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Aims: To evaluate the impact of a lay health worker support role in the inpatient setting. Background: Healthcare systems are facing critical nursing and nurse assistant staffing shortages. These disciplines can be challenging to recruit and retain, leading healthcare leaders to identify innovative staffing models. Whereas lay health workers have been used in the community and low-income setting, there is scant evidence of their use in the inpatient setting. We implemented a lay health worker role, called Patient Attendant Service Aides (PASAs), on two medical/surgical units at a community hospital. Methods: A pre/post-implementation design was used for this study. An online survey was provided to nurses, nursing assistants, and PASAs on the two medical/surgical units to assess their satisfaction and perceptions of the role. Nursing quality metrics, patient satisfaction, and nursing and nursing assistant turnover were evaluated before and after implementing the role. Results: The online survey showed that nurses and nursing assistants felt that PASAs helped offload their workload, allowing them to focus on nursing-related tasks. PASAs felt supported by the team and believed they were making a meaningful contribution to the unit. There were slight improvements in patient satisfaction, although not significant. There was a significant improvement in nursing turnover on Unit A, from 71.1% to 21.6% (p = 0.009). Conclusions: This is one of the first studies to evaluate the use of lay health workers in the inpatient setting; we found this role to be a feasible way to offload tasks from clinical staff. This role may serve as a pathway for workforce development, as several PASAs are now enrolled in nursing assistant training. Nurse managers may consider using lay health workers in the inpatient setting as they face severe clinical staff shortages. [ABSTRACT FROM AUTHOR]

The stellar magnitude scale is grounded in the human perception of starlight and is one of the basic concepts in astronomy. However, its introduction is not easy to incorporate in the classroom. We propose a simple demonstration related to the observational aspect of the stellar magnitude scale. [ABSTRACT FROM AUTHOR]

Introduction: Kidney transplant graft function depends on optimised haemodynamics. However, high fluid volumes risk hypervolaemic complications. The Edwards Lifesciences ClearSight™ device permits fluid titration through markers of preload and beat-to-beat blood pressure monitoring. We evaluated the implementation of a novel goal-directed haemodynamic therapy protocol to determine whether patient outcomes had improved. Design: A retrospective evaluation of standard care versus goal-directed haemodynamic therapy in adults undergoing kidney transplantation was performed in a single centre between April 2016 and October 2019. Twenty-eight standard-of-care patients received intraoperative fixed-rate infusion and 28 patients received goal-directed haemodynamic therapy. The primary outcome was volume of fluid administered intraoperatively. Secondary outcomes included blood product and vasoactive drug exposure, graft and recipient outcomes. Results: Intraoperative fluid administered was significantly reduced in the goal-directed haemodynamic therapy cohort (4325 vs 2751 ml, P <.001). Exposure to vasopressor (67.9% vs 42.9%, P =.060) and blood products (17.9% vs 3.6%, P =.101) was unchanged. Immediate graft function (82.1% vs 75.0%, P =.515), dialysis requirement (14.3% vs 21.4%, P =.729) and creatinine changes post-operatively were unchanged. In the goal-directed haemodynamic therapy cohort, 1 patient had pulmonary oedema (3.6%) versus 21.4% in the standard cohort. Patients in the goal-directed haemodynamic therapy group were more likely to mobilise within 48 hours of surgery (number needed to treat = 3.5, P =.012). Conclusions: Protocolised goal-directed haemodynamic therapy in kidney transplantation was safe and may improve patient, graft, and surgical outcomes. Clinical trials assessing goal-directed approaches are needed. [ABSTRACT FROM AUTHOR]

Health Canada reviewed national and international literature to develop a framework that identifies best practices for developing and implementing Heat Alert and Response Systems (HARS) to protect citizens from extreme heat events. A comparative case study was conducted based upon the framework and the experiences of two Canadian jurisdictions that piloted many of the best practices in the development of new HARS. Table-top exercises, heat-health vulnerability assessments, and community consultations were used to inform the development and implementation of HARS plans. Implementation of the framework by local authorities revealed different and unique challenges facing rural and urban communities in protecting people from extreme heat events. Opportunities within each pilot for taking effective public health adaptive actions that draw upon existing strengths and resources were also identified. Key aspects of HARS development including those related to education and engagement, development of an alert protocol, creation of a heat response plan, and identification of communication activities should be tailored to the needs of individual communities or regions and be informed by specific characteristics related to existing and future vulnerability.

This inaugural editorial introduces the research topics addressed by the journal Change and Adaptation in Socio-Ecological Systems (CASES). A recent literature analysis revealed that the amount of integrative, interand transdisciplinary research activities on climate and global change, adaptive strategies, actor behaviors and response opportunities has increased significantly in the last few decades. Also, research activities on major drivers for the change and adaptation of socio-ecological systems, namely climate change, socio-economic and political changes and technological development have increased considerably since the 1950s. A publication platform that allows for overarching perspectives, integrative viewpoints, and the exchange of ideas among related disciplines in Socio-Ecological Systems (SES) science is provided by the new journal CASES.

General warming and extreme weather events associated with climate change are expected to negatively impact water utilities. Water utilities will need to adapt to continue providing safe drinking water and wastewater services. In 2012, the Canadian Water and Wastewater Association (CWWA) conducted a survey of 53 water utility officials to understand the expert perceptions of climate change risks and preparedness of Canadian utilities for current and future impacts. Results indicated that there is low awareness among water utility officials (30%) of thepossible impacts of climate change on water utilities, and more than half have not conducted climate change vulnerability assessments (65%) and do not have operational plans to address climate change impacts (56%). Officials from smaller utilities, which are considered to be more vulnerable to impacts, were of those less aware of these risks and reported taking fewer preparedness activities. Efforts to prepare water utilities for climate change impacts in Canada would benefit from education of utility officials about possible climate change risks, encouraging assessments of vulnerabilities, and increased training with new adaptation tools and resources.