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The Magnet® journey has increased in relevance as the sources of evidence reflect the complex role of the nurse in quality, safety, and the patient care experience. Creating a business case to secure the resources required to embark and travel on the Magnet journey is an essential tool for the chief nurse. Identifying expenses, cost savings or avoidance, and return on investment for nursing services are all important elements of a business case.

As the impact of the COVID-19 pandemic became clear, it was evident that higher education schools and Universities, including schools of nursing were facing enormous challenges to create a safe environment for educational instruction to continue. Clinical education in particular was affected as clinical sites were increasingly unable to accommodate student clinical rotations due to crushing volumes and overwhelming care needs of COVID patients. This article outlines the innovative efforts of one university that set up a robust surveillance testing program that required and provided weekly COVID-19 testing of all students, faculty and staff that were on-campus. The testing center is nurse led and nurse managed, providing a clinical experience for over 50 nursing students each semester, allowing them to accrue community clinical hours so that they can progress through their nursing program. Clinical quality and patient experience outcomes are shared, and lessons learned described.

Diatom assemblages in lake sediments of Lac Noir, southwestern Québec, were studied at a resolution of 10 yr to determine principal drivers of primary producers for the past ~1000 yr. Generalized additive modeling revealed strong links between broadscale climate intervals of the late Holocene, forest composition, and diatom flora. During the Medieval Warm Period (~AD 1200) and onset of the Little Ice Age (~AD 1450), increases in Tabellaria flocculosa str. IIIp at the expense of Discostella stelligera reflected low lake productivity. At AD 1630, an abrupt shift to cooler temperatures and dry conditions triggered a decline in hemlock (Tsuga), replaced by disturbance and cool-adapted taxa. Greater nutrient availability and soil erosion in the catchment led to a corresponding and rapid increase in diatoms with higher optima for nitrogen, such as Asterionella formosa and Fragilaria crotonensis. After AD 1870, an increase in pollen of taxa associated with disturbances signaled the arrival of Euro-Canadians, and associated nutrient inputs to the lake triggered increases in Stephanodiscus minutulus and Achnanthidium minutissimum. Overall results of the study indicate that climate played an important underlying role in lake-ecosystem dynamics; however, disturbances affecting forest composition had more direct influences on the diatom communities of Lac Noir.

A high-resolution sediment record from Lac Brule, southwestern Quebec, was studied to determine the effects of long-term climate change and anthropogenic impacts on cladoceran assemblages of the late Holocene. Temporal shifts in cladoceran communities were closely associated with known century-scale climatic episodes, namely the Medieval Warm Period (750–1250 CE), the Little Ice Age (1450–1850 CE) and the twentieth-century warming. Forward selection indicated the importance of catchment variables and aquatic primary production in governing cladoceran communities. This suggests that higher trophic levels in Lac Brule were responsive to changes in the physical and chemical properties of the lake, perhaps as an indirect consequence of climatic change. The exploitation of the Wallingford-Back Mine in the immediate watershed of Lac Brule from 1924 to 1972 CE also had notable impacts on cladoceran assemblages. To strengthen interpretations of the Lac Brule record, relationships between cladoceran assemblages and limnological variables were studied in surface samples from 31 lakes from the surrounding region. This spatial analysis identified nutrients (phosphorus and nitrogen) and pH as the most influential variables driving changes in present-day cladoceran communities. However, the performance of cladocera-based inference models was insufficient to quantitatively reconstruct variables in the down-core analysis of Lac Brule.

A high-resolution diatom analysis of a varved sediment sequence from Lac Brule, southwestern Quebec, was used to study temporal patterns of environmental change in the late Holocene. Key periods of interest in the record included the Medieval Warm Period (~800–1300 CE), the Little Ice Age (~1450–1850 CE), and post-European settlement (~1850–present). Subfossil diatom assemblages were compared to previously published pollen, cladocera, and sediment records from Lac Brule, revealing complex dynamics between terrestrial vegetation succession, nutrient fluxes, and trophic interactions. Generalized additive models showed a response to long-term climate variability in the diatom record, although it was not the most influential driver of community changes at Lac Brule. Catchment-mediated processes instead played the largest role in governing the structure of diatom assemblages in the lake. For example, nutrient loading following a local fire in the watershed at 1345 CE led to an abrupt and significant increase in Fragilaria spp. Human activity associated with deforestation and the Wallingford-Back Mine (1924–1972 CE) also had strong impacts on the landscape, which triggered further responses in the aquatic communities of Lac Brule.

A high-resolution pollen record from Path Lake in Port Joli Harbour, Nova Scotia, Canada, provides a paleo-ecological perspective on Holocene climate and vegetation variability within the context of local archaeological research. Pollen assemblages in the early Holocene reflect a post-glacial forest dominated byPinus,Tsuga,BetulaandQuercus. During this time, a lower frequency of radiocarbon dated cultural material suggests lower human settlement intensity. Shallow water aquatic (Isoetes) and wetland (Alnus,Sphagnum) taxa increased after 3400 cal yr BP in response to a transition towards wetter climatic conditions. Culturally significant periods, where settlement intensity increased in the Maritimes and Maine, coincide with maximum values of reconstructed total annual precipitation, suggesting that environmental conditions may have influenced prehistoric human activity. European settlement, after 350 cal yr BP, was marked by a rise inAmbrosia. The impact of anthropogenic fire disturbances on the landscape was evidenced by peak charcoal accumulations after European settlement.

During August through September 2009, a surge in emergency department (ED) visits for 2009 pandemic influenza A (pH1N1) illness occurred in Georgia, particularly among children. To understand surge preparedness and capacity, we obtained influenza-like illness (ILI) ED visit data from the Georgia State Electronic Notifiable Disease Surveillance System (SendSS) and conducted a retrospective, Internet-based survey among all 26 metro Atlanta ED managers with reference to the period 1 July-1 October 2009. SendSS detected a marked and progressive increase in mean monthly ILI visits from 1 July-1 October 2009, which more than tripled (from 399 to 2196) for the 2 participating EDs that cared for pediatric patients during this time. ED managers reported patient volume surges, resulting in space and supply limitations, especially at pediatric EDs. Most (92%) of the facilities had current pandemic influenza plans. Pandemic planning can help to ensure preparedness for natural and man-made disasters and for future influenza pandemics.

Background. An abrupt increase in the incidence of legionellosis in the United States has been noted since 2003. Whether the recent increase is associated with shifting epidemiologic trends has not been well characterized. Methods. We analyzed all cases of legionellosis reported to the Centers for Disease Control and Prevention through the National Notifiable Disease Surveillance System from 1990 through 2005. Results. A total of 23,076 cases of legionellosis were reported to the Centers for Disease Control and Prevention from 1990 through 2005. The number of reported cases increased by 70% from 1310 cases in 2002 to 2223 cases in 2003, with a sustained increase to 12000 cases per year from 2003 through 2005. The eastern United States showed most of the increases in age-adjusted incidence rates after 2002, with the mean rate in the Middle Atlantic states during 2003–2005 exceeding that during 1990–2002 by 96%. During 2000–2005, legionellosis cases were most commonly reported in persons aged 45–64 years. Persons aged !65 years comprised 63% of total cases in 2000–2005. Age-adjusted incidence rates in males exceeded those in females for all age groups and years. Legionellosis incidence showed marked seasonality in eastern states, with most cases reported in the summer or fall. Conclusions. Reported legionellosis cases have increased substantially in recent years, particularly in the eastern United States and among middle-aged adults. Legionella infection should be considered in the differential diagnosis of any patient with pneumonia. Public health professionals should focus increased attention on detection and prevention of this important and increasing public health problem.

Experienced mindfulness practitioners suggest that the most effective way to teach mindfulness to children is through modelling our own practice. As the Zen Master Thich Nhat Hanh says in his book ...

The objective of this study was to investigate knowledge and perceptions of executive directors of long-term care facilities in a large western state regarding oral health of residents, barriers to the provision of optimal oral health care and the collaborative practice role for dental hygienists.A descriptive, exploratory online survey research design was utilized. A purposive sample of executive directors of long-term care facilities in a large western state certified for Medicare/Medicaid reimbursement was used. An online survey was developed to investigate perceptions and knowledge regarding oral health of long-term care residents, protocol for provision of, and barriers to optimal oral health care, and support for employment of dental hygienists in long-term care facilities. Statistics used for data analysis included frequency distributions, Spearman's rho correlation coefficient and the Mann-Whitney test.Executive directors in long-term care facilities included in the study perceived oral health as an important aspect of general health; however, a knowledge deficit was identified related to oral disease as an exacerbating factor to systemic disease. Financial concerns and low interest among residents/families were identified as major barriers to accessing care. Executive directors supported interprofessional practice of nurses working with dental hygienists to optimize oral health care of residents. No significant associations were found between demographics and facility characteristics.Awareness of the knowledge and perceptions of executive directors providing leadership in these facilities can provide avenues to creating needed change, which can foster improvement in the oral and overall health status of long-term care residents. Support for interprofessional work of nurses and dental hygienists can open a door for innovative practice that optimizes oral health care of long-term care facility residents through the application of shared expertise.

A study was conducted with pansies (Viola wittrockiana) on a tobacco float bed system to determine if plugs could successfully be grown into transplants and to determine nutrient levels that wouldprovide the best transplants. Transplants were grown in a soilless media in 72-cell polystyrene float trays, floating on four different nutrient concentrations: 25, 50, 100, or 200 ppm. Length of time needed to produce regular-size transplants is reduced by half. Only 3 weeks are needed using the floating bed system, while 6 to 9 weeks are needed for the conventional method. Transplants displayed vigorous growth with normal morphology. Plant height and weight are significantly enhanced by increasing the nutrient concentration.