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Forest restoration through mechanical thinning, prescribed burning, and other management actions is vital to improving forest resilience to fire and drought across the Western United States, and yields benefits that can be monetized, including improvements in water supply and hydropower. Using California's Sierra Nevada as a study area, we assess the water and energy benefits of forest-restoration projects. By using a scalable top-down approach to track annual evapotranspiration following forest disturbance, coupled with hydropower simulations that include energy-price information, and marginal prices for water sales, we project the potential economic benefits of hydropower and water sales accruing to water-rights holders. The results found that water-related benefits from strategically planned fuels-reduction treatments now being carried out can be sufficient to offset costs of management actions aimed at forest restoration, especially in the face of climate change. Our findings justified investments in restoring forests and reinforce the central role of water and hydropower providers in partnerships for management of source-water watersheds. Results also highlighted the importance of accurate, scalable data and tools from the hydrology and water-resources community., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Many barriers for patient access to medications for opioid use disorder (MOUD) exist in current care practices. Previous literature has evaluated subsets of pharmacists, patients, and prescribers; however, few have collectively evaluated the perspectives of all 3 groups., Objective: The objective of the study was to identify barriers, facilitators, and opportunities for improvement in Indiana community pharmacy MOUD care practices from the perspectives of peer recovery coaches, community pharmacists, and prescribers to optimize patient care., Methods: Individual semistructured interviews were conducted with each participant. Interviews explored stakeholders' perspectives on their current role in MOUD care practices and how current pharmacy practices could be improved. Data were analyzed using preconceived deductive and iterative inductive codes. The first author analyzed all transcripts, of which 3 were also analyzed separately by the last author to confirm consistent utilization of codes. All transcripts were coded once, followed by a second coding to ensure inductive codes were thoroughly applied., Results: Ten peer recovery coaches, 10 pharmacists, and 6 prescribers were included. Interviews identified barriers, facilitators, and opportunities for improvement in current MOUD care practices. Stigma was a major barrier identified by all groups. Other barriers identified included limited patient engagement at pharmacies and lack of access to patient-specific health information in community pharmacy settings. Pharmacists also identified additional barriers including Drug Enforcement Administration regulations and difficulties balancing patient care with external factors like insurance and legal policies. Positive prescriber/pharmacist relationships were identified as a facilitator of care. Opportunities for improvement included having community MOUD resource information available at pharmacies, further education on MOUD for pharmacists, and increased collaboration between pharmacists and prescribers., Conclusion: Many barriers exist in current MOUD care practices. Additional pharmacist MOUD education and intentional collaboration between pharmacists, peer recovery coaches, and prescribers would facilitate better care and leverage the accessibility of pharmacists within their communities., (Copyright © 2022 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Introduction: Open reduction and internal fixation (ORIF) is considered the standard care for displaced tibial tubercle fractures, but closed reduction and internal fixation (CRIF) can also be successful. Our aim was to compare outcomes between ORIF and CRIF for tibial tubercle fractures., Materials and Methods: Children younger than 18 years presenting for a tibial tubercle fracture at a single institution. The main outcomes were operative details (blood loss, tourniquet time, operative time) and complications. Follow-up of at least one month was required., Results: 98 fractures from 95 patients were included. Follow-up averaged 8.7 months. 49% of the fractures had intraarticular involvement (type III). The most common associated injuries were patellar tendon tears and compartment syndrome, occurring in 10.2% and 3.1% of patients, respectively. No meniscal or ligamentous injuries were encountered. ORIF was performed for 81 fractures and CRIF for 17. Both groups were similar regarding sex, age, weight, and follow-up duration (P>0.4). No tourniquet was used for CRIF, while the majority of ORIF cases utilized a tourniquet for an average of 50.6 minutes. Operative blood loss was 31mL less in CRIF (P<0.0001), and the procedure of CRIF was 23.3 minutes shorter than ORIF (P=0.0003). All cases, except 1 fracture treated with ORIF, achieved union. The complication rate was similar in both groups (P=0.79). At final follow-up, patients from both groups had favorable outcomes, with normal knee range of motion and angulation, gait, and quadriceps strength on exam., Discussion: CRIF is often overlooked in the surgical treatment of displaced tibial tubercle fractures. It is a less invasive treatment option for such fractures and has advantages such as less bleeding, avoiding a tourniquet, and shorter operative duration. Patients treated with either ORIF and CRIF healed with similar rates of complications and had a satisfactory outcome. Given the rarity of associated meniscal or ligamentous injuries, open reduction to visualize the joint surface might not be needed for most patients. The two most common associated injuries, patellar tendon tears and compartment syndrome, can be preliminarily diagnosed pre-operatively., Conclusion: Closed reduction could be initially attempted for tibial tubercle fractures, even ones with intraarticular extension., Competing Interests: Declaration of Competing Interest Each of the authors declares that he does not have any conflicts of interest to disclose., (Copyright © 2020. Published by Elsevier Ltd.)

Objectives: To describe the five Phase I Pharmacy Quality Alliance (PQA) demonstration projects and discuss lessons learned across the projects., Design: Descriptive nonexperimental study., Setting: United States from July 2008 to November 2009., Participants: Community pharmacies from five states., Intervention: Pharmacies viewed their performance scores on a reporting website and provided feedback., Main Outcomes Measures: Pharmacy performance scores and pharmacist feedback about the scores and reporting websites., Results: Considerable variation was found in the pharmacy performance scores. Some pharmacies did not have enough patients taking medications that were included in specific performance measures. Use of a website to report pharmacy performance was feasible across several different approaches. PQA has developed measures of pharmacy performance that can be used in programs intended to report pharmacy performance., Conclusion: It is feasible to calculate pharmacy performance scores and create Web-based pharmacy performance reports to provide feedback to community pharmacists. Further development of pharmacy performance reporting should occur.

Objective: To determine if student satisfaction with high school foodservice is directly related to participation in the foodservice., Design: A valid and reliable survey was conducted in a variety of classes such as English, history, and health science in grades 9 through 12, representing students aged 13 through 19 years. Students were asked 38 questions concerning variety of food, food quality, foodservice staff, aesthetics of the serving and dining area, and demographics., Subjects/setting: The study was conducted with 1,823 students from 9 schools representing 4 geographic regions., Statistical Analysis: Stepwise multiple regression was used to determine the independent variables (attributes desired by the students) that most highly correlated with the dependent variable (satisfaction with the school foodservice overall)., Results: Variables most highly correlated with overall satisfaction were variety of food offered, flavor of food, attractiveness of food on the serving line, staff smiling and greeting students, quality of food choices, choices that allow students to meet cultural and ethnic preferences, courteousness of the staff, and quality of ingredients. Variety of food offered was the best predictor of satisfaction. A statistically significant difference was found (P<.01) between groups that never ate school lunch and those that ate school lunch 3 to 5 times per week on dining ambiance, food quality, and staff. The results indicate that satisfaction with foodservice is associated with purchase behavior in school foodservice programs., Applications: School foodservice and nutrition programs are critically important for providing nutrition to millions of our future leaders. Today it is not enough to prepare healthful, good-tasting food. High school students are sophisticated and are exposed at an early age to a variety of dining experiences including fast foods, ethnic cuisine, and fine dining. These factors have influenced the attributes students use to evaluate school foodservice. To maintain participation levels and financial stability, school foodservice professionals should evaluate student satisfaction with food quality, variety, and other variables that affect overall satisfaction and participation. These data may then be incorporated into continuous quality improvement and strategic planning. Marketing must be incorporated into the strategic plan to influence student participation.

Objective: To conduct a nationwide study on the opinions of dietitian preceptors regarding the intangible benefits to hospitals and medical centers of training dietetics students in approved preprofessional practice programs (AP4s) and to compare the findings with a similar survey of dietetic internships., Design: A questionnaire was adapted from a 1990 study of preceptors in dietetic internships to investigate the benefits of training dietetics students in AP4s., Sample: Program directors and dietitians who supervise and teach students in the 117 preprofessional programs approved by The American Dietetic Association were sent pretested questionnaires. Responses to the survey were received from 312 dietitians who supervise students in 74 practice programs., Statistical Analysis: Descriptive statistics were used to calculate frequency of response. t Tests were used to compare mean differences between the opinions of preceptors in AP4s and internships. Analysis of variance and Scheffe post-hoc test were used to determine the demographic characteristics related to the dietitians' opinions of benefits., Results: Strongest agreement (agree to strongly agree) was found for three items: sense of satisfaction from seeing students develop as professionals (4.34); belief that teaching students makes the job more interesting (4.17); and real sense of achievement in working with students (4.05). Significant differences were found between the groups on six items and, in all but one instance, the internship preceptors were more in agreement with the statements on intangible benefits than the AP4 preceptors., Applications/conclusions: The preceptors generally agreed that intangible benefits exist for departments that are AP4 sites and the professionals that work in them. As programs develop from AP4s into accredited internships, examination of intangible and monetary benefits may affect the continuation of dietetics training programs.

Objective: We explored the direct economic benefits of hospital dietetics departments sponsoring an internship for dietetics studies., Design: Forty-five dietetics departments in US hospitals participated in a mail survey that involved comprehensive data collection procedures using three instruments, including activity logs recorded by 298 dietitians and interns., Main Outcome Measures: Direct benefits were defined as the net student labor provided to the department during routine and staff relief experiences that released professional labor for other work. Net student productivity during routine assignments was calculated by subtracting the time dietitians spent teaching during a typical work week from the amount of time dietetic interns spent performing professional services without direct supervision. Student productivity during staff relief rotations was calculated by multiplying the number of students assigned to this type of experience by the length of the rotation., Results: While involved in routine learning experiences, dietetic interns provided a direct benefit. The difference between the time interns spent in independent, professional service in the departments and the time dietitians spent in activities designed specifically for teaching was a mean of 29 hours in favor of the students. All departments received a direct benefit from assigning dietetic interns to a staff relief rotation. The median number of weeks of student labor gained by the departments per year was 24., Statistical Analyses: A paired t test was used to analyze the difference between the time dietitians devoted to teaching interns and the time students spent in independent, professional service in the departments. The difference was very highly significant (P < .001), Applications: This study is a beginning step in objectively documenting positive outcomes associated with sponsoring a dietetic internship. It also represents a model that could be used by program directors to study the economic impact of their supervised practice program on the sponsoring organization.

Identifying what it is about the way nurse-midwives care for women that might contribute to healthy outcomes for women and infants requires clear definition of that care process. This article describes our efforts to define the theoretical construct of the nurse-midwifery care process. These efforts culminated in the development of a middle range descriptive theory of nurse-midwifery care. We share those efforts with others in the hopes of encouraging dialogue and the testing of this theory in a variety of clinical settings.