Curriculum Vitae Yeur-Hur Lai, RN, Ph.D.

Curriculum Vitae Yeur-Hur Lai, RN, Ph.D. CURRENT POSITION Professor School of Nursing, College of Medicine, National University (NTU) President Sigma Theta Tau International, Honor Society of Nursing, Lamda Beta AT-Large Chapter, ADDRESS: School of Nursing College of Medicine National University 1 Jen-Ai Road, Taipei 100, Phone: 886-2-3393-6515 Fax : 886-2-23393-1027 Email: yhlai@ha.mc.ntu.edu.tw CITIZEN: ONS MEMBERSHIP: # 23268 (1987 present) PROFESSIONAL EDUCATION Short-Term Post- 2000 Doctoral Training Duke University Medical Center Durham Ph.D.,Nursing 1996 University of North Carolina at Chapel Hill (UNC-CH) MSN, Nursing 1988 University of Pennsylvania, Oncology Nursing Specialty Chapel Hill Philadelphia BSN, Nursing 1984 National University Taipei 1

PROFESSIONAL EXPERIENCE 3/2005 - present 8/ 2005 - present 8/ 2005-12/ 2006 1/2005- present 9/2004 present 4/2003 present 1/2002 present 4/2003 - present 12/2002- present 4/2003 present 1/2002 present 7/2001 8/2002 1/2001 present 1/2001- present 8/1998 7/2001 6/1998-1/2002 Committee member, Pain Curriculum Committee (Nursing), International Association for the Study of Pain (IASP) Member, Pain Education Initiate, IASP sponsored Forum Committee member, Cancer Policy Committee, Department of Health (DOH), Bureau of Executive Yuan President, Sigma Theta Tau International, Honor Society of Nursing, Lamda Beta Chapter-AT-Large, Grant Reviewer, Bureau of Health Promotion, Department of Cancer Prevention and Treatment Professor President, Oncology Nursing Society in Chair, Pain Assessment Committee, Chinese Association for the Study of Pain (CASP), Committee member, Cancer Pain and Symptom Management Committee, Cooperative Oncology Group, National Health Research Institute (NHRI), Reviewer, Oncology Nursing Forum Reviewer, Pain journal Acting Dean, College of Nursing, Taipei Medical University Board member, Sigma Theta Tau, Reviewer, Journal of Oncology Nursing of Associate professor and Chair, Graduate Institute of Nursing, Taipei Medical University Chair, Continuing Education Committee Oncology Nursing Society of In charge the nation wide cancer nursing training in Associate Chair, Oncology Nursing Committee The Nurses Association of, the Republic of China Committee member, Nursing Research Committee 2

The Nurses Association of, Republic of China Associate Editor, New Taipei Journal of Nursing 6/1998 6/2000 Program Coordinator, National Cancer Nursing Training Program in, Department of Health Promotion and Disease Prevention, The Executive Yuan, The Republic of China 1/1998 present Consultant, Nursing Research Section, Cancer Clinical Trial in the National Health Research Institute (NHRI) 6/1998 present Consultant of the Children Cancer Foundation in the Republic of China () 1/1997 present Grant Reviewer, Nursing Research Section, National Science Council (NSC) of, the Republic of China 8/1996 7/1998 Associate Professor, Graduate Institute of Nursing Chair, Continuing Education Committee Oncology Nursing Society in 9/1992-6/1996 Ph.D. student and research assistant in University of North Carolina at Chapel Hill, Focusing on cancer pain study 8/1990-7/1992 Program Coordinator, National Cancer Nursing Training Program in, Department of Health Promotion and Disease Prevention, The Executive Yuan, The Republic of China 8/1990-8/1992 Head nurse in Medical Oncology ward at National University Hospital 8/1988-7/1990 Oncology Clinical Nurse Specialist National University Hospital 8/1987-8/1988 Studying in oncology master program in U. Pennsylvania 7/1984-4/1987 Staff nurse in medical oncology ward and chemotherapy outpatient clinic at the Chung-Gung Memorial Hospital MEMBERSHIP IN PROFESSIONAL ORGANIZATION Nurses' Association of the Republic of China () National University Alumni Association Oncology Nursing Society (ONS) (USA) Oncology Nursing Society in (ONST) Cancer Medical Association in the Republic of China 1984-present 1984-present 1987-present 1996-present 1996-present 3

International Association for Study of Pain (IASP) The American Society of Psychosocial and Behavioral Oncology/AIDS (ASPBOA) American Pain Society (APS) Lung Cancer Association in the Republic of China () American Society of Pain Management Nurses Multinational Association of Supportive Cancer in Care 1996-present 1998-present 1999-present 2000-present 2002-present 2004-present RESEARCH AND WORKING PROJECTS (Principal Investigator in recent 5 years) 2005-2008 Comparison of the Effects of Pain Education and Caregiver-Assisted Pain Intervention on Patients and Primary Caregivers Cancer Pain Management Experiences A Randomized Controlled Clinical Trial (NSC94-2314-B-002-314, NSC95-2314-B-002-068, NSC96-2314-B-002-024) 2005 National Oncology Nursing Training Program: Training for the Seed Nurses for Cancer Pain, Chemotherapy and Cancer Care Leaders 2003-2005 Symptom Severity, Hope and Quality of Life in Oral Cancer Patients An One Year Longitudinal Approach (NSC-92) 2003-2006 The National Tobacco Control and Smoking Cessation Nursing Program in : Development of Guideline, Training Courses, Personnel Training, and Integration of Nursing Curriculum (Bureau of Health Promotion, BHP-92-Anti-Tobacco-2J03). 2003-2004 Nutrition Status and Contents of Intakes in Hospitalized Cancer Patients: Current Status Analysis, Correlated Factors (Department of Health,, DOH92-TD-1096). 2002-2005 Comparison of the Effects of Psychological and Physical Non-Invasive Interventions on Cancer Pain (National Science Council, NSC 91-2314-B-038-040) 2000-2002 Improving Breast Cancer Patients' Quality of Life Interventions for coping with first three months problems (National Science Council, NSC-90; Co-Investigator) 1999-2002 Improving Cancer Pain Management through Different Cognitive-Behavioral Interventions Instruments Validation and 4

Effects Comparison. (NSC-89-2320-B-038-028, Principal Investigator) 1998-1999 The discrepancies between patients and nurses ratings of pain and its related factors. (NSC-88-2314-B-038-107, Principal Investigator) 1997-1998 The use of pharmacological pain coping, related pain treatment beliefs, and perceived difficulties of pain management in ese cancer patients Patient and family s perspective. (NSC-87-2314-B-038-019, Principal Investigator) 1997 The development and test of the Brief Pain Coping Inventory for cancer patients with pain (NSC-86-2314- B-038-048, Principal Investigator) RESEARCH AND WORKING PROJECTS (Co-Investigator in recent 5 years) 2004-2005 The Role of Cytokines in Cancer Radiotherapy Related Fatigue: Experience in Hepatoma Patients Undergoing Treatment (NSC-93) 2002-2003 The effects of stretching exercise in the liver cancer patients receiving radiotherapy (NSC-92) 2001-2002 The effects of relaxation on patients receiving radiation therapy (NMSC 91) 2001-2002 Effect of Self- Care program on breast cancer patients in first three month after diagnosis (NSC 90) PUBLICATIONS 1. Chen SC, Lai YH, Liao CT, Lin CC, Chang JT. (2010). Changes of symptoms and depression in oral cavity cancer patients receiving radition therapy. Oral Oncol, Mar 20. [Epub ahed of print] (SCI) 2. Shun SC, Lai YH, Hsiao FH. (2009). Patient-related barriers to fatigue comunication in cancer patients receiving active treatment. Oncologist,.Sep; 14(9):936-43. Epub 2009 Sep 8. (SCI) 3. Chen SC, Lai YH, Liao CT, Chang JT, Lin CC. (2009). Unmet information needs and preferences in newly dignosed and surgically treated oral cavity cancer patients. Oral Oncol,Nov;45(11):946-52. Epu 2009 Jul 23. (SCI) 4. Chen SC, Laio CT,Lin CC, Chang JT, Lai YH. (2009). Distress and care needs in newly diagnosed oral cavity cancer patients receiving surgery. Oral Oncol,Sep;45(9):815-20. 5

Epub 2009 Feb 27. (SCI) 5. Lai YH, Guo SL, Keefe FJ, Tsai LY, Shun SC, Liao YC, Li IF, Liu CP, Lee YH. (2009). Multidimensional Pain Inventory-Screening Chinese version (MPI-sC) :psychometric tesing in terminal cancer patients in Taiwna. Support Care Cance, Dec;17(12) :1445-53. Epub 2009 Feb 26. (SCI) 6. Lally RM, Chalmers KI, Johnson J, Kojima M, Endo E, Suzuki S, Lai YH, Yang YH, Degner L, Anderson E, Molassiotis A. (2008). Smoking behavior nd patient deucation practices of oncology nurses in six contries. Eur J Oncol Nurs, Sep;12(4) :372-9. Epub 2008 Jun 11. (SCI) 7. Lee YH, Tsai YF, Lai YH, Tsai CM. (2008). Fatigue experience and coping strategies in ese lung cancer patients receiving chemotherapy. J Clin Nurs, Apr ;17(7) :876-83. (SCI) 8. Chang PH, Lai YH, Shun SC, Lin LY, Chen ML, Uang Y, Tsai JC, Huang GS, Cheng SY. (2008). Effects of a walking intervention on fatigue-related experiences of hospitalized acute myelogenous leukemia patients undergoing chemotherapy :a randomized controlled trial. J Pain Symptom Manage, May;35(5):524-34. Epub 2008 Feb 15. (SCI) 9. Shun SC, Chiou JF, Lai YH, Yu PJ, Wei LL, Tsai JT, Kao CY, Hsiao YL. (2008). Changes in quality of life and its related factors in liver cancer patients receiving stereotactic radiation therapy. Support Care ancer, Sep;16(9) :1059-65.Epub 2008 Jan 16. (SCI) 10. Lai YH, Shun SC, Shaio YL, Chiu CF, et al. (2007). Fatigue Experiences in Hepatocellular Carcinoma Patients during Six Weeks of Stereotactic Radiotherapy. Oncologist, 12: 221-30. (SCI) 11. Chien CC, Fu WM, Huang HI, Lai YH, Tsai YF, Go SL, Wu TJ, Ling D. (2007) Expression of Neurotrophic Factors in Neonatal Rates after Peripheral Inflammation. J Pain, 8: 161-7. (SCI) 12. Tsai LY, Lee YF, Lai YH, Liu GP, Chang SY, Chang SY, Tu GD (2007). Fatigue and Its Associated Factors in Hospice Cancer Patients in. Cancer Nurs, 30, 24-30. (SCI)(Corresponding) 13. Lee YH, Tsai YF, Lai YH, Tsai CM. (Accepted) Fatigue experience and coping strategies in ese lung cancer patients receiving. Journal of Clinical Nursing (SCI) 14. Chen SC, Lai YH, Liao CT, Lin CC. (2005). Psychometric testing of the Impact of Event Scale Chinese Version (IES-C) in oral cancer patients in. Support Care Cancer, 13, 485-492. (SCI) 15. Shun SC, Lai YH, Jing TT, et al. (2005) Fatigue Patterns and Correlates in Male Liver Cancer Patients Receiving Transcatheter Hepatic Arterial Chemoembolization. Support Care Cancer, 13, 311-317 (SCI) (corresponding ) 6

16. Tsai YF, Tsai HH, Lai YH, Chu TL (2005). Pain Prevalence, experiences and management strategies among the elderly in ese nursing homes. J Pain Symptom Manage (SCI) 17. 18. 19. Lai, Y-H., Guo, S-L., Keefe FJ., Tsai, S-L., Chien C-C., Song, Y-S., Chen, M-L. (2004). Effects of brief pain education on hospitalized cancer patients with moderate to severe pain. Support Care Cancer, 12. 2004 May Epub. (SCI) Lai, Y-H., Chen, M-L, Tsai, L-Y. et al. (2003). Are nurses prepared to manage cancer pain? A national survey of nurses knowledge about pain control in. J pain Symptom Manage. 26, 1016-1025. (SCI) Lai, Y-H. Dalton, JA. Belyea, M. et al. (2003). Development and testing of the Pain Opioid Analgesics Beliefs Scale Cancer in ese cancer patients. Journal of Pain and Symptom Management. 25, 376-385. (SCI) 20. Lin, C-C., Tsai H-F., Chiou, J-F., Lai, YH. Kao, C-C., Tsou, T-S. (2003). Changes in levels of hope after diagnostic disclosure among ese patients with cancer. Cancer Nursing. 26, 155-160. (SCI) 21. Hsiao, YL., Lai, Y-H., Chiou, J-F., Tsai, J-T., Yeh, C-H., Chung, T-S., Kao, C-Y., & Lin, M-L. (2003). Evaluation of the changes of fatigue and hematology index level in hepatocellular cancer patients receiving stereotactic radiation therapy. Therapeutic Radiology and Oncology, 10, 197-208. 22. Lee, Y-S., Tsai, Y-F., Lai, Y-H., Kao, R-H. (2002). Fatigue levels and related factors in lung cancer patients during chemotherapy. Formosan Journal of Medicine. 6, 797-804. 23. Lai, Y-H., Keefe, F., Sun, W-J., Tsai, L-Y., Chen, P-L., Chiou, C-F., Wei, L-L. (2002). The relationship of pain-specific beliefs to adherence of analgesic regimens in ese cancer patients A preliminary study. Journal of Pain and Symptom Management. 24, 425-423. (SCI) 24. Cheng, S-Y., Lai, Y-H., Chang, L-J., Wu, C-I., Chen, P-L. (2002). Determine of the association of symptom distress, self-efficacy, social-support and quality of life among breast cancer patients. New Taipei Journal of Nursing. 4(1), 9-21. 25. Huang, T. W., Lai, Y. H., She, L. G., Cheng, A. L., & Shung, C. Y. (2001). The effects of massage on decreasing fatigue in head and neck patients receiving chemotherapy. Formosan Journal of Medicine. 5, 369-378. 26. Shung, C. Y., Lai, Y. H., Chen, M. L., Wu, G. S., & Huang, T. W. (2001). The effects of systematic health teaching on decreasing symptom distress in breast cancer patients receiving mastectomy. New Taipei Journal of Nursing. 3(1), 91-102. 27. Shu, L. L., Lai, Y. H., Cheng, S. H. & Chang, Y. P. (2001). Nurses knowledge about cancer pain management A survey in Southern area. Chung Gung Nursing Journal. 12(3), 200-207. 7

28. Lai, Y. H. (2000). Beliefs about cancer pain and opioid analgesics: Scale development and current status. Journal of Nursing Research, 8(5), 557-567. 29. Wei, L. L., Tang, C. Y., Yu, H. H., & Lai, Y. H. (2000). Comparison of the needs in hospitalized elderly patients and nurses perceptions. New Taipei Journal of Nursing, 2(2), 83-95. 30. Lai, Y. H., Cheng, S. Y., Chang, L. Y., & Wei, L. L. (2000). Beliefs about and knowledge of cancer pain and narcotic analgesics and related factors in undergraduate student nurses. New Taipei Journal of Nursing, 2(2): 5-15. 31. Chen, S.H., Lai, Y. H., Lin, C. C., & Chen, H. C. (2000). The acute post-traumatic responses in hospitalized hand Injury patients-scale development and current status. Chung Gung Nursing, 10 (4), 31-39. 32. Cheng, S. Y., Young, L. L., Cheng, P. L., & Lai, Y. H. (2000). Implementation of arm exercise in post-mastectomy breast cancer patients: Current status and related factors. Journal of Nursing, 47(1), 33-42. 33. Tsai, S. W., Lai, Y. H., Chen, M. L., & Chen,, S. S. (2000). The relationship of physio-sensory characteristics of cancer pain and disease uncertainty. Journal of Nursing Research, 8(1), 59-70. 34. Chen, S. H., & Lai, Y. H. (2000). Introduction of Pender's Health Promotion Model Theory. Chung-Gung Nursing, 10 (4), 55-61. 35. Chen, P. Y., See, L. C., Wang, C. H., Lai, Y. H., Chang, H. K. & Chen, M. L. (1999). The Impact of pain on the anxiety and depression of cancer patients. Formosan Journal of Medicine, 3(4), 373-382. 36. Lai, Y. H. (1998). Symptom distress and home care needs in patients receiving chemotherapy in an outpatient setting. Journal of Nursing Research, 6(4), 279-289. 37. Tsai, L. F., Lin, C. C., Lai, Y. H., & Tsou, S. S. (1998). The relationship of the caregiver s concerns about using analgesics to the patient s cancer pain management. Journal of Nursing Research, 6(4), 327-336. 38. Cheng, A. L., Lai, Y. H., & Yu, Y. C. (1998). Research nurses for clinical trials of anti-cancer drugs: Developing a new subspecialty in. Drug Information Journal, 32 (suppl), 1279S-1218S. 39. Lai, Y. H. (1996). The use of cognitive-behavioral pain coping in ese cancer patients with pain. Unpublished doctoral dissertation, University of North Carolina at Chapel Hill. SELECTED RESEARCH PAPER PRESENTATIONS IN CONFERENCES 1996 Dec. The use of cognitive-behavioral pain coping Taipei 8

in ese cancer patients (paper presented in the Annual meeting of the Oncology Nursing Society in ) 1997 March Pain beliefs in cancer patients in (Paper presented in the Cancer Pain Management Symposium sponsored by the Oncology Nursing Society in ) Taipei 1997 April Cancer patients' pain beliefs and their relationship to patients' use of analgesics (poster presented in the Annual Meeting of the Cancer Medical Association in 1998 May The use of cognitive-behavioral pain coping in ese cancer patients (poster presented in the 1 st International Conference on Research in palliative Care: Methodologies and Outcome) 1999 Feb Relationship of pain-specific beliefs to adherence with analgesic regimens in ese Cancer patients (paper presented at 5 th National Conference on Cancer Nursing Research) Taipei Bethesda USA Newport Beach USA 1999 Aug The relationship between characteristics of cancer pain Vienna and psychological distress in ese cancer patients Austria (poster presented in the 9 th World Congress on Pain) 2000 Jan Development and validation of the Pain and Narcotic Analgesics Beliefs Scale Cancer Version (paper presented in the 8 th Annual Research Meeting of the Oncology Nursing Society in the Republic of China) 2000 Aug Patients beliefs about cancer pain and Narcotic use Scale development and Current status (paper presented at 11 th International Conference On Cancer Care Nursing) Taipei Oslo Norway 2002 Aug. Effects of pain education and relaxation on controlling San Diego cancer-related pain in Preliminary results. USA Poster presented in the 11 th International Association of Study for Pain (IASP). 2003 Feb. The development and testing of the Pain Opioid Analgesic Belief Scale. Paper presented in First International Japanese cancer Nursing Conference. Osaka, Japan 9

2004 March Management of Cancer related Pain and Fatigue (Invited Presentation in the Annual Conference of Society of Blood and Marrow Transplantation of ROC) 2004 April Cancer Pain Management: Cognitive-Behavioral Approach (Invited Presentation in Chinese Association For Study of Pain Annual Conference) Taipei Taichung 2004 May Post-Operative Pain and Coping in Patients Receiving Lung Surgery (Paper presented in the 2nd Joint Conference of American Pain Society and Canadian Pain Society) 2004 June Truth Telling about Cancer Diagnosis and Prognosis in the Transition during the current 2 decades (Invited Presentation in the Multinational Association of Supportive Care in Cancer, MASCC annual congress) 2004 Sept Reconstructing pain inside the brain (moderator), ese Anesthesiology Association Annual Academia Conference Vancouver Canada Miami USA Tau-Yuan 2004 Dec Striving for Oncology Nurses Stress Management in Oncology Nursing Taichung 2005 March The Sleeping Problems on Cancer Patients ( Invited Presentation in the Sleeping Symposium sponsored by the Nursing Collage at Taipei Medical University) Taipei 2005 May The Nutrition Problems on Cancer Patients (Invited Presentation in the 31 st Annual Conference of Chinese Nutrition Association) Taipei 2005 May Tobacco Control in. Invited presentation in the 23 rd Quadrennial Congress, International Council of Nurses (ICN). Taipei 2005 July (1). Pain and Symptom Profile in Patients with Oral Cavity Cancer After Surgery, (2). Nutrition Status and Related Factors in Hospitalized Cancer Patients in. (Paper presented in the 17 th International Symposium of Multinational Association for the Support Care in Cancer, MASCC) Geneva Switzerland 10

2005 Aug Effects of Pain Education, Relaxation and Cognitive Restructuring on Cancer Pain. (Paper presented in the11 th World Congress on Pain, International Association for the Study of Pain, IASP) Sydney Australia MAJOR CONTINUITING EDUCATION PROGRAMS AND CONFERENCES INCHARGED 1988 1990 1990 1992 Oncology Nursing Training Program (6 weeks program, held once a year ) National Oncology Nursing Training Program (2 months intensive training lectures and clinical training with 10 months follow up program, once a year). National University Hospital Department of Health Promotion and Disease Prevention, The Executive Yuan,, The Republic of China 1997 Cancer Pain Management Workshop Oncology Nursing Society in 1997 Terry Fox International Nursing Conference in Cervical Cancer Chung-Gung Memorial Hospital and Terry Fox Foundation 1998 Cancer Symptom Management Workshop (two days program, with guest speakers, Dr. Jo Ann Dalton and Dr. Sandra Ward) 1998 Terry Fox International Nursing Conference in Breast Cancer Graduate Institute of Nursing, Taipei Medical College Chung-Gung Memorial Hospital and Terry Fox Foundation 1998 Trends and Advanced Treatments in Oncology Oncology Nursing Society in 1999 Cancer Patients Quality of Life (two-day workshop, invited Dr. Betty Ferrell as international speaker) Graduate Institute of Nursing, Taipei Medical College 1999 Terry Fox International Nursing Conference in Brain Tumor 1999 The Role and Function of Nurses in Cancer Clinical Trial (one-day workshop held in the first day in Annual meeting of Cooperative Chung-Gung Memorial Hospital and Terry Fox Foundation Sponsored by Cooperative Oncology Group (TCOG) and 11

Oncology Group, invited Miss Jennifer Aikin, to give talks about cancer clinical trials) 1999 Nursing Care of Elderly Cancer Patients (one day workshop) National Health Research Institute (NHRI) Oncology Nursing Society in 2000 Oncology Nursing Research (one-day workshop) Oncology Nursing Society in 2000 Terry Fox International Nursing Conference in GI Cancer 2000 Continuity of Cancer Care --- From Hospital to Home 2001 Symptom Management in Cancer Care (one-day workshop) Chung-Gung Memorial Hospital and Terry Fox Foundation Oncology Nursing Society in Oncology Nursing Society in 2001 Side Effects and Symptoms Management in Cancer (two-day workshop) 2001 Terry Fox International Nursing Conference in Head and Neck Cancer (will invite Dr. Judith Paice to give talks about pain management) Oncology Nursing Society in Chung-Gung Memorial Hospital and Terry Fox Foundation 2002 Coping with Chronic Illness Cancer and Stroke Dr. Judith Johnson Wu-Fan General Hospital & Oncology Nursing Society in 1998-2001 Held 4-week Basic Oncology Nursing Training Program, and 4-week Advanced Oncology Nursing Training Program at least once a year Oncology Nursing Society in MAJOR AREAS OF SPEECH 1. Cancer Pain Assessment 2. Cancer Pain Management 3. Post-operative Pain Assessment and Management 4. Non-pharmacological Intervention for Pain 5. Symptom Management in Cancer Care 6. Cancer Related Fatigue Management 7. Oncology Emergencies 8. Psychological Care 12

9. Communication with Cancer Patients 10. Coping with Cancer 11. Cancer Nursing Research AWARD AND HONOR 1983 Best Academic Performance Award (in Junior undergraduate program 1984 Best Academic Performance Award (in Senior undergraduate program) 1984 Distinguish Clinical Practice Performance Award (in graduation) 1985 Best Staff Nurse Award 1992 Nursing Leadership Award from The America Bureau of Medical Advanced Council (ABMAC) National University National University National University Memorial Chung-Gung Hospital ABMAC 1994 Cancer Education Award NCI (through a major project in UNC-CH) 1994 Mary P. Speight Scholarship UNC-CH 1994 Outstanding Academic Performance of Graduate Study 1995 Linda Waring Matthews Cancer Research Award UNC-CH UNC-CH 1997 Distinguish Research Award National Science Council 1999 2000 Distinguish Teacher Award Distinguish Teacher Award Taipei Medical U. Taipei Medical U. 2000 Distinguish Nursing Leader Award Taipei Nurses Association 2001 Nursing Research Award in Adult Health Care Nurses Association 13

2001 Distinguish Research Award National Science Council () 2002 ONS International Award for Contribution to Cancer Care Oncology Nursing Society (USA) 2004 Distinguished Nurses Award National Leagues of Nursing in 14