Rural Hospital Nursing Skill Mix and Work Environment Associated with Frequency of Adverse Events.

Introduction: Though rural hospitals serve about one fifth of the United States (U.S.), few studies have investigated relationships among nursing resources and rural hospital adverse events. Objectives: The purpose was to determine relationships among nursing skill mix (proportion of Registered Nurses (RNs) to all nursing staff), the work environment and adverse events (medication errors, patient falls with injury, pressure ulcers, and urinary tract infections) in rural hospitals. Methods: Using a cross-sectional design, nurse survey data from a large study examining nurse organizational factors, patient safety, and quality from four U.S. states were linked to the 2006 American Hospital Association data. The work environment was measured using the Practice Environment Scale of the Nursing Work Index (PES-NWI). Nurses reported adverse event frequency. Data analyses were descriptive and inferential. Results: On average, 72% of nursing staff were RNs (range = 45% to 100%). Adverse event frequency ranged from 0% to 67%, across 76 hospitals. In regression models, a 10-point increase in the proportion of RNs among all nursing staff and a one standard deviation increase in the PES-NWI score were significantly associated with decreased odds of frequent adverse events. Conclusion: Rural hospitals that increase the nursing skill mix and improve the work environment may achieve reduced adverse event frequency

Pesticide seed treatments containing neonicotinoids have limited effect on soil microbial community structure under different tillage regimes

Pesticide seed treatments (PST) which contain fungicides and insecticides are commonly used in agriculture; however, little is known about their effect on soil microbial communities and soil health. Neonicotinoids – controversial insecticides which are common in PST – have received criticism due to potential non-target effects. While fungal pathogens need to be moderated, PST have the potential to disturb broader fungal communities which could lead to reduced nutrient cycling and poor soil health. Given the broad use of PST, their effect on soil fungi needs to be studied within the context of other agricultural management practices. For example, tillage regimes can result in distinct fungal communities which may respond differently to PST. An experimental site was established in 2013 with a corn-soy rotation under three tillage treatments: Full-till, Strip-till, and No-till. Since 2016, seeds with or without PST (fungicides and insecticides) were planted under each tillage regime in a fully factorial design. In 2018, bulk soil was collected from within rows while soy was growing. A range of soil physicochemical variables were measured, and soil function was determined with substrate-induced respiration and enzyme assays. DNA was extracted from soil and the ITS region was sequenced to determine fungal community structure and diversity. While tillage significantly affected fungal community structure (p \u3c 0.01), there was no effect of PST on either community structure (p = 0.59) or diversity (p = 0.52). This indicates that PST does not affect bulk soil fungal communities; however, they may have an impact at different temporal or spatial scales than those studied here. Across all treatments, fungal community structure correlated with soil water holding capacity (rs = 0.23, p = 0.04) and electrical conductivity (rs = 0.26, p = 0.01). Despite not finding an effect of PST on fungal communities, we did find that PST increased potentially mineralizable nitrogen under no-till and shifted community level physiological profiles determined by substrate-induced respiration. These results suggest that while PST can affect certain aspects of soil health, there are no clear effects on the soil fungal community

Parity at a Price: The Emerging Professional Liability of Mental Health Providers

This Article considers the issues associated with emerging professional liability claims against mental health care providers. Part II supplies background information regarding this liability, including the elements of these claims. Part III details the decreasing stigma associated with obtaining mental health services and its impact on professional liability, while Part IV summarizes advancements in mental health treatment that have enhanced the functional capacities of potential litigants. The remaining Parts explore changes in the delivery of mental health care where litigation may be focused, including the increasing use of psychotropic medications (Part V), the expanding role of primary care physicians and other health care providers with limited training and experience pertaining to the treatment of mental illness (Part VI), the surge in pediatric psychotropic prescriptions (Part VII), the emergence of the informed consent doctrine and psychiatric advance directives (Part VIII), and the continuing development of Tarasoff-related liability (Part IX)

Discovery of a Metal-Line Absorber Associated with a Local Dwarf Starburst Galaxy

We present optical and near-infrared images, H I 21 cm emission maps, optical spectroscopy, and Hubble Space Telescope/Space Telescope Imaging Spectrograph ultraviolet spectroscopy of the QSO/galaxy pair SBS 1122+594/IC 691. The QSO sight line lies at a position angle of 27 degrees from the minor axis of the nearby dwarf starburst galaxy IC 691 (cz_gal = 1204+-3 km/s, L_B ~ 0.09 L*, current star formation rate = 0.08-0.24 solar masses per year) and 33 kpc (6.6 arcmin) from its nucleus. We find that IC 691 has an H I mass of M_HI = (3.6+-0.1) x 10^8 solar masses and a dynamical mass of M_dyn = (3.1+-0.5) x 10^10 solar masses. The UV spectrum of SBS 1122+594 shows a metal-line (Ly-alpha + C IV) absorber near the redshift of IC 691 at cz_abs = 1110+-30 km/s. Since IC 691 is a dwarf starburst and the SBS 1122+594 sight line lies in the expected location for an outflowing wind, we propose that the best model for producing this metal-line absorber is a starburst wind from IC 691. We place consistent metallicity limits on IC 691 ([Z/Zsun] ~ -0.7) and the metal-line absorber ([Z/Zsun] < -0.3). We also find that the galaxy's escape velocity at the absorber location is v_esc = 80+-10 km/s and derive a wind velocity of v_w = 160+-50 km/s. Thus, the evidence suggests that IC 691 produces an unbound starburst wind that escapes from its gravitational potential to transport metals and energy to the surrounding intergalactic medium.Comment: 31 pages, 8 figures; AJ in press; a version with high resolution figures can be downloaded from http://casa.colorado.edu/~keeney/research/papers/IC691.pd

Child Life Specialists in the Neonatal Intensive Care Unit : Are They Prepared to Work with This Unique Population?

Certified child life specialists (CCLS) are one of many healthcare professionals who work with premature infants hospitalized in the Neonatal Intensive Care Unit (NICU). The current study investigates the role of CCLS and what type of education and training is needed to sustain this role. An online survey was developed for the study with specific questions about CCLS duties and responsibilities in the NICU. Via the Child Life Council forum 69 CCLS completed the survey. Findings indicate there are no clear guidelines about the specific role of a CCLS in the NICU, and that participants received differing education and training prior to and since becoming certified. A more standardized approach to education and training for future CCLS working in the NICU is necessary.  M.S

Soil microbial communities vary in composition and functional strategy across soil aggregate size class regardless of tillage

The physicochemical environment within aggregates controls the distribution of carbon and microbial communities in soils. Agricultural management, such as tillage, can disrupt aggregates and the microscale habitat provided to microorganisms, thus altering microbial community dynamics. Categorizing microbial communities into life history strategies with shared functional traits—as has been done to understand plant community structure for decades—can illuminate how the soil physicochemical environment constrains the membership and activity of microbial communities. We conducted an aggregate scale survey of microbial community composition and function through the lens of the yield–acquisition–stress (Y–A–S) tolerator life history framework. Soils collected from a 7-year tillage experiment were separated into 4 aggregate size classes and enzyme activity, multiple-substrate-induced respiration, and carbon use efficiency were measured to reveal trade-offs in microbial resource allocation. Microbial community structure was interrogated with bacterial and fungal marker gene sequencing, and metagenomic features such as community weighted genome size and traits conferring stress tolerance were predicted using PICRUSt2. Consistent with our hypothesis, aggregates of different size classes harbored distinct microbial communities manifesting distinct life history strategies. Large macroaggregate communities \u3e2 mm were classified as acquisition strategists based on increased enzyme activity relative to other aggregate size classes. Small and medium microaggregate (0.25–2 mm) communities did not show a strong tendency toward any particular life history strategy. Genes conferring stress tolerance were significantly enriched in microaggregates \u3c0.25 mm (indicative of stress tolerators); however, these communities also had the highest carbon use efficiency (indicative of yield strategists). We found trade-offs in resource allocation between communities classified as yield and acquisition strategists consistent with the Y–A–S framework. Tillage did not alter life history strategies within aggregates, suggesting that the aggregate physicochemistry plays a larger role than agricultural management in shaping microbial life history at the scale studied

Lower Postsurgical Mortality for Individuals with Dementia with Better-Educated Hospital Workforce

Surgical patients age 65 and over with Alzheimer’s disease and related dementias (ADRD) were more likely to die within 30 days of admission and to die after a complication than those without ADRD. Having better-educated nurses in the hospital improved the likelihood of good outcomes for all surgical patients, but had a much greater effect in individuals with ADRD. Specifically, a 10% increase in the proportion of nurses with a Bachelor of Science in Nursing (BSN) degree or higher was associated with 10% lower odds of death and 10% lower odds of dying after a complication for surgical patients with ADRD

Mendelian Randomization Analyses Suggest Childhood Body Size Indirectly Influences End Points From Across the Cardiovascular Disease Spectrum Through Adult Body Size

Background Obesity is associated with long‐term health consequences including cardiovascular disease. Separating the independent effects of childhood and adulthood obesity on cardiovascular disease risk is challenging as children with obesity typically remain overweight throughout the lifecourse. Methods and Results This study used 2‐sample univariable and multivariable Mendelian randomization to estimate the effect of childhood body size both independently and after accounting for adult body size on 12 endpoints across the cardiovascular disease disease spectrum. Univariable analyses identified strong evidence of a total effect between genetically predicted childhood body size and increased risk of atherosclerosis, atrial fibrillation, coronary artery disease, heart failure, hypertension, myocardial infarction, peripheral artery disease, and varicose veins. However, evidence of a direct effect was weak after accounting for adult body size using multivariable Mendelian randomization, suggesting that childhood body size indirectly increases risk of these 8 disease outcomes via the pathway involving adult body size. Conclusions These findings suggest that the effect of genetically predicted childhood body size on the cardiovascular disease outcomes analyzed in this study are a result of larger body size persisting into adulthood. Further research is necessary to ascertain the critical timepoints where, if ever, the detrimental impact of obesity initiated in early life begins to become immutable