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While the majority of influenza-infected individuals show no or mild symptomatology, pregnant women are at higher risk of complications and infection-associated mortality. Although enhanced lung pathology and dysregulated hormones are thought to underlie adverse pregnancy outcomes following influenza infection, how pregnancy confounds long-term maternal anti-influenza immunity remains to be elucidated. Previously, we linked seasonal influenza infection to clinical observations of adverse pregnancy outcomes, enhanced lung and placental histopathology, and reduced control of viral replication in lungs of infected pregnant mothers. Here, we expand on this work and demonstrate that lower infectious doses of the pandemic A/California/07/2009 influenza virus generated adverse gestational outcomes similar to higher doses of seasonal viruses. Mice infected during pregnancy demonstrated lower hemagglutination inhibition and neutralizing antibody titers than non-pregnant animals until 63 days post infection. These differences in humoral immunity suggest that pregnancy impacts antibody maturation mechanisms without alterations to B cell frequency or antibody secretion. This is further supported by transcriptional analysis of plasmablasts, which demonstrate downregulated B cell metabolism and post-translational modification systems only among pregnant animals. In sum, these findings corroborate a link between adverse pregnancy outcomes and severe pathology observed during pandemic influenza infection. Furthermore, our data propose that pregnancy directly confounds humoral responses following influenza infection which resolves post-partem. Additional studies are required to specify the involvement of plasmablast metabolism with early humoral immunity abnormalities to best guide vaccination strategies and improve our understanding of the immunological consequences of pregnancy. [ABSTRACT FROM AUTHOR]

Biogenic volatile organic compounds (BVOC) participate in reactions that can lead to secondarily formed ozone and particulate matter (PM) impacting air quality and climate. BVOC emissions are important inputs to chemical transport models applied on local to global scales but considerable uncertainty remains in the representation of canopy parameterizations and emission algorithms from different vegetation species. The Biogenic Emission Inventory System (BEIS) has been used to support both scientific and regulatory model assessments for ozone and PM. Here we describe a new version of BEIS which includes updated input vegetation data and canopy model formulation for estimating leaf temperature and vegetation data on estimated BVOC. The Biogenic Emission Landuse Database (BELD) was revised to incorporate land use data from the Moderate Resolution Imaging Spectroradiometer (MODIS) land product and 2006 National Land Cover Database (NLCD) land coverage. Vegetation species data are based on the US Forest Service (USFS) Forest Inventory and Analysis (FIA) version 5.1 for 2002-2013 and US Department of Agriculture (USDA) 2007 census of agriculture data. This update results in generally higher BVOC emissions throughout California compared with the previous version of BEIS. Baseline and updated BVOC emission estimates are used in Community Multiscale Air Quality (CMAQ) Model simulations with 4 km grid resolution and evaluated with measurements of isoprene and monoterpenes taken during multiple field campaigns in northern California. The updated canopy model coupled with improved land use and vegetation representation resulted in better agreement between CMAQ isoprene and monoterpene estimates compared with these observations. [ABSTRACT FROM AUTHOR]

Hospitalized oncology patients have an increased potential for falls related to many conditions including decreased nutrition, chemotherapy side effects and post-operative complications. During auditing of fall prevention safety protocol, it was noted that there was a lack of compliance with all aspects of the protocol. This prompted the falls committee to ask each manager to come up with a solution to increase adherence to the hospital-approved fall prevention protocols. The purpose of this process improvement initiative was to evaluate the impact of placing the "Fall Safety Checklist" (FSC) and "Patient Safety Education Sheet" (PES) in the patient room. The goal was to see an increase in the compliance use of these tools during bedside shift report by the Registered Nurse. This process improvement initiative used a Fall Safety Checklist during shift handoffs to complete a point- by-point review of the fall prevention interventions mandated by the hospital's fall prevention protocol. It also uses a "Patient Safety Education Sheet" which the patient signs to acknowledge the purpose of the fall safety initiatives. Both the FSC and PES are placed in the same spot in each patient room. The FSC is to be reviewed and updated at the beginning of the shift during patient handoff times. The PES sheet is to be reviewed with the patient upon arrival to the unit and reinforced when/if the patient is deemed a fall risk. Compliance data was collected for 4 months after intervention. The unit was audited weekly by the Clinical Nurse Specialist prior to placing the fall tools at the bedside. The compliance percentage prior to the intervention was 52%. After the initiation of the intervention, compliance increased to 88%. Compliance with fall protocols can help decrease fall rates of oncology patients. By placing the checklist forms in the patient room, the staff are held accountable for the completion of these forms. By making the forms more visible it allows the staff to use during bedside shift report. The goal of the fall safety checklist is to verify that all fall prevention interventions are in place at the change of shift and that the patient is aware of these interventions. [ABSTRACT FROM AUTHOR]

A recent uptick in mediport infections at Karmanos Cancer Institute (KCI), provided an opportunity to review standards and procedures related to mediports. A systematic review of current process can be used to attempt to identify deviations from standards. Since most mediports are accessed and maintained in the ambulatory settings, this area was the focus of the review. Standardized care and messaging from initiation of care and throughout the care continuum can be an impactful way to provide quality and safe patient care. The purpose was to assemble a task force of key stakeholders to systematically review and create a standardized process for mediport care with the goal of decreasing infections. A task force of key stakeholders reviewed the process of patients who had a mediport placed at KCI through continued care and maintenance. The process review began with the education patients received about CHG bathing prior to placement and continued through general mediport care. Real-time observations were completed for mediport placements in interventional radiology as well as in all areas at KCI where mediports are accessed and maintained. Gaps were identified in education prior to port placement and lack of standardization of care and maintenance. The task force created a plan for education, a standard script for patient education and documentation, and audits for these identified gaps. Education of the standardized process including patient education prior to placement and central line care bundle was provided to all ambulatory nurses. Since implementation of the ambulatory port task force, the number of port infections in the ambulatory setting have decreased. For 2020 overall, 33 port infections were identified in the ambulatory setting. Since implementation of the education and central line care bundle, there have been 12 mediport infections identified as of August 2021. A systematic review of current process from start to finish as well as standardization of care with clear expectations of all areas can decrease infection rates. By forming a task force of key stakeholders and reviewing current process from start to finish, the opportunity is present to reinforce standards of care or enhance current policies with the goal of preventing infections. [ABSTRACT FROM AUTHOR]

The understanding of oxidation in forest atmospheres is being challenged by measurements of unexpectedly large amounts of hydroxyl (OH). A significant number of these OH measurements were made by laser-induced fluorescence in low-pressure detection chambers (called Fluorescence Assay with Gas Expansion (FAGE)) using the Penn State Ground-based Tropospheric Hydrogen Oxides Sensor (GTHOS). We deployed a new chemical removal method to measure OH in parallel with the traditional FAGE method in a California forest. The new method gives on average only 40-60% of the OH from the traditional method and this discrepancy is temperature dependent. Evidence indicates that the new method measures atmospheric OH while the traditional method is affected by internally generated OH, possibly from oxidation of biogenic volatile organic compounds. The improved agreement between OH measured by this new technique and modeled OH suggests that oxidation chemistry in at least one forest atmosphere is better understood than previously thought. [ABSTRACT FROM AUTHOR]

A novel pattern-based model evaluation technique is proposed and demonstrated for air quality models (AQMs) driven by meteorological model (MM) output. The evaluation technique is applied directly to the MM output; however, it is ultimately used to gauge the performance of the driven AQM. This evaluation of AQM performance based on MM performance is a major advance over traditional evaluation methods. First, meteorological cluster analysis is used to assign the days of a historical measurement period among a small number of weather patterns having distinct air quality characteristics. The clustering algorithm groups days sharing similar empirical orthogonal function (EOF) representations of their measurements. In this study, EOF analysis is used to extract space-time patterns in the surface wind field reflecting both synoptic and mesoscale influences. Second, simulated wind fields are classified among the determined weather patterns using the measurement-derived EOFs. For a given period, the level of agreement between the observation-based clustering labels and the simulation-based classification labels is used to assess the validity of the simulation results. Mismatches occurring between the two sets of labels for a given period imply inaccurately simulated conditions. Moreover, the specific nature of a mismatch can help to diagnose the downstream effects of improperly simulated meteorological fields on AQM performance. This pattern-based model evaluation technique was applied to extended simulations of fine particulate matter (PM2.5) covering two winter seasons for the San Francisco Bay Area of California. [ABSTRACT FROM AUTHOR]

Abstract: Methods are presented to extract intra-seasonal meteorological patterns at three scales to explain 24-h fine particulate matter (PM2.5) pollution events: evolving large-scale meteorological scenarios, synoptic regimes driving diurnal variability near the surface, and localized meteorological triggers. The methods were applied to understand how winter weather conditions impacted PM2.5 around the San Francisco Bay Area (SFBA). Analyzing data across 12 winters (November–March) ensured robust characterization of the SFBA conditions. SFBA 24-h PM2.5 exceedances (35μg m−3) required several simultaneous characteristics: a ridge of aloft high pressure moving over SFBA, providing weak surface pressure gradients over Central California; persistent easterly flows through SFBA extending vertically to around the 925-hPa pressure level; orographically channeled winds resulting from stability; enhanced nocturnal cooling under clear-sky conditions providing for enhanced drainage flows off the Central California slopes; and at least two consecutive days of these conditions. [Copyright &y& Elsevier]

Two empirically unresolved areas of study of Gottfredson and Hirschi's (1990) self-control theory are personality and gender. The theory states that personality is unrelated to self-control and crime, and prior studies have found that self-control operates differently for males and females. Using data from confined delinquents in the California Youth Authority (n = 791) and measures derived from the Weinberger Adjustment Inventory which is a superordinate measure of personality, the current study explored the linkages between self-control and institutional misconduct. MANOVA and negative binomial regression models showed that wards with lower self-control/self-restraint had greater levels of diverse institutional misconduct. However, self-control was predictive of misconduct in only three of ten multivariate models and only among males. Self-control was unrelated to institutional misconduct among females. Implications for theory and research on the general theory are provided. [ABSTRACT FROM AUTHOR]

The article identifies the biased values in extended historical records of hourly surface wind measurements using a consistency checking methodology. The motivation of using extended records of surface wind data is to understand the effects of meteorology on tropospheric ozone levels in the San Joaquin Valley of Central California. A description of the San Joaquin Valley study domain is presented. The three types of inconsistent data are discussed which includes annual biases, unexpected values and discontinuities.

Nurses at our NCI-designated comprehensive cancer center pride themselves on providing safe, quality, and compassionate care to our patients and their families. During the pandemic, our abilities to do so were truly tested. Family engagement is essential in the patient's cancer journey and it is routine for them to be at bedside during hospitalizations. We believe limiting visitors, and the loss of their encouragement and support of their loved one, influenced outcomes. Most notably the rates of falls, pressure injuries and infection rates increased during this time. Staff nurses, along with leaders and content experts, routinely participate in committees dedicated to reviewing our nursing sensitive indicators and offer suggestions/ideas of how to improve these measures. However, with the rates increasing, leadership needed to conduct a deeper review of nursing practice. The purpose of the additional task forces was to look at current practice and enhance strategies to improve the quality of care. In addition to meetings that the bedside staff were having, nursing leadership, the quality department, the Clinical Nurse Specialist (CNS), Chief Nursing Officer and content experts (e.g. WOCN, Infection preventionist) all participated in task forces focused on improving quality. The task force, with support from Nurse Practice Council (NPC), implemented new strategies which included re-education of the fall protocol and development of an escalation process for patient refusal, targeted Braden training, case study presentations and standardizing hygiene products used by patients and staff. The rate of falls, infections and pressure injuries have not returned to pre- pandemic rates but are starting to show less variability. While our number of falls, pressure injuries and central line associated blood stream infections (CLABSI) were trending higher than 2020, we have been able to generate momentum with these new initiatives. We expect they will help us return to our norm of providing safe, quality and compassionate care that we can be proud of. By bringing the leaders and content experts together as a task force, a focused review took place and structured action plans were developed more quickly. Discussion at the NPC helped ensure a shorter turnaround time to implementation. [ABSTRACT FROM AUTHOR]

At Karmanos Cancer Center nursing care is delivered using the principles of the Relationship-Based care model. One of the principles in the model is care of self; one way organizations can promote a caring environment is by providing self-care initiatives through education. The COVID pandemic has placed additional stressors on staff not only at work, but also at home. Staff expressed an interest in learning more about self-care and requested additional information. At the time, the organization/unit did not have self-care specific information available for the staff. The purpose of this process improvement project was to provide staff resources on self-care initiatives and heighten the awareness of the importance of self-care. A wellness board was created next to the time clock for staff to view. The wellness board has areas to place information related to mindfulness, exercise, and healthy eating with a goal of changing out information monthly. Once created all staff were educated on development and purpose of the wellness board through email communication. The wellness board is updated by various members of the team and all team members are encouraged to add information they find helpful. After the wellness board was created, the staff were encouraged to discuss self-care throughout the day. Some staff have found the board helpful, but unfortunately it has not been as engaging as originally thought. It has been difficult to have additional staff members providing resources for the board as originally thought. The placement of the board is being evaluated to see if it includes all staff (including those that do not punch in with a time clock). Other units throughout the healthcare system are also looking at the use of a wellness board. Self-care is an important part of an oncology nurse's day especially as they deal with the complexity of care related to COVID and restrictions. A wellness board is a method to be able provide education related to self-care and can easily be replicated in other areas. With proper placement the wellness board can encourage staff to think about wellness and how it can easily be integrated into their busy lives. The wellness board can also promote an environment in which the staff feel supported and valued by leadership and other colleagues. [ABSTRACT FROM AUTHOR]

Related to the restrictions placed by COVID-19; the trainers that are assigned to the network cancer centers were unable to meet in-person in 2020. Since the inception of the train the trainer program in 2016, the group has meet in person yearly at the annual cancer meeting. In 2021, it was evident that the group needed to reconnect and discuss new regulations, staffing issues and reaffirm the competency check off, as well as train new trainers. Due to continued COVID-19 concerns and staffing issues; virtual training sessions were requested by leadership. The purpose of this project was to find alternative means in which to meet with the trainers and reinforce the changes in standards, provide support related to staffing/practice issues and reaffirm the expectations of yearly competencies. In addition, a format to train newly identified trainers needed to be developed. Four sessions were scheduled via a virtual environment for trainers to join. Session times/dates were discussed with the leadership and set based on staff availability. On-line sessions were kept to 2 hours and all trainers were expected to join at least one session to receive information and provide feedback. The format of the virtual presentation was a powerpoint with changes in regulations and review of competencies evaluation; time was built in to discuss clinic challenges and lessons learned from COVID-19. The new trainers also received education of how to complete competency evaluations and expectations. An online document storage system was also put into place for trainers to be able to access documents when needed. All network trainers were able to attend a virtual session and receive information. The trainers reported that the virtual format and session was an effective way to communicate. Using the new virtual format, all trainers now have access to all the documents needed for new hire orientation, competency validation and content from the session presented. When faced with changes in the environment including not being able to meet in person, a virtual environment can help connect groups. Touch points with trainers/preceptors about changing expectations, regulations and discussing challenges is important in maintaining continued competence. Virtual formats allow groups to communicate with others about challenges they are having and have access to data needed to maintain competence. [ABSTRACT FROM AUTHOR]

Reducing readmission rates is on the forefront of every hospitals agenda and oncology patients have an increased risk for readmission due to their complex diagnosis and treatment. Research has shown that discharge follow up phone calls have decreased readmission rates when completed in a timely manner. At Karmanos Cancer Institute, discharge phone calls were originally assigned to the staff RNs to complete when they had down time on the floor. This led to many missed discharge phone calls in the time allotted (10 days). In 2020, a new position was created to address the need of placing discharge phone calls to all patients in a timely manner. The purpose of this initiative was to increase the number of completed discharge phone calls and decrease readmissions of oncology patients. In 2020 a new position was created for a discharge call nurse. This was created to provide structure to the discharge phone call process, increase the number of calls being completed and to decrease readmissions. Two part-time RNs were hired for the position using a script to provide structure to the discharge call. The expectations of the role were three-fold: to call 100% of the discharged patients, to reach patients within 3 days of discharge, and to increase the number of completed calls. During the discharge call the RNs reinforce education, verify supplies have been received, assist with follow-up appointments, and remind patients who/when to call in the event of an emergency. Prior to the dedicated discharge call nurse approximately 35% of discharge patients were being called within ten days of discharge and only 18% of these calls were completed. Since the discharge call nurse position has been created 100% of discharge patients have been called within three days. 77% of these calls included a discussion with the patient/caregiver. The discharge calls have answered patient questions, referrals have been made as well as follow-up clinic visits and there has been an overall decrease in readmission rates. A structured discharge call program can decrease readmission rates and improve patient satisfaction. Having a dedicated team that calls patients allows the patient/caregiver another resource to use if there are issues following discharge. [ABSTRACT FROM AUTHOR]

Research has shown that compliance to universal fall protocols can reduce the incidence of falls for the inpatient population. The oncology population is at an increased risk for falls and falls with injuries, making adherence to fall precautions among this population especially crucial to patient safety. In 2020, there was an increase in patient falls and falls with injury at Karmanos Cancer Institute. This came after implementation of new fall protocols the previous year which resulted in a significant decrease in falls during 2019. The purpose of this project was to determine if auditing the compliance of fall prevention protocols would increase nurse compliance and decrease the number of patient falls. An audit tool which included all portions of the fall prevention protocol was developed to assess staff compliance with the protocol. The tool included use of a fall safety checklist, documentation of fall safety education, the use of a bed alarm, and presence of all fall safety equipment. Audits were performed weekly on acute care units for patients with a Schmid score of 3 or greater. The audits were completed at various times throughout the day to capture compliance among each shift. Registered nurses were notified of noncompliance in real time, at which point appropriate prevention measures were implemented. The audit data was distributed to leadership for review of compliance and to follow up with staff. Fall rates among inpatients at Karmanos continue to fluctuate as well as compliance with the fall protocol. Leadership noticed that consistent completion of audits correlated with increased compliance to fall protocols and increased staff awareness. After initiation of the fall audits staff members have reported increased active awareness of fall prevention protocols. Due to underlying physiological factors the oncology population is at an increased risk for falls which could result in injury. Fall audits can be an effective way to monitor staff compliance and identify areas of opportunity in a unit's fall prevention strategies. Compliance to safety protocols has been shown to increase with regular auditing and feedback. [ABSTRACT FROM AUTHOR]

The distribution of historical ozone levels for a region is tabulated as a function of its prevailing synoptic and mesoscale influences. Meteorological patterns are determined sequentially from extended records of hourly surface wind measurements sampling relevant low-level flows. A visualization method is presented to readily indicate the likelihoods for exceedances to occur under a variety of meteorological conditions. The study domain is San Joaquin Valley (SJV) of California, which is divided into three subregions (North, Central, and South). Each day from May–October of 1996–2004 is labeled using synoptic (single-day) and mesoscale (intra-day) patterns. Emissions levels are assumed roughly constant for this period following the introduction of reformulated gasoline to California. Synoptic motions largely control the regional SJV ozone pollution potential; the same single-day patterns are identified for all three SJV subregions. Additionally, a unique mesoscale flow feature is identified in each subregion that strongly affects its ozone levels: flows through minor Coast Range gaps for N-SJV, the Fresno Eddy for C-SJV, and flows through Mojave Pass for S-SJV. The strength of each mesoscale feature is characterized using 1-h surface u or v wind components that explain local ozone pollution potentials. [Copyright &y& Elsevier]

New early- and late-maturing navel orange varieties have expanded the navel orange season for California's domestic and export fresh-fruit market. For 5 years, we evaluated the fruit-quality characteristics of purported late-season varieties imported from Australia to determine whether they have any advantages over Lane Late, the first late-season navel orange imported from Australia and grown in California. Of the six varieties evaluated, Autumn Gold, Barnfield, Chislet, Powell and Lane Late had late-maturing characteristics, but none of these varieties stood out as having the lates maturing fruit for all traits associated with maturity at all nine locations studied. For certain locations, sample dates and years, there were significant differences among the varieties for quality traits associated with maturity, such as solids-to-acid ratio, percentage acidity and puncture resistance, but these differences varied depending upon location. [ABSTRACT FROM AUTHOR]

A clustering algorithm is developed to study hourly, ground-level wind measurements obtained from a network of monitoring stations positioned throughout the San Francisco Bay Area of California. A statistical model based on principal components analysis (or empirical orthogonal functions) is used to cluster these autocorrelated and cross-correlated observations. Patterns at the synoptic time scale are isolated by using windowing and scaling operations to treat the data. Four dominant wind patterns that affect air quality are identified for the study region, and summer days from 8 yr of historical data are assigned to these modes. One cluster captures a high pressure system over the western United States, the anticyclonic winds of which block the typical marine flow through the study region. Differential heating convects a polluted air mass to a nearby valley in which severe episodes of higher-than-average ozone composition occur. A second pattern represents a seasonal, offshore ridge of high pressure that reduces marine flow and produces a shallow boundary layer. These two clusters capture distinct meteorological regimes that are favorable to ozone buildup and account for nearly all “exceedances” of ozone air-quality standards. Two other clusters have strong marine flow that inhibits ozone buildup. [ABSTRACT FROM AUTHOR]

Features Idealab in Pasadena, California and its case history of entrepreneurship. Company background; Key to success on the Internet according to Idealab CEO Bill Gross; Principles adapted by Idealab in order to achieve competitive advantage.

Over the past year, there has been an increase in patient falls and falls with injury in the ambulatory areas at Karmanos Cancer Center. Reasons for the increased fall rates were thought to include increased patient acuity and visitor restrictions placed due to COVID-19 precautions. In January 2021, a patient fell and sustained a major injury requiring hospitalization which prompted a root cause analysis (RCA) to be completed. As a response to both the rise in falls and suggestions from the RCA, an ambulatory falls task force was created. The purpose of this initiative was to devise and implement a standardized process to improve ambulatory patient safety. The goals were to improve the identification of patients at risk for falls, create consistent Interventions and methods to communicate fall risk of the patient, as well as to improve patient education around falls. Resources from protocols and interventions used in the inpatient units, literature searches and recommendations from associated organizations were collected for review. The task force used these resources to create a standardized ambulatory processes from patient check-in to discharge. The new standardized ambulatory process included assessing the patient for factors that would determine that the patient was a fall risk, determining the indictor needed to communicate risk of fall, and creation of an "Outpatient Safety Education Sheet" for the nurse to review with patients at first visit and when deemed a risk. The new plan also includes improved communication methods as the patient moves between ambulatory areas and use of a "Preventing Falls" safety brochure. Education of the new standardized process was provided to staff members in all ambulatory areas. All ambulatory staff have been educated on the new standardized process. Fall rates are reviewed each month and any gaps in the standardized process are discussed with leadership and staff involved. The task force will continue to meet quarterly to assess the process. Patients have a risk for falling especially when going to a new place, receiving new treatment, and not having a family member present. As we continue to see the acuity of patient increase in the ambulatory areas and limit family members who can be present; it is important to have standardized safety plans in place to limit injury to these patients. [ABSTRACT FROM AUTHOR]

Use of central line care bundles has been reported as one strategy to decrease central line associated blood stream infections (CLABSI). Due to an increase in CLABSIs at Karmanos Cancer Center (KCC), a task force was created to review all current evidence and the current policy/practice. KCC did not have a standardized central line care bundle, and the inpatient and ambulatory settings were using different procedures. Evidence found that incorporating CHG impregnated disks, alcohol caps, standardized CHG bathing, and CHG swabs into care bundles can benefit in the decreasing of CLABSI rates. The purpose of this quality improvement project was to incorporate the best-evidence related to central line care into a standardized bundle and decrease hospital-wide CLABSI rates. A hospital wide central line bundle was implemented to decrease CLABSI rates. This bundle included the implementation of a CHG impregnated disk for all accessed infusaports, alcohol caps on all needless connector access points, changing from alcohol swabs to CHG swabs in all inpatient areas, and re-education of CHG bathing practices in both the ambulatory and inpatient population. All nursing staff received education on the central line bundle. The goal of the education was that all staff would deliver the same care and message to their patients as well as to improve compliance in the use of the bundle. Additional focused education on CHG bathing included documents to discuss all possible scenarios for CHG bathing and patient expectations once they were admitted to the hospital. The standardization of the bundle and education were completed over a six-month period. As of August 2021, there has been a decrease in the overall number of CLABSI from 2020. Staff were receptive to the education and changes to the central line care. Ongoing line audits are being performed to assess continued compliance to the central line bundle. When quality measures such as increased CLABSIs are identified, organizations should look at all care and evidence to pinpoint opportunities to improve or reinforce current practice. Implementation of a standardized central line bundle based on the current evidence can decrease CLABSI rates. [ABSTRACT FROM AUTHOR]

An increase in central line-associated blood stream infections (CLABSIs) in hospitalized oncology patients generated the rollout of a new central line care bundle at Karmanos Cancer Institute. Central line care education was provided to nursing staff and various infection prevention measures were implemented simultaneously. Hospital leadership expressed concern that implementation of several interventions at once may interfere with consistent execution of each. Real time compliance audits were proposed to ensure adherence to all components of the central line care bundle. The purpose of real-time audits of nursing compliance to a new central line care bundle was to improve compliance by providing instant feedback. An audit tool was developed to include critical aspects of central line care. Criteria included type of line, integrity of dressing, presence of drainage, date on dressing, alcohol caps on IV tubing, chlorhexidine gluconate (CHG) soap at shower/bedside, and documentation of IV tubing change and CHG bathing. Using the tool, two intravenous drug therapy (IVDT) nurses performed weekly in-person central line audits. They reinforced central line care teaching and the importance of CHG bathing with the patients, corrected any deviations from policy, and provided verbal reminders to bedside nurses in real time. Results were compiled weekly and distributed to leadership. Upon evaluation of the audit data, inconsistencies with documentation and the presence of CHG soap at the shower/bedside were the most common issues found. As the audits progressed, total compliance to the new central line care bundle improved. Unit managers took an active role in following up with staff to prevent further noncompliance. Current CLABSI rates compared to the previous year are stable. Oncology patients are often immunocompromised and especially vulnerable to CLABSIs. Real time audits with reinforcement of policy helped the nurses comply with their central line care. When compared to retrospective methods, real time audits allow for better risk management and error detection, ideally before infection occurs. The opportunity to provide immediate feedback to the bedside nurse allows for deviations to be corrected sooner and demonstrates to leadership a higher degree of reliability of nursing compliance to a care bundle. [ABSTRACT FROM AUTHOR]

Atmospheric photooxidation of isoprene is an important source of secondary organic aerosol (SOA) and there is increasing evidence that anthropogenic oxidant emissions can enhance this SOA formation. In this work, we use ambient observations of organosulfates formed from isoprene epoxydiols (IEPOX) and methacrylic acid epoxide (MAE) and a broad suite of chemical measurements to investigate the relative importance of nitrogen oxide (NO/ NO2) and hydroperoxyl (HO2) SOA formation pathways from isoprene at a forested site in California. In contrast to IEPOX, the calculated production rate of MAE was observed to be independent of temperature. This is the result of the very fast thermolysis of MPAN at high temperatures that affects the distribution of the MPAN reservoir (MPAN / MPA radical) reducing the fraction that can react with OH to form MAE and subsequently SOA (FMAE formation). The strong temperature dependence of FMAE formation helps to explain our observations of similar concentrations of IEPOX-derived organosulfates (IEPOX-OS; ~1 ng m-3) and MAE-derived organosulfates (MAE-OS; ~1 ng m-3) under cooler conditions (lower isoprene concentrations) and much higher IEPOX-OS (~20 ng m-3) relative to MAE-OS (<0.0005 ng m-3) at higher temperatures (higher isoprene concentrations). A kinetic model of IEPOX and MAE loss showed that MAE forms 10-100 times more ring-opening products than IEPOX and that both are strongly dependent on aerosol water content when aerosol pH is constant. However, the higher fraction of MAE ring opening products does not compensate for the lower MAE production under warmer conditions (higher isoprene concentrations) resulting in lower formation of MAE-derived products relative to IEPOX at the surface. In regions of high NOx, high isoprene emissions and strong vertical mixing the slower MPAN thermolysis rate aloft could increase the fraction of MPAN that forms MAE resulting in a vertically varying isoprene SOA source. [ABSTRACT FROM AUTHOR]

Matching oncology nurses' assignments with patient acuity has critical implications for providing safe, effective, and efficient care. Despite this, there is a lack of well-established methods for accurate assessment of oncology patient acuity. Valid and reliable patient acuity scales are needed to accurately assess acuity of oncology patients. The purpose of this pilot study was to evaluate the psychometric properties (reliability and validity) of the Karmanos Cancer Institute Patient Acuity Scale (KPAS). The Karmanos Cancer Institute (KCI) nurse practice committee charged a small group of nurses to develop a patient acuity scale. Representatives from each inpatient unit were invited to join the acuity scale task force with the goal of developing and proposing a standardized patient acuity scale that could be used across all KCI non-ICU inpatient-nursing units to facilitate making equitable nurse-patient assignment and staffing decisions. The KPAS was developed and organized to rate patients across three levels of acuity (1=stable, 2=complex, 3=high risk) and two domains (severity of illness and nurse workload). Two inpatient units were selected to trial the KPAS (1 bone marrow transplant unit and 1 post-operative surgical unit) for 60 days and would be required to complete the scale five times per day to coincide with daily staff scheduling. At the conclusion of the 60-day pilot, the acuity scale scores were assessed. The following information was also included on the data collection sheets: number of code blue events, number of rapid response events, and number of patient falls. Staff nurses on the two inpatient trial units completed an acuity scale survey. Survey results suggested minimal scale modification and led researchers to conclude that the scale was reliable and valid in capturing KCI acute care population. A standardized acuity scale provides a method to accurately assess all types of oncology patients. The KPAS provided a means for hospital leadership to adequately staff units based on patient acuity. The KPAS created a level playing field where different patient populations could be fairly compared for resource allocation. [ABSTRACT FROM AUTHOR]