Shift Change: Minimizing the COVID-19 Nursing Shortage and Decreasing Nursing Burnout

Burnout and the nursing shortage of the healthcare system is not a new issue for nurses, but the COVID-19 pandemic caused this problem to only get worse (Young, 2021). Most healthcare facilities are severely understaffed. The nursing shortage and symptoms of burnout among nurses working in the Intensive Care Units (ICU) and other high-demand COVID-19 nursing units have been magnified by the COVID-19 pandemic. Inferior working conditions such as increased work times, increased workload, and decreased training in the care of COVID-19 patients magnified nursing burnout and the ongoing nursing shortage (Galanis et al., 2021). Discovering ways to reduce the stress and burnout of the nurses working the frontlines of the pandemic is critical to promoting positive mental health of nurses. Some studies have shown there is a correlation between nursing satisfaction and the shift hours worked. Adverse effects such as stress and burnout of nurses, decreased patient outcomes, and lower patient satisfaction reports are associated with nurses working longer hours (Hoedl et al., 2021). The 2023 National Council of State Boards of Nursing (NCSBN) reported that approximately 100,000 Registered Nurses (RNs) left the workforce because of burnout, stress, or retirement during the COVID-19 pandemic. A change is needed to address the ongoing nursing shortage. A prudent, manageable, and cost-efficient way to help reduce nursing burnout is by decreasing the nursing shifts from twelve-hour to eight-hour shifts on high-stress and high- demand nursing units. The PICOT question that will be used for the evidence-based change is the following: In ICU nurses taking care of COVID-19 patients (P), how do eight-hour shifts (I) compared to twelve-hour shifts (C) affect nursing burnout (O) within eight weeks (T)

Distinguishing the cold conveyor belt and sting jet air streams in an intense extratropical cyclone

Strong winds equatorwards and rearwards of a cyclone core have often been associated with two phenomena, the cold conveyor belt (CCB) jet and sting jets. Here, detailed observations of the mesoscale structure in this region of an intense cyclone are analysed. The {\it in-situ} and dropsonde observations were obtained during two research flights through the cyclone during the DIAMET (DIAbatic influences on Mesoscale structures in ExTratropical storms) field campaign. A numerical weather prediction model is used to link the strong wind regions with three types of ``air streams'', or coherent ensembles of trajectories: two types are identified with the CCB, hooking around the cyclone center, while the third is identified with a sting jet, descending from the cloud head to the west of the cyclone. Chemical tracer observations show for the first time that the CCB and sting jet air streams are distinct air masses even when the associated low-level wind maxima are not spatially distinct. In the model, the CCB experiences slow latent heating through weak resolved ascent and convection, while the sting jet experiences weak cooling associated with microphysics during its subsaturated descent. Diagnosis of mesoscale instabilities in the model shows that the CCB passes through largely stable regions, while the sting jet spends relatively long periods in locations characterized by conditional symmetric instability (CSI). The relation of CSI to the observed mesoscale structure of the bent-back front and its possible role in the cloud banding is discussed

Flexible Models for Solar Sail Control

Solar sails employ a unique form of propulsion, gaining momentum from incident and reflected photons. However, the momentum transferred by an individual photon is extremely small. Consequently, a solar sail must have an extremely large surface area and also be extremely light. The flexibility of the sail then must be considered when designing or evaluating control laws. In this paper, solar sail flexibility and its influence on control effectiveness is considered using idealized two-dimensional models to represent physical phenomena rather than a specific design. Differential equations of motion are derived for a distributed parameter model of a flexible solar sail idealized as a rotating central hub with two opposing flexible booms. This idealization is appropriate for solar sail designs in which the vibrational modes of the sail and supporting booms move together allowing the sail mass to be distributed along the booms in the idealized model. A reduced analytical model of the flexible response is considered. Linear feedback torque control is applied at the central hub. Two translational disturbances and a torque disturbance also act at the central hub representing the equivalent effect of deflecting sail shape about a reference line. Transient simulations explore different control designs and their effectiveness for controlling orientation, for reducing flexible motion and for disturbance rejection. A second model also is developed as a two-dimensional "pathfinder" model to calculate the effect of solar sail shape on the resultant thrust, in-plane force and torque at the hub. The analysis is then extended to larger models using the finite element method. The finite element modeling approach is verified by comparing results from a two-dimensional finite element model with those from the analytical model. The utility of the finite element modeling approach for this application is then illustrated through examples based on a full finite element model

Time Course of Dichoptic Masking in Normals and Suppression in Amblyopes

Purpose: To better understand the relationship between dichoptic masking in normal vision and suppression in amblyopia we address three questions: First, what is the time course of dichoptic masking in normals and amblyopes? Second, is interocular suppression low-pass or band-pass in its spatial dependence? And third, in the above two regards, is dichoptic masking in normals different from amblyopic suppression? Methods: We measured the dependence of dichoptic masking in normal controls and amblyopes on the temporal duration of presentation under three conditions; monocular (the nontested eye—i.e., dominant eye of normals or nonamblyopic eye of amblyopes, being patched), dichoptic-luminance (the nontested eye seeing a mean luminance—i.e., a DC component) and dichoptic-contrast (the nontested eye seeing high-contrast visual noise). The subject had to detect a letter in the other eye, the contrast of which was varied. Results: We found that threshold elevation relative to the patched condition occurred in both normals and amblyopes when the nontested eye saw either 1/f or band-pass filtered noise, but not just mean luminance (i.e., there was no masking from the DC component that corresponds to a channel responsive to a spatial frequency of 0 cyc/deg); longer presentation of the target (corresponding to lower temporal frequencies) produced greater threshold elevation. Conclusions: Dichoptic masking exhibits similar properties in both subject groups, being low-pass temporally and band-pass spatially, so that masking was greatest at the longest presentation durations and was not greatly affected by mean luminance in the nontested eye

Analysis of and workarounds for element reversal for a finite element-based algorithm for warping triangular and tetrahedral meshes

We consider an algorithm called FEMWARP for warping triangular and tetrahedral finite element meshes that computes the warping using the finite element method itself. The algorithm takes as input a two- or three-dimensional domain defined by a boundary mesh (segments in one dimension or triangles in two dimensions) that has a volume mesh (triangles in two dimensions or tetrahedra in three dimensions) in its interior. It also takes as input a prescribed movement of the boundary mesh. It computes as output updated positions of the vertices of the volume mesh. The first step of the algorithm is to determine from the initial mesh a set of local weights for each interior vertex that describes each interior vertex in terms of the positions of its neighbors. These weights are computed using a finite element stiffness matrix. After a boundary transformation is applied, a linear system of equations based upon the weights is solved to determine the final positions of the interior vertices. The FEMWARP algorithm has been considered in the previous literature (e.g., in a 2001 paper by Baker). FEMWARP has been succesful in computing deformed meshes for certain applications. However, sometimes FEMWARP reverses elements; this is our main concern in this paper. We analyze the causes for this undesirable behavior and propose several techniques to make the method more robust against reversals. The most successful of the proposed methods includes combining FEMWARP with an optimization-based untangler.Comment: Revision of earlier version of paper. Submitted for publication in BIT Numerical Mathematics on 27 April 2010. Accepted for publication on 7 September 2010. Published online on 9 October 2010. The final publication is available at http://www.springerlink.co

The Atacama Cosmology Telescope: The LABOCA/ACT Survey of Clusters at All Redshifts

We present a multi-wavelength analysis of eleven Sunyaev Zel'dovich effect (SZE)-selected galaxy clusters (ten with new data) from the Atacama Cosmology Telescope (ACT) southern survey. We have obtained new imaging from the Large APEX Bolometer Camera (345GHz; LABOCA) on the Atacama Pathfinder EXperiment (APEX) telescope, the Australia Telescope Compact Array (2.1GHz; ATCA), and the Spectral and Photometric Imaging Receiver (250, 350, and $500\,\rm\mu m$; SPIRE) on the Herschel Space Observatory. Spatially-resolved 345GHz SZE increments with integrated S/N > 5 are found in six clusters. We compute 2.1GHz number counts as a function of cluster-centric radius and find significant enhancements in the counts of bright sources at projected radii $\theta < \theta_{2500}$. By extrapolating in frequency, we predict that the combined signals from 2.1GHz-selected radio sources and 345GHz-selected SMGs contaminate the 148GHz SZE decrement signal by ~5% and the 345GHz SZE increment by ~18%. After removing radio source and SMG emission from the SZE signals, we use ACT, LABOCA, and (in some cases) new Herschel SPIRE imaging to place constraints on the clusters' peculiar velocities. The sample's average peculiar velocity relative to the cosmic microwave background is $153\pm 383\,\rm km\,s^{-1}$.Comment: 19 pages, 11 figures, Accepted for Publication in The Astrophysical Journa

Exercise Preserves Physical Function in Prostate Cancer Patients with Bone Metastases

The presence of bone metastases has excluded participation of cancer patients in exercise interventions and is a relative contraindication to supervised exercise in the community setting due to concerns of fragility fracture. We examined the efficacy and safety of a modular multi-modal exercise program in prostate cancer patients with bone metastases.Between 2012 and 2015, 57 prostate cancer patients (70.0±8.4 years; BMI 28.7±4.0 kg/m) with bone metastases (pelvis 75.4%, femur 40.4%, rib/thoracic spine 66.7%, lumbar spine 43.9%, humerus 24.6%, other sites 70.2%) were randomised to multi-modal supervised aerobic, resistance and flexibility exercises undertaken thrice weekly (EX, n=28) or usual care (CON, n=29) for 3 months. Physical function subscale of the SF-36 was the primary endpoint as an indicator of patient-rated physical functioning. Secondary endpoints included objective measures of physical function, lower body muscle strength, body composition and fatigue. Safety was assessed by recording the incidence and severity of any adverse events, skeletal complications, and bone pain throughout the intervention.There was a significant difference between groups for self-reported physical functioning (3.2 points, 95% CI 0.4-6.0 points; p=0.028) and lower body muscle strength (6.6 kg, 95% CI 0.6-12.7; p =0.033) at 3 months favouring EX. However, there was no difference between groups for lean mass (p=0.584), fat mass (p=0.598), or fatigue (p=0.964). There were no exercise-related adverse events or skeletal fractures and no differences in bone pain between EX and CON (p=0.507).Multi-modal modular exercise in prostate cancer patients with bone metastases led to self-reported improvements in physical function and objectively measured lower body muscle strength with no skeletal complications or increased bone pain.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal

Habitat heterogeneity enables spatial and temporal coexistence of native and invasive macrophytes in shallow lake landscapes

Macrophyte invasive alien species (IAS) fitness is often hypothesised to be associated with beneficial environmental conditions (environmental matching) or species-poor communities. However, positive correlations between macrophyte IAS abundance and native plant richness can also arise, due to habitat heterogeneity (defined here as variation in abiotic and native biotic conditions over space and time). We analysed survey and palaeoecological data for macrophytes in satellite lakes along the Upper Lough Erne (ULE) system (Northern Ireland, UK), covering a gradient of eutrophication and connectivity to partition how environmental conditions, macrophyte diversity and habitat heterogeneity explained the abundance of Elodea canadensis, a widely distributed non-native macrophyte in Europe. E. canadensis abundance positively correlated with macrophyte richness at both the within- and between-lake scales indicating coexistence of native and invasive species over time. E. canadensis was also more prolific in highly connected and macrophyte-rich lakes, but sparser in the more eutrophic-isolated ones. Partial boosted regression trees revealed that in eutrophic-isolated lakes, E. canadensis abundances correlated with water clarity (negatively), plant diversity (positively), and plant cover (negatively) whereas in diverse-connected lakes, beta diversity (both positively and negatively) related to most greatly E. canadensis abundance. Dense macrophyte cover and unfavourable environmental conditions thus appear to confer invasibility resistance and sufficient habitat heterogeneity to mask any single effect of native biodiversity or environmental matching in controlling E. canadensis abundance. Therefore, in shallow lake landscapes, habitat heterogeneity variously enables the coexistence of native macrophytes and E. canadensis, reducing the often-described homogenisation effects of invasive macrophytes.Output Status: Forthcoming/Available Onlin