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Malnutrition is associated with increased morbidity and mortality after trauma. The Geriatric Nutritional Risk Index (GNRI) is a validated scoring system used to predict the risk of complications related to malnutrition in nontrauma patients. We hypothesized that GNRI is predictive of worse outcomes in geriatric trauma patients.This was a single-center retrospective study of trauma patients 65 years or older admitted in 2019. Geriatric Nutritional Risk Index was calculated based on admission albumin level and ratio of actual body weight to ideal body weight. Groups were defined as major risk (GNRI82), moderate risk (GNRI 82-91), low risk (GNRI 92-98), and no risk (GNRI98). The primary outcome was mortality. Secondary outcomes included ventilator days, intensive care unit length of stay (LOS), hospital LOS, discharge home, sepsis, pneumonia, and acute respiratory distress syndrome. Bivariate and multivariable logistic regression analyses were performed to determine the association between GNRI risk category and outcomes.A total of 513 patients were identified for analysis. Median age was 78 years (71-86 years); 24 patients (4.7%) were identified as major risk, 66 (12.9%) as moderate risk, 72 (14%) as low risk, and 351 (68.4%) as no risk. Injury Severity Scores and Charlson Comorbidity Indexes were similar between all groups. Patients in the no risk group had decreased rates of death, and after adjusting for Injury Severity Score, age, and Charlson Comorbidity Index, the no risk group had decreased odds of death (odds ratio, 0.13; 95% confidence interval, 0.04-0.41) compared with the major risk group. The no risk group also had fewer infectious complications including sepsis and pneumonia, and shorter hospital LOS and were more likely to be discharged home.Major GNRI risk is associated with increased mortality and infectious complications in geriatric trauma patients. Further studies should target interventional strategies for those at highest risk based on GNRI.Prognostic and Epidemiologic; Level III.

Higher education faculty worldwide experienced heightened stressors due to the COVID-19 pandemic, from completing their professional roles and responsibilities virtually to balancing personal and professional stressors. Consequently, the pandemic created many adjustments for pre-tenure counseling faculty across research, teaching, and service. In response to this pandemic, we explored the impact of the COVID-19 pandemic on the personal and professional lives of four pre-tenure counseling faculty members. Accordingly, we used collaborative autoethnography to investigate our experiences and narratives as pre-tenure counseling faculty, which resulted in seven overarching themes. We discussed the implications for practice, advocacy, education, and faculty training.

This article is a 20-year content analysis of counseling journals exploring refugees and refugee issues from 1998-2018. The investigation intended to identify publication trends in counseling journals and the field’s responsiveness to the refugee crisis and global climate. An exhaustive analysis of American Counseling Association (ACA) and ACA division journals was conducted. Themes of the publishing trends, gaps in the literature, and recommendations for future research are presented for the counseling field.

Professional and competent ethical decision-making relies on a counselor’s ability to examine potential personal biases and cultural differences. Experiential activities can assist counselors-in-tr...

In a world that is more interconnected than ever, the counseling profession has continued in its efforts to train more foreign-born counselors. The process of professional identity development of this population remains an understudied topic in the literature. The current study examined the experiences of foreign-born counselors navigating the professional identity development process in U.S. counselor education. A phenomenological qualitative research design was used to explore the experiences of six foreign-born counselors. Several themes arose that include barriers, assets, and counseling profession limitations. Implications for counselor education are discussed.

IntroductionDysphagia is associated with increased morbidity, mortality, and resource utilization in hospitalized patients, but studies on outcomes in geriatric trauma patients with dysphagia are limited. We hypothesized that geriatric trauma patients with dysphagia would have worse clinical outcomes compared with those without dysphagia.MethodsPatients with and without dysphagia were compared in a single-center retrospective cohort study of trauma patients aged ≥65 years admitted in 2019. The primary outcome was mortality. Secondary outcomes included intensive care unit (ICU) length of stay (LOS), hospital LOS, discharge destination, and unplanned ICU admission. Multivariable regression analyses and Bayesian analyses adjusted for age, Injury Severity Score, mechanism of injury, and gender were performed to determine the association between dysphagia and clinical outcomes.ResultsOf 1706 geriatric patients, 69 patients (4%) were diagnosed with dysphagia. Patients with dysphagia were older with a higher Injury Severity Score. Increased odds of mortality did not reach statistical significance (OR 1.6, 95% CI 0.6 to 3.4, p=0.30). Dysphagia was associated with increased odds of unplanned ICU admission (OR 4.6, 95% CI 2.0 to 9.6, p≤0.001) and non-home discharge (OR 5.2, 95% CI 2.4 to 13.9, p≤0.001), as well as increased ICU LOS (OR 4.9, 95% CI 3.1 to 8.1, p≤0.001), and hospital LOS (OR 2.1, 95% CI 1.7 to 2.6, p≤0.001). On Bayesian analysis, dysphagia was associated with an increased probability of longer hospital and ICU LOS, unplanned ICU admission, and non-home discharge.ConclusionsClinically apparent dysphagia is associated with poor outcomes, but it remains unclear if dysphagia represents a modifiable risk factor or a marker of underlying frailty, leading to poor outcomes. This study highlights the importance of screening protocols for dysphagia in geriatric trauma patients to possibly mitigate adverse outcomes.Level of evidenceLevel III.

Due to their diversity of applications in research and industry, nanomaterials have gained a great technological importance in the last two decades. Among others, polymeric nanoparticles (NPs) attract a special interest in polymer batteries and solar cells.[1,2] Charge transfer is the main process underlying the charging/doping of polymer NPs.[2] This process involves uptake and release of ions from the polymer and has typically been studied using the ensemble method, that is by immobilizing a large number of these particles on an electrode and measuring the resulting charge/discharge response. Understanding the underlying process steps using ensemble studies is difficult, since charge transfer and mass transport processes are overlapping and thus can only be estimated. In addition, the ensemble method can be misleading since particles often agglomerate on the electrode so that only a fraction of their surface is accessible. Thus, probing the intrinsic response at the single particle level is necessary to understand, for instance, the charging process and ion intercalation capacity in rechargeable polymer batteries. This can be achieved, by single nanoparticle impact electrochemistry.[3-5] Herein we demonstrate how quantifying the charging/doping of single particles of industrially important polymers can be achieved using this “nano impact” method. The polymeric NPs were successfully synthesized and characterized using UV-Vis, FTIR, DLS and SEM. For comparison, the doping behavior of ensembles of the NPs was investigated using cyclic voltammetry. Furthermore, the effect of dopant on the doping kinetics was studied. By linking the nano impact results with independent sizing data, it can be revealed whether the entire particle is doped, or a sort of core-shell structure is made. Importantly, the intrinsic kinetics of the doping of single NPs are investigated and the rate determining step in the doping process is determined. This work adds new insights into the charging of conducting polymers at the single particle scale which is expected to have a significant impact on emerging applications such as polymer batteries and supercapacitors. Literature: [1] Electrically Conducting Polymers: An Emerging Technology, Bakhshi, A. K.; Pooja Rattan. Current Science, 1997, 73, 648–651. [2] Electrochemically Active Polymers for Rechargeable Batteries, Novák, P; Müller, K; Santhanam, K.S.V.; Haas, O. Chem. Rev. 1997, 97, 207-281 [3] Electrode-particle impacts: a users guide, Sokolov, S. V.; Eloul, S.; Kätelhön, E.; Batchelor-McAuley, C.; Compton, R. G. Physical chemistry chemical physics: PCCP 2016, 19, 28–43. [4] Electrochemistry at single bimetallic nanoparticles - using nano impacts for sizing and compositional analysis of individual AgAu alloy nanoparticles, Saw, E. N.; Grasmik, V.; Rurainsky, C.; Epple, M.; Tschulik, K. Faraday discussions 2016, 193, 327–338. [5] Doping of single polymeric nanoparticles, Zhou, X.-F.; Cheng, W.; Compton, R. G. Angewandte Chemie (International ed. in English) 2014, 53, 12587–12589.

This article is a 20-year content analysis of counseling journals exploring refugees and refugee issues from 1998-2018. The investigation intended to identify publication trends in counseling journals and the field’s responsiveness to the refugee crisis and global climate. An exhaustive analysis of American Counseling Association (ACA) and ACA division journals was conducted. Themes of the publishing trends, gaps in the literature, and recommendations for future research are presented for the counseling field.