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Effective pain management for orthopedic major joint replacement is key to achieving earlier recovery, better functioning, and high rates of patient satisfaction. In an effort to decrease opioid dependency, practitioners are turning to multimodal pain management, which involves the use of multiple analgesic agents and techniques. In order to utilize this technique, a patient’s history of and preoperative consumption of medications to treat pain impacts the success of this regimen. Multimodal pain management involves the use of NSAIDS, acetaminophen, NMDA antagonists, gabapentin, serotonin inhibitors, regional techniques and opioids as needed. It is necessary for the nurse to understand the mechanism of pain and how the multimodal adjuncts target the pain response in order to benefit the patient’s perioperative course as well as their postoperative and discharge management.

The development of psychomotor and procedural skills requires opportunities for repetitive practice combined with specific, informational feedback from the teacher, another expert, or simulator to correct performance errors. Practice enables learners to refine skills and progress through the phases of motor learning: cognitive, associative, and autonomous. Practice should be spaced over time, can occur in dyads, and can rapidly cycle between practicing and receiving feedback and coaching until skills are mastered. The purpose of this article is to examine psychomotor skill learning in nursing and to suggest strategies for nurse educators in teaching motor and procedural skills in nursing programs, as well as in clinical settings. J Contin Educ Nurs. 2016;47(6):278-282.

Secondary forest succession may restore microclimatic refugia for ectotherms and play a fundamental role in mitigating the combined effects of deforestation and climate warming on biodiversity; however, empirical evidence remains limited by short-term, coarsescale, and solely taxonomic-based approaches. We hypothesize that ant assemblage composition will respond differently to an increased frequency of extreme heat events between sites with and without microclimatic refugia provided by secondary forest's regrowth. We test this hypothesis by integrating comprehensive historic surveys (1992)(1993)(1994) and contemporary resampling (2015-2017) of ant assemblages to investigate how soil surface temperatures (estimated by microclimatic models [30 × 30 m]) and physical parameters (e.g., canopy cover) over the past >20 yr drive changes in their taxonomic, functional, and phylogenetic diversity for open (grasslands and shrublands) and closed (secondary forests) habitat types. Our results show a significant spatial turnover in the ant assemblage composition in both habitat types over the past two decades. Furthermore, for taxonomic, functional and phylogenetic spatial beta diversity, temperature became the primary variable explaining the differences in species composition among sites in open habitats, but not in closed habitats. Nevertheless, leaf litter cover may, to a certain extent, provide some thermal buffer for litter-dwelling species exposed to extreme heat. On the contrary, within forests, canopy cover mitigated the adverse impact of extreme heat on ant assemblages, with a shift toward smaller body size observed over time only in sites with lower canopy cover. These findings highlight the importance of restored canopy in providing thermal buffering for understory ectotherms. While tropical forest restoration represents an essential component in enhancing species resilience under climate warming, additionally we considered that the restoration of microclimatic regimes across different land use types is essential to conserve tropical biodiversity across the deforested landscape.

Abstract. The recent proliferation of high-quality global gridded environmental datasets has spurred a renaissance of studies in many fields, including biogeography. However, these data, often 1 km at the finest scale available, are too coarse for applications such as precise designation of conservation priority areas and regional species distribution modeling, or purposes outside of biology such as city planning and precision agriculture. Further, these global datasets likely underestimate local climate variations because they do not incorporate locally relevant variables. Here we describe a comprehensive set of 30 m resolution rasters for Hong Kong, a small tropical territory with highly variable terrain where intense anthropogenic disturbance meets a robust protected area system. The data include topographic variables, a Normalized Difference Vegetation Index raster, and interpolated climate variables based on weather station observations. We present validation statistics that convey each climate variable's reliability and compare our results to a widely used global dataset, finding that our models consistently reflect greater climatic variation. To our knowledge, this is the first set of published environmental rasters specific to Hong Kong. We hope this diverse suite of geographic data will facilitate future environmental and ecological studies in this region of the world, where a spatial understanding of rapid urbanization, introduced species pressure, and conservation efforts is critical. The dataset (Morgan and Guénard, 2018) is accessible at https://doi.org/10.6084/m9.figshare.6791276.

Species delimitation can be difficult when the divergence between focal taxa is in the incipient stage of speciation, because conflicting results are expected among different data sets, and the species limits can differ depending on the species concept applied. We studied speciation history and investigated the impact on taxonomic decision-making when using different types of data in a Taiwanese endemic sister-species pair of stag beetles, Lucanus miwai and Lucanus yulaoensis, from sky island habitats. We showed that the two geographical taxa can be diagnosed by male mandibular shape. We found two mitochondrial co1 lineages with pairwise sequence divergence > 3%; however, L. miwai might not be monophyletic. The result of our multispecies coalescent-based species delimitation using five nuclear loci supported the evolutionary independence of the two sister species, but the calculated values of the genealogical divergence index (gdi) corresponded to the ambiguous zone of species delimitation. We also showed that post-divergence gene flow is unlikely. Our study demonstrates challenges in the delineation of incipient species, but shows the importance of understanding the speciation history and adopting integrative approaches to reconcile seemingly conflicting results before making evolutionarily relevant taxonomic decisions.

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