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Excessive daytime sleepiness (EDS) is the most common symptom of sleep-disorders. Although high levels of EDS have been reported among firefighters, there is a limited understanding on EDS in firefighters. A cross-sectional survey was conducted in full-time firefighters (

Salon gatherings featuring conversations about current themes in a profession are evolving with time and practice to meet the needs of modern nurses and their clinical partners. Nursing clinical educators at a Midwestern pediatric hospital system offered a nursing salon experience as a new component of education days to provide an opportunity for clinical staff to engage in content and conversations about practice in a setting away from direct patient care. The objective of the nursing salons was to engage in professional reflection. Staff members of a professional development center and a department of quality and safety collaborated to provide this experience for over 500 nurses, clinical support associates, and leaders, to enhance clinical education days.

BACKGROUND The Whole School, Whole Community, Whole Child (WSCC) model is an evidence‐based comprehensive framework to address health in schools. WSCC model use improves health and educational outcomes, but implementation remains a challenge. METHODS Working with 6 schools in 2 districts in the Midwest, we used a mixed‐methods approach to determine the people, systems, and messages needed to activate WSCC implementation. We report on social network analysis and message testing findings and research translation to develop the Healthy Schools Toolkit. RESULTS Social networks for both districts included more than 150 individuals. Both demonstrated network densities less than half of the desirable threshold, with evidence of clustering by role and minimal cross‐school relationships, posing challenges for WSCC implementation. Across stakeholder groups, messages that emphasize empathy, teamwork, and action were well‐received, especially when shared by trusted individuals through communication channels that align with stakeholder needs. CONCLUSIONS The Healthy Schools Toolkit provides an example of a translational product that helps to bridge research with practice. With features that highlight 6 design principles, the toolkit provides complementary activities that schools and districts can use as they plan for integration of the WSCC model.

BACKGROUND Hypoglycemia can be a common occurrence in hospitalized patients, both those with and without diabetes. Hypoglycemia poses significant risks to hospitalized patients, including increased mortality. OBJECTIVES This was a retrospective pre-post study of hypoglycemic patients in an academic medical center of an intervention to improve timely staff nurse adherence to a hypoglycemia protocol. The number of mild and severe hypoglycemia events pre- and postintervention, timeliness of adherence to the hypoglycemia protocol, the number of treatment interventions, and time to return patients to euglycemia were analyzed. METHODS Data from hospitalizations of patients who experienced hypoglycemia (

Introduction: Current research in the areas of liver transplant and cognitive function has primarily examined cognitive changes from pre- to 1-year posttransplant, resulting in an insufficient understanding of cognitive trajectory beyond early periods of transplant and its impact on self-management. This study aimed (1) to describe global and domain-specific cognitive function in liver transplant recipients who survived more than 6 months after transplant and (2) to describe patient and clinical characteristics of recipients with impaired global and/or domain-specific cognitive function. Further, this study explored the potential relationships between cognitive function and self-management by examining differences in cognitive function by levels of self-management. Design: This secondary data analysis included 107 adult liver transplant recipients, who had a functioning transplant for at least 6 months. Data of cognitive function, demographic and clinical characteristics, and self-management were extracted for this study. T tests, Mann-Whitney tests, and Kruskal-Wallis tests were used to examine differences in cognitive function by variables. Results: More than half of the recipients had global cognitive impairment. Significant differences were found in global and domain-specific cognitive function. Older, male, married, or deceased donor recipients had lower cognitive test scores than younger, female, single, or living donor recipients. There were no significant differences in global and domain-specific cognitive function by time since transplant and levels of self-management. Discussion: Future longitudinal studies should examine the long-term trajectory of cognitive function posttransplant. Other factors such as caregivers’ participation in self-management should be accounted for in future studies when examining the relationship between cognitive function and self-management.

Background: Cardiovascular disease is the leading cause of death in kidney transplant recipients. Physical activity after transplant is the most modifiable nonpharmacological factor for improving cardiovascular outcomes. Few studies have tested walking interventions to enhance daily steps and health outcomes in older kidney recipients. Methods: Using a pilot feasibility randomized clinical trial design, we tested the feasibility and efficacy of a 6-month SystemCHANGE™ (Change Habits by Applying New Goals and Experience) + Activity Tracker intervention for recruitment, retention, daily steps, and health outcomes (blood pressure, heart rate, body mass index, waist circumference, and physical function). The SystemCHANGE™ + Activity Tracker intervention taught participants to use a multicomponent intervention that connects person-centered systems solutions combined with visual feedback from a mobile activity tracker to achieve daily step goals. Results: Fifty-three participants (mean age 65 years, 66% male, and 57% white) participated with 27 in the intervention and 26 in the control group. The study protocol was feasible to deliver with high adherence to the protocol in both groups. The intervention group increased daily steps at 3 months (mean difference, 608; standard error = 283, P = .03) compared to the control group. The secondary outcome of heart rate decreased for the intervention group (baseline [mean] 74.4+ 10.8 [standard deviation, SD;] vs 6 months [mean] 67.6+ 11.3 [SD]; P = .002) compared to the control group (baseline [mean] 70.67+ 10.4 [SD]; vs 6 months [mean] 70.2 + 11.1 [SD]; P = .83). Conclusions: SystemCHANGE™ + Activity Tracker intervention appears to be feasible and efficacious for increasing daily steps in older kidney recipients.

Observations of volatile organic compounds (VOCs) from a surface sampling network and simulation results from the EMAC (ECHAM5/MESSy for Atmospheric Chemistry) model were analyzed to assess the impact of increased emissions of VOCs and nitrogen oxides from U.S. oil and natural gas (O&NG) sources on air quality. In the first step, the VOC observations were used to optimize the magnitude and distribution of atmospheric ethane and higher-alkane VOC emissions in the model inventory for the base year 2009. Observation-based increases of the emissions of VOCs and NOx stemming from U.S. oil and natural gas (O&NG) sources during 2009–2014 were then added to the model, and a set of sensitivity runs was conducted for assessing the influence of the increased emissions on summer surface ozone levels. For the year 2014, the added O&NG emissions are predicted to affect surface ozone across a large geographical scale in the United States. These emissions are responsible for an increased number of days when the averaged 8-h ozone values exceed 70 ppb, with the highest sensitivity being in the central and midwestern United States, where most of the O&NG growth has occurred. These findings demonstrate that O&NG emissions significantly affect the air quality across most of the United States, can regionally offset reductions of ozone precursor emissions made in other sectors, and can have a determining influence on a region’s ability to meet National Ambient Air Quality Standard (NAAQS) obligations for ozone.

The current experiment tested the effect of social media use on college women's appearance comparisons, mood, and body satisfaction. We randomly assigned 308 undergraduate women (aged 18-26) to use Facebook, use Instagram, or play a matching game (the control condition) on an iPad for seven minutes. Compared to the Facebook condition, Instagram users retrospectively reported spending more time viewing images or videos containing people. Participants in both the Facebook and Instagram conditions also retrospectively reported engaging in more appearance comparisons relative to those in the control condition, but Instagram users reported significantly more appearance comparisons than those in the Facebook condition. Those who used Instagram, but not Facebook, showed decreased body satisfaction, decreased positive affect, and increased negative affect. Results are consistent with previous research suggesting social media use influences body satisfaction and social comparison, and that Instagram may be a particularly harmful platform when it comes to body image because of its focus on photos over text.

Achievement of the 1.5 °C limit for global temperature increase relies on the large-scale deployment of carbon dioxide removal (CDR) technologies. In this article, we explore two CDR technologies: soil carbon sequestration (SCS), and carbon capture and storage (CCS) integrated with cellulosic biofuel production. These CDR technologies are applied as part of decentralized biorefinery systems processing corn stover and unfertilized switchgrass grown in riparian zones in the Midwestern United States. Cover crops grown on corn-producing lands are chosen from the SCS approach, and biogenic CO2 in biorefineries is captured, transported by pipeline, and injected into saline aquifers. The decentralized biorefinery system using SCS, CCS, or both can produce carbon-negative cellulosic biofuels (≤-22.2 gCO2 MJ-1). Meanwhile, biofuel selling prices increase by 15-45% due to CDR costs. Economic incentives (e.g., cover crop incentives and/or a CO2 tax credit) can mitigate price increases caused by CDR technologies. A combination of different CDR technologies in decentralized biorefinery systems is the most efficient method for greenhouse gas (GHG) mitigation, and its total GHG mitigation potential in the Midwest is 0.16 GtCO2 year-1.

Objective Promotion of physician well-being has emerged as a national priority, yet meaningful interventions depend on further understanding the factors that promote and detract from physician well-being. The aim of this study was to better understand the perspectives of academic pediatricians regarding the factors influencing their well-being. Methods We conducted a qualitative study using grounded theory methodology. In June 2018, we performed facilitated focus groups with academic pediatric faculty at our institution. Focus groups were audio recorded, transcribed, and analyzed using the constant comparative method to identify key themes. Results Fifty-four pediatricians participated in the focus groups. Key themes included 1) pediatricians feel inundated by collective professional and personal pressures, 2) pediatricians feel they have lost control over how time at work is spent, and 3) obscured professional-personal boundaries can cause erosion of personal life. Conclusions Pediatricians identified 3 key barriers to well-being: collective pressures, including increasing and competing academic and clinical responsibilities; low value tasks that consume their time; and erosion of personal life. This study adds to the growing literature describing physician well-being as strongly influenced by workplace factors, and offers examples of modifiable factors for further investigation.

The purpose of this study was to evaluate associations among depressive symptoms, trust of healthcare provider, and health behavior in adolescents who live in a rural area. Two hundred twenty-four adolescents aged 14–19 years old attending public high school in the Midwestern United States were surveyed. Results showed a diagnosis of depression, trust of healthcare provider, health awareness, and stress management predicted depressive symptoms in adolescents living in a rural area. Healthcare providers should take extra care to promote trust in the healthcare provider-patient relationship with adolescents and to follow guidelines for annual screening of adolescents for depressive symptoms. Nursing implications include adolescent psychoeducation to improve health awareness and stress management.

Purpose The purpose of this study was to explore and describe the features of Individualized Education Plans (IEPs) for a cohort of students with traumatic brain injury (TBI) to help elucidate current special education practices for students with TBI. Method We obtained permission from administrators of a local school district of 41,000 students in a Midwestern state to review de-identified IEP records of students verified with TBI. We examined demographic information (i.e., cause and age at time of injury), IEP services and intensity, IEP goal categories, and previous verification status. Results Descriptive results support that intervention services were more intense for students with TBI with greater lengths of time postinjury. Target behaviors within goals were more often related to math and reading than to the cognitive processes that govern these skills, such as attention, memory, and executive functioning. Finally, more than a third of our sample had been verified with a disability and were receiving special education services via an IEP prior to their TBI. Conclusions This work represents an important first step in understanding the special education services for students with TBI. Future research should explore interventions that are ecologically valid for school-based settings and are developed to address the idiosyncratic deficits of students with TBI, particularly interventions that focus on the underlying cognitive processes experienced by these students.

BACKGROUND Despite dual method (DM) contraception being effective in reducing repeat-births and sexually transmitted infections (STIs), Latinx adolescent parents who live in non-traditional migration areas remain vulnerable for both outcomes. OBJECTIVE This study applied the Unified Theory of Behavior (UTB) and drew upon Bronfenbrenner's social ecological model to explore multiple stakeholders' (adolescent parents, caregivers, and nurses) perceptions of factors that influence DM intentions and use among Latinx adolescent parents. METHODS Semi-structured interviews with Latinx adolescent parent-caregiver dyads and nurses were analyzed using thematic analysis. RESULTS Study findings revealed that while all participant groups considered medical providers as DM influencers, contradicting views related to caregivers' as DM influencers emerged among adolescent parents and caregivers. Findings suggest that DM is deemed both acceptable and effective; and adolescent parents' reported DM self-efficacy. DM obstacles included negative emotions, environmental constraints, and poor knowledge and skills. CONCLUSIONS Study results suggest that constructs from the UTB framework are useful in identifying individual and social factors that can potentially influence DM intentions and use among Latinx adolescent parents. IMPLICATIONS FOR PUBLIC HEALTH NURSING This study's findings have potential implications for public health nurses interested in designing community-based interventions to reduce repeat-births and STIs among Latinx adolescent parents.

Aim This study aimed to evaluate the patterns and potential risk factors associated with the occurrence of Salmonella sp. and Escherichia coli in selected United States swine feed mills. Methods and results A total of 405 samples were collected during fall 2018, spring and summer 2019 from selected sites including floors, equipment, shoes and feed in six feed mills in the US Midwest region. Each sample was analysed for the presence of Salmonella and E. coli with culture methods and confirmed by PCR. A survey regarding production volumes, hygiene practices and microbial testing capabilities was conducted in each facility All mills had at least one sampling site positive for either Salmonella or E. coli. Of the 405 samples, 4·7, and 14·1% were positive for Salmonella sp., and E. coli respectively. Sites with higher percentages of positive samples were the receiving, manufacturing, and control area floors. The survey responses indicated that the age of the mill might be a risk factor for bacterial contamination: the older the facility, the higher the number of positive samples. Other risk factors evaluated, such as the production capacity, did not appear to relate to bacterial prevalence. Conclusion The data documents the presence of E. coli and Salmonella in selected US swine feed mills, and an association between E. coli occurrence and number of ingredient suppliers to feed mill. Significance and impact of the study This information could be used to understand risk factors affecting the occurrence of Salmonella sp. and E. coli in feed mills and help implement monitoring and mitigation strategies for public health.

Vascular access team (VAT) nurses receive many consults to place short peripheral catheters (SPCs), a portion of which do not require skilled insertion by a VAT member. VAT nurses at a health care organization in the Midwestern United States developed a program to train direct care nurses as unit-based vascular access champions to increase and improve SPC placement, care, and maintenance. Twenty-one nurses from 6 units were selected to train as vascular access champions; knowledge and confidence around SPC placement were assessed before, immediately after, and 6 months after the training. The training sessions resulted in increased knowledge of SPC insertion, as well as care and maintenance by vascular access champions and other direct care nurses on the units. The percentage of unwarranted VAT referrals for SPC placement decreased on the participating hospital units.

Within a case study design, this paper clarifies community problems, and assesses a Community Health Improvement Plan development process using a framework of explanatory models and change theories that links the macro social model, the materialistic model, social cognitive theory, theory of fundamental causes, and community organizing theory. Properties of demographic and health status artifacts are consistent with the core constructs in both the macro social and the materialistic models. The constructs in social cognitive theory and the theory of fundamental causes seem to influence program strategies even as socio-economic factors were only minimally addressed. At the organizing level, the Plan excelled in locality development and social planning but was short on social action. The findings suggest a need for social action as a model of practice in solving persistent social and health problems, and for research that investigates if social action practice can predict success in resolving these problems.

This study examined a serial mediation model testing the effects of STS on turnover intention through executive leaders' use of transformational leadership as perceived by child welfare workers and then organizational commitment while controlling for age, gender, and social work degrees.Survey data were collected from 264 child welfare workers at one Midwestern state.The results supported the serial mediation model, corroborated by the finding that the impact of STS on turnover intention has disappeared as a result of transformational leadership and organizational commitment between the two variables.The findings of the study provide practical implications for training transformational leadership styles to leaders training at the middle manager and executive leadership levels in child welfare agencies.

Background Extended hospitalization in neonatal intensive care units subjects preterm infants to multiple stress exposures that affect long-term cognitive functioning, motor development, and stress reactivity. Measurement of stress exposure is challenging with multiple measures of stress exposure in use, including counts of skin-breaking or invasive procedures or counts of noxious sensory exposures. Objectives The purpose of this analysis was to compare measures of stress exposure commonly used by researchers and to determine the predictive validity of these measures for early neurobehavior. We accomplished this objective through the following specific aims: (a) describe the stress exposures of preterm infants in the first 2 weeks of life, (b) determine the correlations among measures of stress exposure, and (c) compare the predictive validity of measures of stress exposure for early neurobehavior. Methods Very preterm infants born between 28 and 31 weeks postmenstrual age were enrolled from four neonatal intensive care units in a large Midwest city. We measured stress exposure over the first 14 days of life for each infant as a count of skin-breaking procedures, a count of invasive procedures, and cumulative scores derived from the Neonatal Infant Stressor Scale. Neurobehavior was assessed at 35 weeks postmenstrual age using the motor development and vigor and alertness/orientation subscales from the Neurobehavioral Assessment of the Preterm Infant. We used Spearman's rho to determine correlations among the measures of stress exposure and multiple linear regression to determine the predictive validity of each stress exposure measure for neurobehavioral outcomes. Results Seventy-one preterm infants were included in the analysis. We found marked variance across individuals in all measures of stress exposure. There were moderate-high correlations among the measures of stress exposure. No measure of stress exposure was associated with early neurobehavior. Discussion The stress experiences of hospitalized preterm infants vary. This variance is reflected in all measures of stress exposure. Because measures of stress exposure are highly correlated, the most objective measure requiring the least interpretation should be used. However, the currently available measures of stress exposure used in this analysis may not reflect the infant's physiological stress responses and fail to associate with early neurobehavior.

Objective The present study tested a hypothesized mediation model in which the seven contingencies of self-worth proposed by Crocker and Wolfe mediate the association between global self-esteem and eating disturbances in college women. Method This study utilized a sample of 408 college women. Path analysis was used to produce a model in which the association between global self-esteem and eating disturbances was accounted for through contingencies of self-worth. Results The finalized model indicated that self-worth based on appearance and competition mediated the link between global self-esteem and both drive for thinness and bulimic symptoms. Self-worth based on virtue mediated the link between global self-esteem and bulimic symptoms. Conclusion The present findings clarify facets of self-worth accounting for the association between global self-esteem and eating disturbances in college women, and point to how self-worth based on one's appearance, or the ability to outdo others, is centrally implicated in this relationship.

Background and PurposeThe purpose of this study was to assess psychometric properties of the Perceptions of Brain Injury Survey (PBIS), an instrument designed to assess nurses' perceptions and preparation to care for patients with traumatic brain injury (TBI).MethodsWe adapted two instruments to create the PBIS, and 724 nurses completed the PBIS at three hospitals.ResultsFinal instrument has 66 items and is composed of four subscales, which can be used independently. Results showed Cronbach's alpha for the overall scale was excellent (.93) and alphas for each composite subscale were acceptable to excellent (.73–.93). Findings also suggest good discriminant validity and evidence of external validity.ConclusionsThe PBIS is a reliable and valid measure for assessing nurses' perceptions of caring for patients with TBI in practice or research.

Health care provider communication proficiency is critical in the initiation and revisitation of these discussions throughout the trajectory of chronic illness. The delivery of palliative care (PC) throughout the continuum of illness has traditionally been underutilized. Nurses have the ability to significantly improve PC utilization through the use of advance care planning strategies to confidently initiate conversations with patients and families at multiple points throughout the continuum of illness. Nurses are uniquely positioned to contribute to the improvement of care provided to terminally and chronically ill patients because of the relationship developed and the knowledge of patient-specific disease progression that unfolds during the time spent with patients. In this study, nurses improved communication efficacy by learning to utilize advance care planning-specific interview strategies inclusive of scripting and cued language when initiating PC conversations. The preintervention/postintervention confidence levels of nurses in initiating early PC conversations significantly increased to improve the delivery of PC to patients.

The purpose of this study was to test the development of personality and psychological well-being model. This was a cross-sectional, descriptive design. The 448 participants were recruited from older adults living in a Midwest community in the United States. After Institution of Research Board approval, the trained researchers explained this study to older adults who lived in the community. After agreeing to participate, they signed an informed consent form. The structured questionnaires were used to perform data collection. Path analysis was used to examine this model. SPSS 23 version was employed to examine the instruments’ reliabilities and descriptive data. In this model, family interaction and spiritual well-being had significant influences on personality, which had a significant influence on selecting coping strategies. Using different coping strategies influenced on the outcome variables (e.g., psychological well-being and suicidal ideation). The family interaction and spiritual well-being played a critical role on the outcome variables.

Community climate toward sexual and gender minority (SGM) youth is associated with higher rates of victimization and poorer health and wellbeing-related outcomes such as depression and suicidal ideation. However, this field of research has underemphasized the experiences of transgender youth, particularly within the Midwestern context which is marked by vast rurality and characterized as sociopolitically conservative. Using qualitative and community-based methods, this study identified factors that impact community climate from the perspective of transgender youth (n = 19) in the Midwest and situated them within the Ecological Systems Theory (EST). Thematic analysis of interviews revealed four themes: resources, visibility, policies, and ideologies. Themes often crossed levels within the EST, indicating the complexity and interrelated nature of climate across local, regional, and national contexts. Implications for theory, research, and practice are discussed.

OPREVENT2 was a multilevel, multicomponent (MLMC) adult obesity prevention that sought to improve access and demand for healthier food and physical activity opportunities in six Native American communities in the Southwest and Midwest. OPREVENT2 worked with worksites, food stores, schools (grades 2–6), through social media and mailings, and with a local community action committee (CAC), in each of the three intervention communities, and was implemented in six phases. We conducted a process evaluation to assess implementation of each intervention component in terms of reach, dose delivered and fidelity. Implementation of each component was classified as high, medium or low according to set standards, and reported back at the end of each phase, allowing for improvements. The school and worksite components were implemented with high reach, dose delivered and fidelity, with improvement over time. The school program had only moderate reach and dose delivered, as did the social media component. The CAC achieved high reach and dose delivered. Overall, study reach and dose delivered reached a high implementation level, whereas fidelity was medium. Great challenges exist in the consistent implementation of MLMC interventions. The detailed process evaluation of the OPREVENT2 trial allowed us to carefully assess the relative strengths and limitations of each intervention component.

BACKGROUND: Accurately documenting pediatric atopic dermatitis (AD) severity is important, but research tools, such as Eczema Area and Severity Index (EASI), are too time consuming for clinical settings. Product of the Physician Global Assessment and affected percentage of body surface area (PGA×BSA) is a new, rapid measure of psoriasis severity. OBJECTIVE: To evaluate an Investigator Global Assessment and body surface area product (IGA×BSA) as an easy-to-use severity measure for pediatric AD. METHODS: Patient-reported and objective disease severity measures were collected from 195 caretaker/child dyads (child age range, 5–17 years) with almost clear (Validated Investigator Global Assessment for AD [vIGA] of 1) to severe (vIGA of 4) AD. Data were assessed with Spearman coefficients and plots. Severity strata were proposed by using an anchoring approach based on the EASI. RESULTS: IGA×BSA correlates better with the EASI than IGA alone (r = 0.924 vs r = 0.757, P < .001). Bland-Altman plot indicates high and consistent agreement between IGA×BSA and the EASI. Suggested severity strata for IGA×BSA are 0–30, mild; 30.1–130, moderate; and 130.1–400, severe (κ = 0.760). LIMITATIONS: The patient cohort was predominantly from the midwestern United States. CONCLUSIONS: IGA×BSA (using the vIGA) is a simple measure that correlates well with the EASI in patients with mild to severe pediatric AD. Future work is needed to affirm reliability across IGA scales and responsiveness to change.

Transgenic corn expressing insecticidal proteins derived from the bacterium Bacillus thuringiensis (Bt) is an important pest management tool. Western corn rootworm, Diabrotica virgifera virgifera LeConte, is a key pest of corn in the midwestern United States that has developed field-evolved resistance to all available Bt traits. The first Bt trait to be commercialized for management of rootworm was Cry3Bb1 in 2003, and field-evolved resistance appeared in 2009. In this study, we examined fields in counties where greater-than-expected injury to Cry3 (Cry3Bb1 or mCry3A) corn roots (>1 node) had previously been reported (problem counties) and counties where injury had not been reported (non-problem counties). Four to eight fields were sampled per county in 2015, 2016, and 2017 to quantify rootworm abundance, root injury, Cry3Bb1resistance, and rootworm management strategies. Rootworm abundance, root injury, and resistance to Cry3Bb1 did not differ between county types. Management tactics differed between county types, with problem counties growing more corn, using more soil insecticide, and growing more Cry34/35Ab1 corn. Additionally, a comparison of root injury to Bt and non-Bt corn within fields indicated that farmers derived an economic benefit from planting Bt corn to manage corn rootworm. Our results suggest that rootworm populations are similar between problem and non-problem counties in Iowa due to similar levels of selection pressure on Cry3 corn, but problem county fields have applied more management tactics due to previous rootworm issues in the area.

Background. Having dependent children may affect cancer treatment decisions. We sought to describe women’s surgery and chemotherapy decisions in nonmetastatic breast cancer by parental status. Methods. We conducted a secondary analysis of the 2015 cross-sectional Share Thoughts on Breast Cancer Study, conducted in 7 Midwestern states in the United States, restricted to women of prime parenting age (aged 20–50 years) who consented to the use of their medical records ( N = 225). We examined treatment decisions using data visualization and logistic regression (adjusted for age, stage, family history of breast cancer, income, education, race, health insurance, and partner status). Results. Women with dependent children received bilateral mastectomy more often than women without dependent children (adjusted odds ratio 3.09, 95% confidence interval 1.44–6.62).We found no differences in the receipt of chemotherapy by parental status. Women reported more active roles in surgery than in chemotherapy decision making. Conclusions. As a likely factor in cancer treatment decisions, parental status should be addressed in clinical practice and research. Future research should assess patients’ sense of ownership in treatment decision making by treatment type.

In the United States, having limited access to health care has been an ongoing concern that could cause detrimental effects for minority populations, specifically the Hispanic population. Numerous barriers to accessing health care were identified for both pediatric and adult Hispanic patients who were born with craniofacial conditions. Barriers that were determined to impact Hispanic patients with craniofacial conditions from receiving medical and health services included language and communication, patient-health care provider relationships, socioeconomic status and finances, insurance status, timely access to appointments, citizenship and immigration status, and lack of family and social support. Interventions for these barriers were also proposed to increase support for Hispanic patients. Lamentably, there is scant research that investigates how these barriers affect this special population, despite the limitations that they have in their ability to access health care. In addition, these barriers to treatment have dire consequences for individuals with craniofacial conditions. The findings and proposed interventions discussed in this review article provide measures to minimize these barriers and define ways to benefit Hispanic patients with craniofacial conditions.

The current study investigated associations among cognitive empathy, affective empathy, internalizing problems, and the five steps of the bystander intervention model (notice bullying events, interpret as an event requiring intervention, accept responsibility for intervening, know how to intervene, and act). Participants included 336 fourth and fifth grade students (58.9% boys) at a school in the Midwest region of the United States. Hierarchical regression analyses indicated that greater cognitive empathy was related to noticing bullying events, accepting responsibility to intervene, and knowing how to intervene. Affective empathy was significantly related to the actual act of intervention. Further, significant interactions revealed that affective empathy was positively associated with interpreting bullying as an event that required intervention at low and moderate levels of internalizing problems, but not at high levels of internalizing problems. Overall these findings underscore the need to examine the decision to intervene as the culmination of a series of steps as outlined in the bystander intervention model, with each step potentially influenced by a unique set of precursors.

Background: Previous research shows that pediatricians inconsistently utilize the ethics consultation service (ECS). Methods: Pediatricians in two suburban, Midwestern academic hospitals were asked...

Suckling piglets play an important role at maintaining influenza A virus (IAV) infections in breeding herds and disseminating them to other farms at weaning. However, the role they play at weaning to support and promote genetic variability of IAV is not fully understood. The objective here was to evaluate the genetic diversity of IAV in pigs at weaning in farms located in the Midwestern USA. Nasal swabs (n = 9,090) collected from piglets in breed-to-wean farms (n = 52) over a six-month period across seasons were evaluated for the presence of IAV. Nasal swabs (n = 391) from 23 IAV-positive farms were whole-genome sequenced. Multiple lineages of HA (n = 7) and NA (n = 3) were identified in 96% (22/23) and 61% (237/391) of the investigated farms and individual piglets, respectively. Co-circulation of multiple types of functional HA and NA was identified in most (83%) farms. Whole IAV genomes were completed for 126 individual piglet samples and 25 distinct and 23 mixed genotypes were identified, highlighting significant genetic variability of IAV in piglets. Co-circulation of IAV in the farms and co-infection of individual piglets at weaning was observed at multiple time points over the investigation period and appears to be common in the investigated farms. Statistically significant genetic variability was estimated within and between farms by AMOVA, and varying levels of diversity between farms were detected using the Shannon-Weiner Index. Results reported here demonstrate previously unreported levels of molecular complexity and genetic variability among IAV at the farm and piglet levels at weaning. Movement of such piglets infected at weaning may result in emergence of new strains and maintenance of endemic IAV infection in the US swine herds. Results presented here highlight the need for developing and implementing novel, effective strategies to prevent or control the introduction and transmission of IAV within and between farms in the country.

Native pollinators are important for providing vital services in agroecosystems; however, their numbers are declining globally. Bees are the most efficient and diverse members of the pollinator community; therefore, it is imperative that management strategies be implemented that positively affect bee community composition and health. Here, we test responses of the bee and flowering plant communities to land management treatments in the context of grasslands in the upper Midwestern United States, a critical area with respect to bee declines. Twelve sites were selected to examine floral resources and wild bee communities based on three different types of grasslands: tallgrass prairie remnants, ungrazed restorations, and grazed restorations. Total bee abundance was significantly higher in ungrazed restorations than remnants, but there were no significant differences among grasslands in community composition or Shannon diversity. Across the three grassland types we also examined mass and lipid stores as nutritional health indicators in three sweat bees (Halictidae), Augochlora pura, Agapostemon virescens, and Halictus ligatus. Although there were no differences in lipid content, total average bee mass was significantly higher in Ag. virescens collected from ungrazed restorations as compared to remnants. Floral abundance of native and non-native species combined was significantly higher in grazed restorations compared to remnants and ungrazed restorations. However, ungrazed restorations had higher abundance and richness of native flowering ramets. These data suggest that bee abundance and nutrition are driven by high abundance of native flowering plant species, rather than total flowering plants.

Background Early diagnosis and treatment of familial hypercholesterolemia reduces patient morbidity and mortality associated with coronary heart disease. Despite guidelines recommending screening of all pediatric patients aged 9 to 11 years, universal screening rates are reportedly low. Evaluating current screening practices provides key insights to inform and improve screening rates in the future. Objective The objective of the study was to assess universal cholesterol screening rates for a large cohort of pediatric patients within one healthcare system and at the individual provider and clinic levels. Methods A retrospective review of more than 50,000 electronic health records of children aged 9 to 11 years seen at 46 primary care clinics in a large Midwestern healthcare system between 2011 and 2016 was completed. Descriptive statistics of cholesterol screening status, lipid test results, and patient demographics were used for comparisons of factors influencing screening rates. Results Between 2011 and 2016, 4.0% of eligible pediatric patients were screened in the healthcare system. A majority of clinics and providers screened 4.0% or fewer of eligible patients. Six of the 333 providers (1.8%) screened >10% of eligible patients and completed a majority of the screening at the three higher screening clinics. Conclusion Rates of universal cholesterol screening for pediatric patients were low. Low guideline adherence may be an issue in more than one large healthcare system and state. A small number of physicians appear to be driving screening in clinics with higher screening rates. Further investigation into the motivations of these higher screening providers and the barriers faced by low-screening providers may help inform efforts to improve cholesterol screening rates.

Objectives To determine whether nurses wearing nail polish pose a greater infection risk to patients than nurses who are not wearing nail polish. Sample & setting 89 direct patient care oncology nurses at a large midwestern National Cancer Institute-designated comprehensive cancer center. Methods & variables The investigators assigned participants' three middle fingers of their dominant hand to three groups. Results Comparison of colony-forming units revealed that one-day-old polish exhibited fewer gram-positive microorganisms than the unpolished nail (p = 0.04). The four-day-old polish showed significantly more microorganisms than the one-day-old polish (p = 0.03). The same trend was demonstrated for gram-negative microorganisms, but the difference was not statistically significant (p = 0.3 and p = 0.17, respectively). Implications for nursing The results should be interpreted and applied to expert nursing practice in the care of vulnerable patient populations. Each institution and practitioner should make their own decisions and interpretation of evidence into practice.

Religious congregations are social settings where people gather together in community to pursue the sacred (Pargament, 2008). Such settings are important to understand as they provide a context for individuals to develop relationships, share ideas and resources, and connect individuals to larger society (Todd, 2017a). Yet, research to date has not deeply examined the inherently relational nature of religious congregations. Thus, in this study, we used social settings theory (Seidman, 2012; Tseng & Seidman, 2007) to develop and test hypotheses about relationships within one Christian religious congregation. In particular, we used social network analysis to test hypotheses about relational activity, popularity, and homophily for friendship and spiritual support types of relational links. Our findings demonstrate how relational patterns may be linked to participation in congregational activities, occupying a leadership role, a sense of community and spiritual satisfaction, stratification, socialization, and spiritual support. Overall, this advances theory and research on the relational aspects of religious congregations, and more broadly to the literature on social settings. Limitations, directions for future research, and implications for theory and religious congregations also are discussed.

Background: As the issues of incivility, lateral and horizontal violence, and bullying continue in nursing, strategies are needed to address these disruptive behaviors. Educational activities raise awareness of these issues and can improve the ability to reduce the frequency and overall impact of incivility. Method: This study used a pretest/posttest quasiexperimental mixed-methods design to improve dialogue and interpersonal engagement and to create behavioral change. The Workplace Civility Index (WCI) was used to measure interventional success. Results: WCI scores improved significantly ( p < .00001) for the experimental group postintervention. In contrast, the WCI scores decreased significantly for the control group ( p = .000227). Within the experimental group, all participants noted the successful use of a positive conflict management strategy after the educational intervention. Conclusion: Although further research is recommended, this study provided evidence to support the efficacy of an asynchronous provider-directed, learner-paced e-learning educational activity in decreasing incivility and increasing perceived comfort level during critical conversations between nurses. [ J Contin Educ Nurs . 2020;51(3):138–144.]

The purpose of this study was to examine the treatment effects of the Incredible Years Teacher Classroom Management (IY TCM), a universal classroom management intervention, on the outcomes of children with aggressive behavior in elementary school. Classroom management has been demonstrated as a factor in either escalating children's aggressive behavior or decreasing those problematic behaviors. Participants included 1,817 students (Grade K to 3) and 105 teachers from nine elementary schools in a large urban Midwestern school district. Teachers were randomly assigned to receive IY TCM or to a wait-list comparison group. The hypotheses were that baseline levels of aggression would moderate the relationship between intervention status and outcomes. Findings indicated the hypothesized moderation effect on several outcome variables; specifically, children with baseline aggression problems who were in IY TCM classrooms had significantly improved math achievement, emotional regulation, prosocial behaviors, and observed aggression in comparison to similar peers in the control classrooms. Implications for practice and future research based on the findings are discussed. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Considerable evidence has highlighted the heightened susceptibility of developmental delay in children from low-income homes; consequently, this study explored whether environmental toxicant exposure may be a contributing factor to disruption in language and cognitive development for children reared in poverty. Using a sample of 190 low-income mothers and their young children, mothers completed questionnaires on toxicant exposure in the home environment. Exposure to toxicants, especially pesticides, was reported by about 20% of mothers at or around pregnancy, and 30% when their children were between 1 and 2 years of age. Toxicant exposure was significantly associated with lags in language and cognition even when controlling for socioeconomic factors. Study findings highlight the importance of the American Academy of Pediatrics’ policy statements arguing for pediatricians to take a strong anticipatory guidance role in counseling parents to limit chemical exposure in the home and engage in safe storage practices.

Purpose: This study examines the association between nonparticipation in wellness activities and employee turnover risk. Design: Retrospective, cross-sectional analysis. Setting: Large university in the Midwestern United States. Participants: Employees with continuous employment during 2016 and complete human resources and wellness program data (n = 34 405). Methods: Demographic, health risk assessment (HRA), and wellness program participation data were collected in 2016 and paired with administratively recorded turnover status from 2017. For the multivariate analyses, logistic regression models were used. Results: There were statistically significant associations between various socioeconomic and demographic characteristics (gender, age, race, wage, union and faculty status, and health score) with turnover status. Also, all 3 participation levels (participated in the HRA only, participated in the HRA and wellness programming, and participated in wellness programming only) had lower odds of experiencing turnover compared to nonparticipants (participated in the HRA only [adjusted odds ratio, AOR: 0.89; confidence interval, CI: 0.80-0.99], participated in wellness program(s) only [AOR: 0.77; CI: 0.62-0.95] and participated in both the HRA and program(s) [AOR: 0.82; CI: 0.74-0.91], respectively). Conclusion: Employee participation in wellness program activities appears to represent a measure of engagement with work. Nonparticipation in these programs is associated with increased risk of employment turnover in the subsequent year.

An increasing number of college students are experiencing food insecurity. This study seeks to examine food insecurity through a campus climate lens. The campus climate lens is particularly relevant since extant literature indicates a positive correlation between perceptions of campus climate and academic outcomes. Survey data was collected from 1,295 students at one Midwestern university in order to measure experiences with food insecurity and campus climate. Findings indicate that food insecure students have significantly less favorable perceptions of campus climate as compared to their food secure counterparts. These less favorable perceptions could place food insecure students at risk for compromised academic outcomes. Universities are encouraged to address food insecurity. Social work educators/practitioners in universities are well-positioned to lead this charge, thereby promoting the social and economic well-being of the increasingly diverse student body. Current and proposed social work efforts related to this topic are discussed.

This study examined the stress and coping patterns of middle school teachers. A final teacher sample of 102 and student sample of 1450 agreed to participate in the study. We conducted a latent profile analysis of the teachers' self-reported levels of stress and coping at the beginning of the school year and used the resulting profiles to predict teacher practices and student outcomes over time. Nearly all teachers were characterized by high stress and high coping (66%) or high stress and low coping (28%). Based on concurrent ratings and observations, the High Stress/Low Coping profile had higher burnout and lower self-efficacy, higher rates of observed reprimands, and higher student-reported depression in comparison to the other classes. The most adaptive profile, Low Stress/High Coping (6% of sample), had lower burnout, greater parent involvement and higher student prosocial skills in comparison to the other groups. Profiles also predicted the maintenance of most of these effects and the increase of some effects over the school year. Examining stress and coping in combination can inform efforts to improve teacher well-being and have a positive influence on student learning environments.

Introduction Cellulitis is commonly treated in the emergency department (ED). Oritavancin is a novel, broad-spectrum antibiotic which provides an entire treatment course for cellulitis with one dose. However, optimal ED prescribing scenarios for oritavancin have not been well defined. The purpose of this study was to identify a population of ED patients with cellulitis who would be most appropriate to receive oritavancin. Methods This was a descriptive, retrospective study conducted at a Midwest healthcare system with two EDs. Over a 1 year period, all adult patients admitted from the ED to an inpatient ward with an ICD-10 diagnosis for cellulitis were reviewed using a priori defined criteria to identify potentially avoidable admissions (PAA). Potentially avoidable admissions were further characterized and compared to the non-avoidable admission population. Identified patient-specific criteria for PAAs were used to develop oritavancin inclusion/exclusion criteria and a case selection flowchart. Results Eighty-six patients were identified during the study period. Nine patients (10.5%) were deemed a PAA. A majority of the PAA population had at least one risk factor for treatment failure (55% with diabetes mellitus) and this group was significantly younger than the non-PAA group (42.2 vs 58.6 years; P = 0.01). There were no differences between the PAA group and the non-PAA group in regard to non-age demographics, other risk factors for outpatient treatment failure, comorbidities, or length of stay. Conclusion Oritavancin is an outpatient treatment alternative for cellulitis patients whose only justification for planned admission is the presence of one or more risk factors for treatment failure.

Background Antibiotic use in hospitals is high, particularly in surgical specialty and intensive care units. Antimicrobial stewardship programmes (ASPs) are increasingly intervening in antibiotic use by surgeons and intensivists. However, there is limited information on the features which characterize antibiotic decision making in the surgical intensive care unit (SICU), an area in hospital practice where critically ill surgery patients can be kept under close observation. Aim To explore the features which characterize antibiotic decision making in the SICU. Methods A total of 160 h of ethnographic observation and 10 semi-structured interviews were conducted at two teaching hospitals in the USA. Data were analysed using thematic coding. Findings Three key characteristics of SICU practice with regard to antibiotic use were identified: (1) physical proximity makes SICU clinicians acutely aware of changes in patient status; (2) communication of patient status relies on active involvement by SICU clinicians; (3) SICU clinicians have contested and variable autonomy over antibiotic decisions. Conclusions Antibiotic decision making in the SICU is a complex process involving multiple clinician teams with varying levels of physical proximity to and autonomy over patient cases. This study found that the SICU clinician team has increased physical proximity to patient cases but little autonomy over antibiotic decisions. If these characteristics are not considered, antimicrobial stewardship (AMS) interventions may have diminished success in addressing high levels of the antibiotic use in the SICU.

Objectives Expectant and parenting students (EPS) at community colleges are an underserved and often under-resourced group. In a rural, Midwestern state, the department of public health was awarded the Pregnancy Assistance Fund (PAF) grant to assist this population. This paper outlines the results of the implementation evaluation and offers suggestions for programs and evaluators working with this population in the community college setting. Methods We conducted a multicomponent evaluation utilizing quantitative and qualitative methods. Evaluation activities included tracking activities/services, surveys and interviews with participants, and interviews with community college staff implementing grant activities. The research team calculated frequencies for quantitative data and coded qualitative data for themes. Results Data from the community colleges and students’ self-reports revealed that EPS most commonly received concrete support from the program, often in the form of stipends or gift cards. Students reported that concrete support was beneficial and helped to relieve financial stress during the semester. Students’ major barriers to participation were lack of knowledge about the program and busy schedules that prevented them from accessing PAF services. Staff reported that difficulty identifying EPS and the short one-year project period were major implementation challenges. Conclusions for Practice We recommend that community colleges work to identify EPS, use fellow EPS to recruit program participants, and implement programming that works with the students’ schedules.

Background: Managing the safety climate in health care is a promising tool for improving employee and patient safety in the health care work environment. Gaps in the theoretical and conceptual underpinnings of safety climate, as well as the evidence base for its practical application in health care remain. The purpose of this study was to evaluate the number of work injuries occurring in health care work units and associated safety climate beliefs. Methods: A retrospective analysis was conducted utilizing organizational staff survey data collected by a large medical hospital in the Midwest in 2015. Employees ( n = 32,327) were invited to identify safety climate perceptions via survey. Injuries, days restricted, and days absent were identified through the Hospital’s Occupational Safety and Health Administration (OSHA) log. Zero inflated negative binomial regressions used injuries as dependent variables and safety climate perceptions as independent variables. Findings: In all, 23,599 employees completed the survey (73% response rate) across 1,805 employee work units which were defined as groupings of employees reporting to a single supervisor. We found that there was an association between fewer injuries and health care workers indicating that they share responsibility for compliance with safety rules and procedures (relative risk [RR] = 0.98, 95% confidence interval [CI] = [0.98, 0.99]). Conclusion/Application to Practice: This study supports the use of a safety climate measure to assess working units’ perceptions of employee safety. A continued focus on the health and safety of employees who interact directly with patients is warranted, as well as employees who do not provide direct patient care.

Extant media literacy interventions have been delivered in person, limiting their potential for large scale reach, implementation, and dissemination. Although emerging evidence suggests the interventions can impact behavior, the theoretical mediators that can explain the efficacy remain unknown. This study investigated the efficacy and mediators of a web-based media literacy intervention for reducing indoor tanning behavior among young women. Participants were randomly assigned to one of three conditions: a media literacy intervention with counter argument production, a media literacy intervention with counter story production, or an assessment-only control condition. The outcomes of indoor tanning behavior and intention were evaluated with 3- and 6-month follow-ups. Results indicated significant effects of the web-based intervention on reducing indoor tanning behavior at the follow-ups. Changes in perceived media realism completely mediated the intervention effects on behavior. Perceived media realism, positive and negative outcome expectancies, and collective efficacy partially mediated intervention effects on intention. This study demonstrates the efficacy of a web-based media literacy intervention and the theoretical mechanisms underlying the efficacy. It indicates that by altering perceived media realism, outcome expectancies, and collective efficacy, web-based media literacy interventions could generate behavioral effects.

BACKGROUND: Analgesics, sedatives, and neuromuscular blockers are commonly used medications for mechanically ventilated air medical transport patients. Prior research in the emergency department (ED) and intensive care unit (ICU) has demonstrated that depth of sedation is associated with increased mechanical ventilation duration, delirium, increased hospital length-of-stay (LOS), and decreased survival. The objectives of this study were to evaluate current sedation practices in the prehospital setting and to determine the impact on clinical outcomes. METHODS: A retrospective cohort study of mechanically ventilated patients transferred by air ambulance to a single 812-bed Midwestern academic medical center from July 2013 to May 2018 was conducted. Prehospital sedation medications and depth of sedation [Richmond Agitation-Sedation Scale score (RASS)] were measured. Primary outcome was hospital LOS. Secondary outcomes were delirium, length of mechanical ventilation, in-hospital mortality, and need for neurosurgical procedures. Univariate analyses were used to measure the association between sedatives, sedation depth, and clinical outcomes. Multivariable models adjusted for potentially confounding covariates to measure the impact of predictors on clinical outcomes. RESULTS: Three hundred twenty-seven patients were included. Among those patients, 79.2% of patients received sedatives, with 41% of these patients achieving deep sedation (RASS = −4). Among patients receiving sedation, 58.3% received at least one dose of benzodiazepines. Moderate and deep sedation was associated with an increase in LOS of 59% (aRR: 1.59; 95%CI: 1.40–1.81)and 24% (aRR: 1.24; 95% CI: 1.10–1.40), respectively. Benzodiazepines were associated with a mean increase of 2.9 days in the hospital (95% CI, 0.7–5.1). No association existed between either specific medications or depth of sedation and the development of delirium. CONCLUSIONS: Prehospital moderate and deep sedation, as well as benzodiazepine administration, is associated with increased hospital LOS. Our findings point toward sedation being a modifiable risk factor and suggest an important need for further research of sedation practices in the pre-hospital setting.

Soybean aphid, Aphis glycines Matsumura, remains the most economically damaging arthropod pest of soybean in the midwestern United States and southern Canada. Foliar applications of a limited number of insecticide modes of action have been the primary management tactic, and pyrethroid resistance was documented recently with full concentration–response leaf-dip and glass-vial bioassays. Full concentration–response bioassays can be cumbersome, and a more efficient assessment tool was needed. In this study, we implemented a diagnostic-concentration glass-vial bioassay using bifenthrin and λ-cyhalothrin. Bioassays were conducted with field-collected soybean aphid populations to assess the geographic extent and severity of resistance to pyrethroids. In 2017, 10 of 18 and 11 of 21 field populations tested with bifenthrin and λ-cyhalothrin, respectively, had mean proportion mortalities less than the susceptible laboratory population. In 2018, 17 of 23 and 13 of 23 field populations tested with bifenthrin and λ-cyhalothrin, respectively, had mean proportion mortalities less than the susceptible laboratory population. Populations collected after reported field failures of a pyrethroid insecticide generally had mean proportion mortalities less than the susceptible laboratory population. In both years, there was a strong correlation between chemistries, which suggests cross-resistance between these insecticides. The diagnostic-concentration glass-vial bioassays reported here will provide the foundation for an insecticide resistance monitoring program with the ability to determine practical levels and geographic extent of insecticide resistance.

BACKGROUND: Infants who are admitted to a neonatal intensive care unit (NICU) may experience significant symptom burden. Parents are often distressed by these symptoms, which can affect their long-term coping and distress. There is limited research examining nurse perceptions of infant well-being (symptoms, suffering, and quality of life (QOL) and associations with nurse distress. OBJECTIVE: The objective of this descriptive study was to explore associations between nurse perceptions of infant well-being and self-reported distress. METHODS: Nurses caring for infants with potentially life-threatening/life-limiting conditions were recruited from a Level IV NICU in the Midwestern United States as a part of a study on infant symptom burden. Nurses reported their perceptions of infant well-being and their own distress on a five-point Likert scale. Surveys were administered at the bedside weekly for up to twelve weeks depending on length of stay. Infant suffering and QOL were examined in relation to nurse distress. A cross-classified multilevel model was used to account for dependence within nurse and within patient. RESULTS: A total of 593 surveys were collected from nurses. Using a cross-classified multilevel model with variables entered simultaneously, nurse perception of greater infant suffering and lower infant QOL were significantly associated with greater nurse distress. DISCUSSION: Preliminary evidence shows that greater perceived infant suffering and lower perceived infant QOL may be associated with greater levels of self-reported distress in NICU nurses. Further work is needed to better understand factors related to symptom management in the NICU and the potential role of caregiver distress and compassion fatigue in NICU nurses.