Strategies to Reduce Turnover Among Black Home Healthcare Aides

AbstractMany individuals prefer to remain in their homes as they age instead of entering a long-term care facility. As the proportion of older Americans rapidly grows, the demand for delivery of nonmedical services by home healthcare aides (HHAs) is expected to increase. However, the national and local supply of HHAs is insufficient and must be rectified to meet a projected increase of older Americans by 2050. This research study involved exploring this problem for one small home healthcare organization in the Maryland suburbs outside of Washington, DC with an HHA workforce that was comprised predominantly of Black/African American and African women. Using a single case qualitative study design, data were collected through semi-structured interviews with the organization’s behavioral health leaders and a review of organizational records. The study was grounded in the Baldrige Excellence Framework which describes concepts and behaviors that characterize high-performing organizations. Thematic qualitative analyses were conducted to describe practices the organization used to recruit and retain their HHA workforce and to compare these practices to effective strategies according to scholarly literature. Results showed the organization had a practical foundation upon which it can build successfully to improve its HHA recruitment and retention practices and reduce staff shortages and turnover. The study also addressed a literature gap involving how racial, ethnic, and culturally-based perspectives involving elder caregiving might be used to enhance HHA recruitment and retention. Actionable recommendations are presented to strengthen the organization and contribute to positive social change

Strategies to Reduce Turnover Among Black Home Healthcare Aides

Many individuals prefer to remain in their homes as they age instead of entering a long-term care facility. As the proportion of older Americans rapidly grows, the demand for delivery of nonmedical services by home healthcare aides (HHAs) is expected to increase. However, the national and local supply of HHAs is insufficient and must be rectified to meet a projected increase of older Americans by 2050. This research study involved exploring this problem for one small home healthcare organization in the Maryland suburbs outside of Washington, DC with an HHA workforce that was comprised predominantly of Black/African American and African women. Using a single case qualitative study design, data were collected through semi-structured interviews with the organization’s behavioral health leaders and a review of organizational records. The study was grounded in the Baldrige Excellence Framework which describes concepts and behaviors that characterize high-performing organizations. Thematic qualitative analyses were conducted to describe practices the organization used to recruit and retain their HHA workforce and to compare these practices to effective strategies according to scholarly literature. Results showed the organization had a practical foundation upon which it can build successfully to improve its HHA recruitment and retention practices and reduce staff shortages and turnover. The study also addressed a literature gap involving how racial, ethnic, and culturally-based perspectives involving elder caregiving might be used to enhance HHA recruitment and retention. Actionable recommendations are presented to strengthen the organization and contribute to positive social change

Determining the effects of cattle grazing treatments on Yosemite toads (Anaxyrus [=Bufo] canorus) in montane meadows.

Amphibians are experiencing a precipitous global decline, and population stability on public lands with multiple uses is a key concern for managers. In the Sierra Nevada Mountains (California, USA), managers have specifically identified livestock grazing as an activity that may negatively affect Yosemite toads due to the potential overlap of grazing with toad habitat. Grazing exclusion from Yosemite toad breeding and rearing areas and/or entire meadows have been proposed as possible management actions to alleviate the possible impact of cattle on this species. The primary objective of this study was to determine if different fencing treatments affect Yosemite toad populations. We specifically examined the effect of three fencing treatments on Yosemite toad breeding pool occupancy, tadpoles, and young of the year (YOY). Our hypothesis was that over the course of treatment implementation (2006 through 2010), Yosemite toad breeding pool occupancy and early life stage densities would increase within two fencing treatments relative to actively grazed meadows due to beneficial changes to habitat quality in the absence of grazing. Our results did not support our hypothesis, and showed no benefit to Yosemite toad presence or early life stages in fenced or partially fenced meadows compared to standard USDA Forest Service grazing levels. We found substantial Yosemite toad variation by both meadow and year. This variation was influenced by meadow wetness, with water table depth significant in both the tadpole and YOY models

Terrestrial organic carbon storage in a British moorland

Accurate estimates for the size of terrestrial organic carbon (C) stores are needed to determine their importance in regulating atmospheric CO2 concentrations. The C stored in vegetation and soil components of a British moorland was evaluated in order to: (i) investigate the importance of these ecosystems for C storage and (ii) test the accuracy of the United Kingdom's terrestrial C inventory. The area of vegetation and soil types was determined using existing digitized maps and a Geographical Information System (GIS). The importance of evaluating C storage using 2D area projections, as opposed to true surface areas, was investigated and found to be largely insignificant. Vegetation C storage was estimated from published results of productivity studies at the site supplemented by field sampling to evaluate soil C storage. Vegetation was found to be much less important for C storage than soil, with peat soils, particularly Blanket bog, containing the greatest amounts of C. Whilst the total amount of C in vegetation was similar to the UK national C inventory's estimate for the same area, the national inventory estimate for soil C was over three times higher than the value derived in the current study. Because the UK's C inventory can be considered relatively accurate compared to many others, the results imply that current estimates for soil C storage, at national and global scales, should be treated with caution

Growth and mass wasting of volcanic centers in the northern South Sandwich arc, South Atlantic, revealed by new multibeam mapping

New multibeam (swath) bathymetric sonar data acquired using an EM120 system on the RRS James Clark Ross, supplemented by sub-bottom profiling, reveals the underwater morphology of a not, vert, similar 12,000 km2 area in the northern part of the mainly submarine South Sandwich volcanic arc. The new data extend between 55° 45′S and 57° 20′S and include Protector Shoal and the areas around Zavodovski, Visokoi and the Candlemas islands groups. Each of these areas is a discrete volcanic center. The entirely submarine Protector Shoal area, close to the northern limit of the arc, forms a 55 km long east–west-trending seamount chain that is at least partly of silicic composition. The seamounts are comparable to small subaerial stratovolcanoes in size, with volumes up to 83 km3, indicating that they are the product of multiple eruptions over extended periods. Zavodovski, Visokoi and the Candlemas island group are the summits of three 3–3.5 km high volcanic edifices. The bathymetric data show evidence for relationships between constructional volcanic features, including migrating volcanic centers, structurally controlled constructional ridges, satellite lava flows and domes, and mass wasting of the edifices. Mass wasting takes place mainly by strong erosion at sea level, and dispersal of this material along chutes, probably as turbidity currents and other mass flows that deposit in extensive sediment wave fields. Large scale mass wasting structures include movement of unconsolidated debris in slides, slumps and debris avalanches. Volcanism is migrating westward relative to the underlying plate and major volcanoes are asymmetrical, being steep with abundant recent volcanism on their western flanks, and gently sloping with extinct, eroded volcanic sequences to their east. This is consistent with the calculated rate of subduction erosion of the fore-arc

Real-Time Measurement of Solute Transport Within the Lacunar-Canalicular System of Mechanically Loaded Bone: Direct Evidence for Load-Induced Fluid Flow

Since proposed by Piekarski and Munro in 1977, load-induced fluid flow through the bone lacunar-canalicular system (LCS) has been accepted as critical for bone metabolism, mechanotransduction, and adaptation. However, direct unequivocal observation and quantification of load-induced fluid and solute convection through the LCS have been lacking due to technical difficulties. Using a novel experimental approach based on fluorescence recovery after photobleaching (FRAP) and synchronized mechanical loading and imaging, we successfully quantified the diffusive and convective transport of a small fluorescent tracer (sodium fluorescein, 376 Da) in the bone LCS of adult male C57BL/6J mice. We demonstrated that cyclic end-compression of the mouse tibia with a moderate loading magnitude (–3 N peak load or 400 µɛ surface strain at 0.5 Hz) and a 4-second rest/imaging window inserted between adjacent load cycles significantly enhanced (+31%) the transport of sodium fluorescein through the LCS compared with diffusion alone. Using an anatomically based three-compartment transport model, the peak canalicular fluid velocity in the loaded bone was predicted (60 µm/s), and the resulting peak shear stress at the osteocyte process membrane was estimated (∼5 Pa). This study convincingly demonstrated the presence of load-induced convection in mechanically loaded bone. The combined experimental and mathematical approach presented herein represents an important advance in quantifying the microfluidic environment experienced by osteocytes in situ and provides a foundation for further studying the mechanisms by which mechanical stimulation modulates osteocytic cellular responses, which will inform basic bone biology, clinical understanding of osteoporosis and bone loss, and the rational engineering of their treatments. © 2011 American Society for Bone and Mineral Research

Bias effects of short- and long-term color memory for unique objects

Are objects remembered with a more saturated color? Some of the evidence supporting this statement comes from research using “memory colors”—the typical colors of particular objects, for example, the green of grass. The problematic aspect of these findings is that many different exemplars exist, some of which might exhibit a higher saturation than the one measured by the experimenter. Here we avoid this problem by using unique personal items and comparing long- and short-term color memory matches (in hue, value, and chroma) with those obtained with the object present. Our results, on average, confirm that objects are remembered as more saturated than they are

The imperative for controlled mechanical stresses in unraveling cellular mechanisms of mechanotransduction

BACKGROUND: In vitro mechanotransduction studies are designed to elucidate cell behavior in response to a well-defined mechanical signal that is imparted to cultured cells, e.g. through fluid flow. Typically, flow rates are calculated based on a parallel plate flow assumption, to achieve a targeted cellular shear stress. This study evaluates the performance of specific flow/perfusion chambers in imparting the targeted stress at the cellular level. METHODS: To evaluate how well actual flow chambers meet their target stresses (set for 1 and 10 dyn/cm(2 )for this study) at a cellular level, computational models were developed to calculate flow velocity components and imparted shear stresses for a given pressure gradient. Computational predictions were validated with micro-particle image velocimetry (μPIV) experiments. RESULTS: Based on these computational and experimental studies, as few as 66% of cells seeded along the midplane of commonly implemented flow/perfusion chambers are subjected to stresses within ±10% of the target stress. In addition, flow velocities and shear stresses imparted through fluid drag vary as a function of location within each chamber. Hence, not only a limited number of cells are exposed to target stress levels within each chamber, but also neighboring cells may experience different flow regimes. Finally, flow regimes are highly dependent on flow chamber geometry, resulting in significant variation in magnitudes and spatial distributions of stress between chambers. CONCLUSION: The results of this study challenge the basic premise of in vitro mechanotransduction studies, i.e. that a controlled flow regime is applied to impart a defined mechanical stimulus to cells. These results also underscore the fact that data from studies in which different chambers are utilized can not be compared, even if the target stress regimes are comparable