CHAPTER ONE Augustine the Philosopher There are, according to Augustine in the early work entitled soliloquia, two principal (indeed, strictly speaking, ...

Objectives: Neuroplastic changes that drive recovery of shoulder/elbow function after stroke have been poorly understood. The purpose of this study was to determine the relationship between neuroplastic brain changes related to shoulder/elbow movement control in response to treatment and recovery of arm motor function in chronic stroke survivors.Methods: Twenty-three chronic stroke survivors were treated with 12 weeks of arm rehabilitation. Outcome measures included functional Magnetic Resonance Imaging (fMRI) for the shoulder/elbow components of reach and a skilled motor function test (Arm (...) Motor Abilities Test, AMAT), collected before and after treatment.Results: We observed two patterns of neuroplastic changes that were associated with gains in motor function: decreased or increased task-related brain activation. Those with significantly better motor function at baseline exhibited a decrease in brain activation in response to treatment, evident in the ipsilesional primary motor and contralesional supplementary motor regions; in contrast, those with greater baseline motor impairment, exhibited increased brain activation in response to treatment. There was a linear relationship between greater functional gain (AMAT) and increased activation in bilateral primary motor, contralesional primary and secondary sensory regions, and contralesional lateral premotor area, after adjusting for baseline AMAT, age, and time since stroke.Conclusions: Recovery of functional reach involves recruitment of several contralesional and bilateral primary motor regions. In response to intensive therapy, the direction of functional brain change (i.e., increase or decrease in task-related brain recruitment) for shoulder/elbow reach components depends on baseline level of motor function and may represent either different phases of recovery or different patterns of neuroplasticity that drive functional recovery. (shrink)

Genomic research results and incidental findings with health implications for a research participant are of potential interest not only to the participant, but also to the participant's family. Yet investigators lack guidance on return of results to relatives, including after the participant's death. In this paper, a national working group offers consensus analysis and recommendations, including an ethical framework to guide investigators in managing this challenging issue, before and after the participant's death.

Background Professional values are important in promoting healthy work environments, patient satisfaction, and quality of care. Magnet® hospitals are recognized for excellence in nursing care and as such, understanding the relationship between nurses' values and Magnet status is essential as healthcare organizations seek to improve patient outcomes. Research question/aim/objectives The research question is: are there differences in individual values, professional values, and nursing care quality for nurses and nurse managers practicing in Magnet, Magnet journey, and non-Magnet direct patient care settings? (...) Research Design This descriptive cross-sectional study is guided and informed by the conceptual framework of the Professional Values Model including individual values, professional values, and nursing care quality. Participants and research context Convenience sampling of registered nurses and nurse managers, responsible for direct patient care, was utilized in a non-profit healthcare system in the Midwest region of the United States. Ethical Considerations Institutional review board approval was obtained. Participants were informed about the right to self-determine participation and assurance of anonymity. Findings 827 (n = 827) nurses and nurse managers responded to the survey. Significant differences were identified in individual values sub-scale: self-enhancement ( p = 0.38), professional values ( p = 0.037), practice environment: participation in hospital affairs ( p = 0.00), foundations for quality care ( p = 0.016), and resources adequacy ( p = 0.012) and in nurse sensitive HCAHPS questions: nurses explained things understandably ( p = 0.00), got help as soon as wanted ( p = 0.00), and treated with courtesy and respect ( p = 0.00). Discussion/Conclusions Findings indicate that fostering individual and professional values may impact nursing practice, regardless of Magnet designation. Promoting professional values may contribute to improved work environments, enhancing patient satisfaction. Study results offer valuable insights for organizations striving to enhance nursing values, impacting quality of care provided to patients. MeSH Terms Cross-Sectional Studies, Respect, Ethics Committees, Patient Satisfaction, Nurse Administrators, and Personal Satisfaction. (shrink)