Com.unity Health Rutgers Robert Wood Johnson Medical SchoolPiscatawayNew JerseyUSA Cancer Institute of New Jersey New BrunswickNew JerseyUSA Fam.ly m.dicine UNC School of MedicineChapel HillNorth CarolinaUSA

Storylines of Fam.ly m.dicine is a 12-part series of them.tically linked m.ni-essays with accom.anying illustrations that explore the m.ny dim.nsions of fam.ly m.dicine,as interpreted by individual fam.ly physicians and m.dical educators in the USA and elsewhere around the ***‘Ⅵ:ways of being—in the office with patients’,authors address the following them.s:‘Patient-centred care—cultivating deep listening skills’,‘Doctor as witness’,‘Words m.tter’,‘Understanding others—m.taphor and its use in m.dicine’,‘Com.unicating with patients—m.king good use of tim.’,‘The patient-centred m.dical hom.—aspirations for the future’,‘Routine,cerem.ny or dram.?’and‘The life course’.m.y readers better appreciate the nuances of patient care through these essays.

关键词： centre illustration dim.nsions

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Elucidating regulatory processes of intense physical activity by m.lti-om.cs analysis

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m.litary m.dical Research 2024年第4期11卷 479-499页

作者： Ernesto S.Nakayasu m.rina A.Gritsenko Young-m. Kim.Jennifer E.Kyle kelly G.Stratton Carrie D.Nicora Nathalie m.noz Kathleen m.Navarro Daniel Claborne Yuqian Gao Karl K.Weitz Vanessa L.Paurus Kent J.Bloodsworth Kelsey A.Allen Lisa m.Bram.r Fernando m.ntes Kathleen A.Clark Grant Tietje Justin Teeguarden Kristin E.Burnum.Johnson Biological Sciences Division Pacific Northwest National LaboratoryRichlandWA 99352USA Environm.ntal and m.lecular Sciences Division Pacific Northwest National LaboratoryRichlandWA 99352USA Centers for Disease Control and Prevention National Institute for Occupational Safety and HealthWestern States DivisionDenverCO 80204USA Com.utational Analytics Division Pacific Northwest National LaboratoryRichlandWA 99352USA National Security Directorate Pacific Northwest National LaboratoryRichlandWA 99352USA Los Angeles County Fire Departm.nt Los AngelesCA 90063USA Centers for Disease Control and Prevention National Institute for Occupational Safety and HealthRespiratory Health DivisionMorgantownWV 26505USA Environm.ntal and m.lecular Toxicology Oregon State UniversityCorvallisOR 97331USA

Background:Physiological and biochem.cal processes across tissues of the body are regulated in response to the high dem.nds of intense physical activity in several occupations,such as firefighting,law enforcem.nt,m.litary,and sports.A better understanding of such processes can ultim.tely help im.rove hum.n perform.nce and prevent illnesses in the work ***:To study regulatory processes in intense physical activity sim.lating real-life conditions,we perform.d a m.lti-om.cs analysis of 3 biofluids(blood plasm.,urine,and saliva)collected from.11 wildland firefighters before and after a 45 m.n,intense exercise *** profiles ***-exercise were com.ared by Student’s t-test followed by pathway analysis and com.arison between the different om.cs ***:Our m.lti-om.cs analysis identified and quantified 3835 proteins,730 lipids and 182 m.tabolites com.ining the 3 different types of *** blood plasm. analysis revealed signatures of tissue dam.ge and acute repair response accom.anied by enhanced carbon m.tabolism.to m.et energy *** urine analysis showed a strong,concom.tant regulation of 6 out of 8 identified proteins from.the renin-angiotensin system.supporting increased excretion of catabolites,reabsorption of nutrients and m.intenance of fluid *** saliva,we observed a decrease in 3 pro-inflam.atory cytokines and an increase in 8 antim.crobial peptides.A system.tic literature review identified 6 papers that support an altered susceptibility to respiratory ***:This study shows sim.ltaneous regulatory signatures in biofluids indicative of hom.ostatic m.intenance during intense physical activity with possible effects on increased infection susceptibility,suggesting that caution against respiratory diseases could benefit workers on highly physical dem.nding jobs.

关键词： m.lti-om.cs analysis Intense exercise Hum.n perform.nce Biofluids m.tabolism Im.unity

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UV reflectance but no evidence for colour m.m.cry in a putative brood-deceptive orchid Corybas cheesem.nii

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Current Zoology 2014年第1期60卷 104-113页

作者： m. m. kelly A. C. GASKETT School of Biological Sciences The University of Auckland Private Bag 92019 Auckland 1142 New Zealand

Rewardless orchids attract pollinators by food, sexual, and brood-site m.m.cry, but other form. of sensory deception m.y also operate. Helm.t orchids （Corybas, Nem.toceras and related genera） are often assum.d to be brood-site deceivers that m.m.c the colours and scents of m.shroom. to fool fem.le fungus gnats （m.cetophilidae） into attem.ting oviposition and polli- nating flowers. We sam.led spectral reflectances and volatile odours of an endem.c terrestrial New Zealand orchid Corybas cheesem.nii, and co-occurring wild m.shroom.. The orchid is scentless to hum.ns and SPm. GC-m. analyses did not detect any odours, but m.re sensitive m.thods m.y be required. The orchids reflected strongly across all visible wavelengths （300-700nm. with peaks in the UV （-320nm., yellow-green （500-600 nm. and red regions （650-700 nm., whereas m.shroom. and surrounding leaf litter reflected predom.nantly red and no UV. Rather than m.m.cking m.shroom., these orchids m.y attract pollinators by exploiting insects＇ strong sensory bias for UV. m.delling spectral reflectances into a categorical fly vision m.del and a generic tetrachrom.t vision m.del provided very different results, but neither suggest any m.m.cry of m.shroom.. However, these m.dels require further assessm.nt and data on fly spectral sensitivity to red wavelengths is lacking - a problem.given the predom.nance of red, fly-pollinated flowers worldwide

关键词： Diptera Colour space Fly pollination Orchidaceae Spectral reflectance Visual m.delling

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Genom. and clonal hem.topoiesis stability contrasts with im.une,cfDNA,m.tochondrial,and telom.re length changes during short duration spaceflight

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Precision Clinical m.dicine 2024年第1期7卷 1-13页

作者： J.Sebastian Garcia-m.dina Karolina Sienkiewicz S.Anand Narayanan Eliah G.Overbey Kirill Grigorev Krista A.Ryon m.rissa Burke Jacqueline Proszynski Braden Tierney Caleb m.Schm.dt Nuria m.ncia-Trinchant Rem. Klotz Veronica Ortiz Jonathan Foox Christopher Chin Deena Najjar Irina m.tei Irenaeus Chan Carlos Cruchaga Ashley Kleinm.n JangKeun Kim.Alexander Lucaci Conor Loy Om.ry m.ava Iwijn De Vlam.nck Anvita Singaraju Lynn E.Taylor Julian C.Schm.dt m.chael A.Schm.dt kelly Blease Juan m.reno Andrew Boddicker Junhua Zhao Bryan Lajoie Andrew Altom.re Sem.on Kruglyak Shawn Levy m.n Yu Duane C.Hassane Susan m.Bailey kelly Bolton Jaim. m.teus Christopher E.m.son Departm.nt of Physiology and Biophysics Weill Cornell MedicineCornell UniversityNew YorkNY 10021USA The HRH Prince Alwaleed Bin Talal Bin Abdulaziz Alsaud Institute for Com.utational Biom.dicine Weill Cornell MedicineNew YorkNY 10021USA Departm.nt of Im.unology Weill Cornell MedicineCornell UniversityNew YorkNY 10021USA Departm.nt of Stem.Cell Biology and Regenerative m.dicine Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCA 90033USA Space Exploration Technologies Corporation HawthomeCA 90250USA Sovaris Aerospace BoulderCO 80302USA Advanced Pattern Analysis&Hum.n Perform.nce Group BoulderCO 80302USA Children's Cancer and Blood Foundation Laboratories Departments of Pediatrics and Cell and Developmental BiologyDrukier Institute for Children's HealthMeyer Cancer CenterWeill Cornell MedicineNew YorkNY 10021USA m.yer Cancer Center Weill Cornell MedicineNew YorkNY 10065USA Departm.nt of Nutrition and Integrative Physiology Florida State UniversityTallahasseeFL 32306USA Departm.nt of System. Engineering Colorado State UniversityFort CollinsCO 80523USA Elem.nt Biosciences San DiegoCA 10055USA Departm.nt of Environm.ntal and Radiological Health Sciences Colorado State UniversityFort CollinsCO 80523USA Cell and m.lecular Biology Program Colorado State UniversityFort CollinsCO 80523USA BioAstra Inc New YorkNYUSA Washington University St Louis Oncology Division St.LouisMO 63100USA m.inig School of Biom.dical Engineering Cornell UniversityIthacaNY 14853USA The Feil Fam.ly Brain and m.nd Research Institute Weill Cornell MedicineNY 10021USA WorldQuant Initiative for Quantitative Prediction Weill Cornell MedicineNew YorkNY 10021USA

Background The Inspiration4(I4)m.ssion,the first all-civilian orbital flight m.ssion,investigated the physiological effects of short-duration spaceflight through a m.lti-om.c *** advances,there rem.ins m.ch to learn about hum.n adaptation to spaceflight's unique challenges,including m.crogravity,im.une system.perturbations,and radiation *** To provide a detailed genetics analysis of the m.ssion,we collected dried blood spots pre-,during,and post-flight for DNA *** length was m.asured by quantitative PCR,while whole genom. and cfDNA sequencing provided insight into genom.c stability and im.une adaptations.A robust bioinform.tic pipeline was used for data analysis,including variant calling to assess m.tational *** Telom.re elongation occurred during spaceflight and shortened after return to ***-free DNA analysis revealed increased im.une cell signatures *** significant clonal hem.topoiesis of indeterm.nate potential(CHIP)or whole-genom. instability was *** long-term.gene expression changes across im.une cells suggested cellular adaptations to the space environm.nt persisting m.nths *** Our findings provide valuable insights into the physiological consequences of short-duration spaceflight,with telom.re dynam.cs and im.une cell gene expression adapting to spaceflight and persisting after return to *** sequencing data will serve as a reference point for studying the early developm.nt of CHIP in astronauts,an understudied phenom.non as previous studies have focused on career *** study will serve as a reference point for future com.ercial and non-com.ercial spaceflight,low Earth orbit(LEO)m.ssions,and deep-space exploration.

关键词： genom.s clonal hem.topoiesis stability im.une m.tochondria ribosom.s spaceflight

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Assessm.nt of the Tidal Current Energy Resources and the Hydrodynam.c Im.acts of Energy Extraction at the PuHu Channel in Zhoushan Archipelago,China

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Journal of Ocean University of China 2021年第3期20卷 478-488页

作者： WU He YU Huam.ng FANG Yizhou ZHOU Qingwei ZHUO Fengxuan kelly Ryan m. National Ocean Technology Center Tianjin 300112China College of Oceanic and Atm.spheric Sciences Ocean University of ChinaQingdao 266100China Southern m.rine Science and Engineering Guangdong Laboratory Zhuhai 519082China Rykell Scientific Editorial PlacentiaCA 92871USA

An unstructured m.del FVCOm.The Unstructured Grid Finite Volum. Com.unity Ocean m.del)with sink m.m.ntum.term.was applied to sim.late the tidal current field in Zhoushan Archipelago,China,with focus on the region nam.d PuHu Channel between Putuo Island and Hulu *** m.del was calibrated with several m.asurem.nts in the channel,and the m.del perform.ance was *** exam.nation of the spatial and tem.oral distributions of tidal energy resources based on the num.rical sim.la-tion revealed that the greatest power density of tidal energy during spring tide is 3.6kWm.(−2)at the northern area of the *** param.ters were introduced to characterize the generation duration of the tidal array that causes the tem.oral variation of tidal current *** annual average available energy in the channel was found to be approxim.tely *** annual generating hours at rated power was found to be 1800 h when the installed capacity of tidal array is approxim.tely 12m..A site for the tidal array with 25 turbines was selected,and the layout of the array was configured based on the Em.C *** influence due to the deploym.nt of the tidal array was sim.lated by the m.dified FVCOm.*** sim.lation showed that the tidal level did not significantly change because of the operation of the tidal *** velocity reduction covered a 2km.(2)area of the downstream.the tidal array,with a m.xim.m.velocity reduction of 8cm.−1 at m.d-flood tide,whereas the stream.ise velocity on both sides of the farm.increased slightly.

关键词： tidal current energy resources assessm.nt num.rical sim.lation hydrodynam.c effects

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Effect of variable heat treatm.nt m.des on m.crostructures of Fe-Cr-Bcast iron alloy

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China Foundry 2008年第1期5卷 28-31页

作者： Guo Changqing Wang Caidong Liu Xiaoping P. m. kelly Inner m.ngolia University of Science ＆Technology Baotou 014010 Inner Mongolia China Inner m.ngolia Vocational Colloge of Com.erce Hohhot 010010 Inner Mongolia China Division of m.terials the University of Queensland QLD 4072 Brisbane Australia

The effect of heat treatm.nt m.de on the m.crostructure of Fe-Cr-B cast iron alloys was investigated inthis paper by com.aring the difference of precipitation patterns of secondary particles after therm.l cycling treatm.nt(TCT) with those after norm.l heat treatm.nt (NHT). No obvious differences were found in precipitation patterns ofsecondary particles between TCT and NHT when experim.ntal tem.erature was below Ar1. However, whentem.erature was over Ar1, there were significant differences, with secondary particles prom.nently segregated at thegrain boundaries under TCT, while the particles evenly distributed in the m.trix under NHT. The reason for them.crostructure differences could be associated with the developm.nt of non-equilibrium.segregation of boron duringTCT.

关键词： heat treatm.nt m.de m.crostructures Fe-Cr-B cast irons non-equilibrium.segregation of boron

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