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Real-time tracking of tool and equipment inventories is a critical function of many organizations and sectors. For prisons and correctional facilities, tracking and monitoring of assets such as cookware, hardware, keys, janitorial equipment, vocational/technical specialty tools, etc., is essential for safety, security, trust, efficiency, education, etc. The performance of automated systems for this purpose can be diminished by a variety of emergent and future sociotechnical factors alone and in combination. This article introduces a methodology for contractor evaluation and selection in acquisition of innovative asset management systems, with an emphasis on evolving system requirements under uncertainty. The methodology features a scenario-based preferences analysis of emergent and future conditions that are disruptive to the performance of the asset-control system. The conditions are across technologies, operating environments, regulations, workforce behaviors, offender behaviors, prices and markets, organizations, cyber threats, etc. The methodology addresses the influence and interaction of the conditions to disrupt system priorities. Examples include: (i) infectious disease disrupting priorities among requirements and (ii) radio-frequency identification (RFID) and wireless-technology innovations disrupting priorities among stakeholders. The combinations of conditions that most and least matter for the system acquisition are characterized. The methodology constitutes a risk register for monitoring sources of risk to project performance, schedule, and cost throughout the system lifecycle. The results will be of interest to both practitioners and scholars engaged in systems acquisition as the pandemic interacts with other factors to affect risk, uncertainty, and resilience of organizational missions and operations.

This systematic review examined and synthesized peer-reviewed research studies that reported the process of integrating social determinants of health (SDOH) or social needs screening into electronic health records (EHRs) and the intervention effects in the United States.Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines, a systematic search of Scopus, Web of Science Core Collection, MEDLINE, and Cochrane Central Register of Clinical Trials was performed. English language peer-reviewed studies that reported the process of integrating SDOH or social needs screening into EHRs within the U.S. health systems and published between January 2015 and December 2021 were included. The review focused on process measures, social needs changes, health outcomes, and health care cost and utilization.In total, 28 studies were included, and half were randomized controlled trials. The majority of the studies targeted multiple SDOH domains. The interventions vary by the levels of intensity of their approaches and heterogeneities in outcome measures. Most studies (82%,Our review supports the current policy efforts to increase U.S. health systems' investment toward directly addressing SDOH. While effective interventions can be more complex or resource intensive than an online referral, health care organizations hoping to achieve health equity and improve population health must commit the effort and investment required to achieve this goal.

A critical concern with crime scene documentation is the accuracy with which a crime scene can be reconstructed. Here, we discuss the accuracy of eight documentation methods as a function of measurement distance between reference ground targets in an outdoor scene. The relative accuracy of each documentation method was assessed with respect to a widely accepted and well-established standard method for land surveying, Total Station, from which measurements served as "ground truth" or reference data. For the majority of methods, the actual relative difference between measurements when compared to Total Station was small (less than a quarter of an inch). Measurements from FARO LiDAR agreed the most with to those of Total Station, while drone without the use of ground control points (GCPs) agreed the least. GCPs or a reference scale were also found to be important in mitigating increasing imprecision with increasing distance when measuring between two targets ~9-85 ft apart via drone and orthomosaic methods. Additionally, there were no statistical differences in the use of 2D (horizontal) or 3D (slope) measurement configurations for the Total Station. Overall, linear regression of difference plots did not reveal meaningful correlation between increasing distance measured and the error of a method when compared to Total Station. As more measurement methods become available, and the need for training and validating new tools become a necessity, these results point to the importance of establishing a ground truth or known distance range on which crime scene measurement methods can be validated.

Context The incidence of extreme heat events (prolonged temperatures above 35°C) is increasing in the northern Victorian dairying region in Australia. This increase is having a significant effect on the performance of perennial ryegrass, which has traditionally been the major perennial species in these pastures. Aim During seven extreme heat events, forage sampling was conducted on commercial farms to evaluate the effects of high temperatures on the nutritive characteristics of perennial ryegrass, tall fescue and lucerne. Our hypothesis was that reductions in nutritive characteristics with an increasing external temperature would vary among species. Methods Before, during and after heat events, replicated samples of the three forage species were collected and analysed for in vitro dry matter digestibility (IVDMD), neutral detergent fibre (NDF), acid detergent fibre (ADF), water soluble carbohydrates (WSC) and crude protein (CP). Several anti-nutritive compounds (alkaloids in perennial ryegrass, and saponins and coumestrols in lucerne) were also measured. Key results None of the temperate forage species evaluated maintained nutritive quality under high temperatures. Linear mixed model (LMM) analyses showed that for each degree rise between 23°C and 40°C, IVDMD and WSC concentrations decreased by 0.2% while NDF and ADF concentrations increased by 0.2% and 0.15% respectively. Concentrations of the alkaloid, ergovaline, in the base of the perennial ryegrass tiller were close to, or above, the recommended threshold level for animal health and welfare in three of the six samples taken during heat events. Conclusions These results suggest that extreme heat events have a detrimental effect on the nutritive characteristics of the evaluated forage species. Implications Heat-induced decreases in nutritive characteristics will potentially have serious implications for milk production and farm productivity. Further research, undertaken under controlled conditions of temperature, humidity and plant growth stage, is recommended to determine the full effect of these extreme summer conditions on forage nutritive characteristics.

This study evaluated and compared the performance of three highly praised high rate anaerobic bioreactors (HRABs), including the expanded granular sludge bed (EGSB) bioreactor, the static granular bed reactor (SGBR), and the down-flow expanded granular bed reactor (DEGBR), for the treatment of poultry slaughterhouse wastewater (PSW) which is characterized by a high concentration in oil and grease, suspended solids, and nutrients. These three bioreactors were operated under mesophilic conditions and followed a similar operational methodology, which consisted of increasing the organic loading rate (OLR) as the bioreactor responded positively to fluctuating organic loads. The response to the fluctuations of the bioreactors was evaluated with respect to the removal of the organic matter contained in PSW at high throughput rate. This study revealed that the three bioreactors performed differently. This dissimilarity in performance was associated with the difference in the configuration of each reactor and the capacity of maintaining a high performance at increased levels of OLR. These configurations are specifically described in this study. Of the three bioreactors that were investigated, the DEGBR performed the best with total chemical oxygen demand (tCOD), biological oxygen demand (BOD5) and fats, oil, and grease (FOG) maximum removal percentages of 99.6%, 99.9% and 99.4%, respectively, for a maximum OLR of 38.9 gCOD/L.day. While the EGSB also provided appreciable results with 99.1%, 99.5% and 97%, for the maximum removal efficiency of tCOD, BOD5 and FOG, respectively. At last, the SGBR achieved tCOD, BOD5 and FOG maximum percentage removal of 97.6%, 99.2% and 97.7%, respectively.

Given the diversity of the scope for inquiry and methodologies used in nursing research, the synthesis of primary research may not be as straightforward as conducting a meta-analysis or systematic review on clinical trials. Scoping reviews offer an option to nursing academics for inquiries involving a range of applications and interpretations. Given the continual advances in evidence-based research, it is, therefore, crucial for nursing to constantly substantiate its research capabilities and uphold standards in its research inquiry. Accordingly, an updated overview would be timely to characterize scoping reviews in the nursing literature. Hence this review aimed to examine the characteristics of scoping reviews published in nursing journals and evaluate the methodological and reporting quality of the scoping reviews.A systematic review.A comprehensive search of three electronic databases (PubMed, CINAHL, and Embase) were conducted. Scoping reviews published in English on or before December 31, 2020 were included, with the criterion that their publication had been in nursing journals indexed in the Journal Citation Reports (2020 Science Edition) of the Web of Science. Two reviewers independently screened the titles and abstracts for eligibility. A standardized data extraction form was used for data collection, and a 29-item checklist was developed to assess the methodological and reporting quality of the scoping reviews. The methodological and reporting quality was assessed independently by four reviewers and subsequently counter-checked by another two reviewers. Descriptive statistics were used to characterize the included papers, and narrative synthesis was undertaken to explain the results.This review included 422 papers from 88 nursing journals. They were published between 2008 and 2021 (median year 2019). Only 15 (3.5%) reviews reported accessible protocols, and 63 (15.0%) presented data on their critical appraisal of the included sources of evidence. Poor reporting of the selection of sources of evidence and data extraction was also identified. Overall, the 422 included reviews had complied with 20 (median [range: 9-27]) of the 29 items on the checklist.Scoping reviews have garnered wider acceptance in nursing research, of which the scopes and methodologies exhibit much diversity. Our systematic review has provided insights into existing scoping reviews published in nursing journals through our characterization of them and appraisal of their methodological and reporting quality. However, our findings underline several areas needing improvement: the lack of transparency, the absence of critical appraisal, non-compliance to established checklists, and inconsistencies in the data processing.Appraising included sources of evidence and maintaining transparency in the conduct and reporting of scoping reviews increases the practical utility of scoping reviews.

In this study, we evaluated the effects of the pandemic on our trauma population. We performed a retrospective review of the trauma registry in the 2 years prior, and then 2 years during the pandemic. We evaluated age, race, gender, injury severity score (ISS), mechanism of trauma, rate of self-inflicted injury, rate of gunshot wounds (GSW), presence of EtOH, drug screen results, mortality, rate of burn traumas, and zip code of residence. Our query captured 5 054 patients before, and 5 731 during the pandemic. We found no statistical difference in age, gender, mechanism of trauma, rate of self-inflicted injuries, and mortality during the pandemic when compared to before. There were statistically significant differences in race, ISS, rate of GSWs, EtOH use, drug screen results, and burn traumas. Geospatial mapping found a rise in GSWs for zip code 36606. Gun violence and substance use rose in our trauma population during COVID-19.

Portal venous thrombosis (PVT) is an uncommon disease associated with highly morbid conditions such as intestinal ischemia and portal hypertension. Patients at higher risk of developing PVT include those with cirrhosis, malignancy, or prothrombotic states. The mainstay of treatment is early initiation of anticoagulation. The first case is a 49-year-old female diagnosed with a cecal mass and PVT. She was started on anticoagulation and underwent a right hemicolectomy with several small bowel resections. She developed portal hypertension that required TIPS and mechanical thrombectomy. The second patient is a 65-year-old female found to have PVT. She was anticoagulated with heparin and given systemic TPA. She developed intestinal ischemia and portal hypertension requiring small bowel resection, TIPS, and mechanical thrombectomy. These cases give insight into the impact of a multidisciplinary team approach to PVT. The role and timing of endovascular treatment is not well established and needs to be further investigated.

Melanocortin peptides containing a 3-(2-naphthyl)-d-alanine residue in position 7 (DNal(2')

Background Roughly 5% of patients with blunt abdominal trauma (BAT) have a blunt bowel and/or mesenteric injury (BBMI). Determining the need for operative management in these patients can be challenging when hemodynamically stable. Single center studies have proposed scoring systems based on CT findings to guide management. Our study aimed to determine the predictability of abdominopelvic CT scan (CT A/P) findings in conjunction with clinical exam to determine the necessity of operative intervention for BBMI. Methods Patients presenting from 2017 to 2022 to the University of South Alabama Level 1 Trauma Center after motor vehicle collision were retrospectively reviewed. Patients with CT findings suggestive of BBMI were further analyzed, noting CT findings, Glasgow coma scale (GCS), shock index, abdominal exam, operative or nonoperative management, and intraoperative intervention. Results 1098 patients with BAT underwent CT A/P. 139 patients had ≥1 finding suggestive of BBMI. 38 patients underwent surgical exploration and 30 had surgically confirmed BBMI. 27 patients required intervention for BBMI. Univariate analysis indicated that pneumoperitoneum ( p < 0.0001), active extravasation of contrast ( p = 0.0001), hemoperitoneum without solid organ injury (SOI) ( p < 0.0001), peritonitis ( p < 0.0001), and mesenteric stranding( p < 0.05) were significantly associated with intervention. Conclusion In total, 30 patients had surgically confirmed BBMI. Active extravasation, pneumoperitoneum, hemoperitoneum without SOI, mesenteric stranding, and peritonitis were significant indicators of BBMI requiring intervention. CT and clinical findings cannot reliably predict the need for surgical intervention without ≥1 of these findings. Initial nonoperative management with serial clinical exams should be strongly considered to reduce incidence of nontherapeutic laparotomies.

Blunt cerebrovascular injury (BCVI) results from blunt trauma causing injury to the carotid and/or vertebral arteries. Its most severe manifestation is stroke. The purpose of this study was to evaluate the incidence, management, and outcomes of BCVI at a level one trauma/stroke center. Data on patients diagnosed with BCVI from 2016 to 2021 were extracted from the USA Health trauma registry with associated intervention performed and patient outcomes. Of the 97 patients identified, 16.5% presented with stroke-like symptoms (SS). Medical management was employed for 75%. Intravascular stent alone was utilized for 18.8%. The mean age of symptomatic BCVI patients was 37.6 with a mean injury severity score (ISS) of 38.2. Within the asymptomatic population, 58% received medical management and 3.7% underwent combination therapy. The mean age of asymptomatic BCVI patients was 46.9 with a mean ISS of 20.3. There were 6 mortalities, only one BCVI related.

As defined by the United States Department of Health and Human Services, the Social Determinants of Health (SDOH) are conditions in the environment that affect health function and outcomes. The SDOH are divided into the following categories: economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community content. It is known that SDOH impact long-term health outcomes. The influence that SDOH have on physical recovery after acute injury is less understood, however. In this study, patients who suffered a traumatic blunt injury completed a survey 12-14 months post-injury to assess their SDOH and physical health before and after their injury. The results showed that for the cohort of patients studied SDOH was the greatest predictor of long-term recovery, having a stronger correlation with recovery than injury severity score (ISS) or hospital length of stay (HLOS).

Trauma patients are especially vulnerable to inadvertent medication reconciliation discrepancies. We conducted a prospective study to evaluate the USA Health University Hospital’s incidence and type of inadvertent medication reconciliation discrepancies among trauma patients. Patients were interviewed for accuracy of their admission medication reconciliation (AMR). Eighty-nine patients were included in this study. Twenty-six patients (29%) never received an AMR. There were 107 inadvertent medication reconciliation errors identified from 30 separate patients (48%), for a rate of 3.6 errors per patient with any error. There was a significant difference in the frequency of inadvertent medication reconciliation discrepancies for patients with >5 medication compared to those with fewer ( P = .00029). In conclusion, trauma centers must be adequately staffed to provide timely, accurate, and available medication lists so that patients can be appropriately cared for.

Diabetes is a major determinate for mortality in trauma patients. Many diabetics are undiagnosed or poorly controlled. Trauma patients disproportionately come from lower socioeconomic status, making missed diagnoses more likely. We aimed to quantify the incidence of undiagnosed or poorly controlled diabetics assessed at a Level 1 Trauma Center. We did a retrospective chart review of admitted trauma patients over a one-month period. Past Medical History, home medication lists, and Hemoglobin A1c on admission were recorded for each patient. We determined that 30 of 173 trauma patients qualifying for the study were diabetic. Furthermore, 30% of these diabetics were undiagnosed or had poorly controlled diabetes. Undiagnosed pre-diabetics made up 20% of the entire study group. Our data show that 26% of trauma patients would benefit from an intervention for improved glucose control. Trauma centers should consider creating routine clinical practice guidelines to identify at-risk patients and provide intervention for long-term management.

BACKGROUND The COVID-19 pandemic prompted widespread implementation of telehealth, including in the inpatient setting, with the goals to reduce potential pathogen exposure events and personal protective equipment (PPE) utilization. Nursing workflow adaptations in these novel environments are of particular interest given the association between nursing time at the bedside and patient safety. Understanding the frequency and duration of nurse-patient encounters following the introduction of a novel telehealth platform in the context of COVID-19 may therefore provide insight into downstream impacts on patient safety, pathogen exposure, and PPE utilization. OBJECTIVE The aim of this study was to evaluate changes in nursing workflow relative to prepandemic levels using a real-time locating system (RTLS) following the deployment of inpatient telehealth on a COVID-19 unit. METHODS In March 2020, telehealth was installed in patient rooms in a COVID-19 unit and on movable carts in 3 comparison units. The existing RTLS captured nurse movement during 1 pre- and 5 postpandemic stages (January-December 2020). Change in direct nurse-patient encounters, time spent in patient rooms per encounter, and total time spent with patients per shift relative to baseline were calculated. Generalized linear models assessed difference-in-differences in outcomes between COVID-19 and comparison units. Telehealth adoption was captured and reported at the unit level. RESULTS Change in frequency of encounters and time spent per encounter from baseline differed between the COVID-19 and comparison units at all stages of the pandemic (all PP>.17). The primary COVID-19 unit quickly adopted telehealth technology during the observation period, initiating 15,088 encounters that averaged 6.6 minutes (SD 13.6) each. CONCLUSIONS RTLS movement data suggest that total nursing time at the bedside remained unchanged following the deployment of inpatient telehealth in a COVID-19 unit. Compared to other units with shared mobile telehealth units, the frequency of nurse-patient in-person encounters decreased and the duration lengthened on a COVID-19 unit with in-room telehealth availability, indicating “batched” redistribution of work to maintain total time at bedside relative to prepandemic periods. The simultaneous adoption of telehealth suggests that virtual care was a complement to, rather than a replacement for, in-person care. However, study limitations preclude our ability to draw a causal link between nursing workflow change and telehealth adoption. Thus, further evaluation is needed to determine potential downstream implications on disease transmission, PPE utilization, and patient safety.

Melanocortin peptides containing a D-naphthylalanine residue in position 7 (DNal(2’)7), reported as melanocortin-3 receptor (MC3R) subtype-specific agonists in two separate publications, were found to lack significant MC3R agonist activity. The cell lines used at the University of Arizona for pharmacological characterization of these peptides, consisting of HEK293 cells stably transfected with human melanocortin receptor subtypes MC1R, MC3R, MC4R, or MC5R, were then obtained and characterized by quantitative PCR. While the MC1R cell line correctly expressed only the hMCR1, the three other cell lines were mischaracterized with regard to receptor subtype expression. Demonstration that a D-naphthylalanine residue in position 7, irrespective of the melanocortin peptide template, results primarily in antagonism of the MC3R and MC4R, then allowed us to search the published literature for additional errors. The erroneously characterized DNal(2’)7-containing peptides date back to 2003; thus, our analysis suggests that systematic mischaracterization of the pharmacological properties of melanocortin peptides occurred.

Asthma is the most common chronic condition among children, with low-income families living in urban areas experiencing significantly higher rates. Evidence based interventions for asthma are routinely implemented in either the home, school, or primary care setting. However, even when caregivers of poor children are engaged in asthma interventions in one setting, they often have to navigate challenges in another setting, such as an under-resourced home, non-supportive school, or disengaged health care provider. The West Philadelphia Asthma Care Implementation Plan aims to compare the effectiveness of a primary care-based intervention, school-based intervention, and combined primary care and school intervention to usual care for improving asthma control in school-age children to explore if the synergistic effect of Community Health Worker (CHW) support in the home, school, and health care environments will result in improved asthma control. Children ages 5–13 with uncontrolled asthma from four West Philadelphia recruitment sites will be eligible for enrollment. The families of school age children interested in participating will be randomized to receive a primary care CHW or usual care. Those identified as attending a participating school will have a CHW-led school intervention or usual care in school. If proven effective, this care coordination program will assist caregivers in assessing resources, improving self-management skills, and ultimately reducing asthma-related ED visits and hospitalizations as well as provide additional information for healthcare systems and policy makers to inform their decisions about how and where to focus additional resources and investments in childhood asthma care to improve health outcomes.

This essay is based on remarks given as part of “The Legacy and Impact of Arnold Hirsch” session at the Urban History Association conference in Columbia, South Carolina, in October 2018. My conference remarks were in part prepared outline, in part extemporaneous riff. This essay takes its cue from my conference remarks, in that it, too, is in flux, building on my prepared outline, my in-the-moment handwritten notes, my memory, and additional ideas postconference. Three themes structured my conference remarks: “making the second ghetto”; “black women: where they be . . . suffering?” and “today: neighborhood change & gentrification.” I maintain that structure here.

Introduction: Asthma evidence-based interventions (EBI) are implemented in the home, school, community or primary care setting. Although families are engaged in one setting, they often have to navigate challenges in another setting.Objective: Our objective is to design and implement a comprehensive plan which integrates EBI's and connects the four sectors in underserved communities such as Philadelphia.Methods: September 2015-April 2016 we implemented a three-pronged strategy to understand needs and resources of the community including 1) focus groups and key informant interviews, 2) secondary data analysis and 3) pilot testing for implementation to determine gaps in care, and opportunities to overcome those gaps.Results: Analysis of the focus group and key informant responses showed themes: diagnosis fear, clinician time, home and school asthma trigger exposures, school personnel training and communication gaps across all four sectors. EBI's were evaluated and selected to address identified themes. Pilot testing of a community health worker (CHW) intervention to connect home, primary care and school resulted in an efficient transfer of asthma medications and medication administration forms to the school nurse office for students with uncontrolled asthma addressing a common delay leading to poor asthma management in school.Conclusion: Thus far there has been limited success in reducing asthma disparities for low-income minority children. This study offers hope that strategically positioning CHWs may work synergistically to close gaps in care and result in improved asthma control and reduced asthma disparities.

The poultry slaughterhouse industry consumes a large volume of potable water for bird processing and equipment cleaning, which culminates in the generation of high strength poultry slaughterhouse wastewater (PSW). The wastewater contains high concentrations of organic matter, suspended solids, nitrogen and nutrients. Most poultry slaughterhouses in South Africa (SA) discharge their wastewater into the municipal sewer system after primary treatment. Due to its high strength, PSW does not meet SA's industrial discharge standards. Discharge of untreated PSW to the environment raises environmental health concerns due to pollution of local rivers and fresh water sources, leading to odour generation and the spread of diseases. Thus, the development of a suitable wastewater treatment process for safe PSW discharge to the environment is a necessity. In this study, a biological PSW treatment process using an Expanded Granular Sludge Bed (EGSB) was evaluated. Response surface methodology coupled with central composite design was used to optimize the performance of the EGSB reactor. The dependant variable used for optimization was chemical oxygen demand (COD) removal as a function of two independent variables, hydraulic retention time (HRT) and organic loading rate (OLR). The interactions between HRT, OLR and COD removal were analysed, and a two factorial (2FI) regression was determined as suitable for COD removal modelling. The optimum COD removal of 93% was achieved at an OLR of 2 g-COD/L/d and HRT of 4.8 days. The model correlation coefficient (R2) of 0.980 indicates that it is a good fit and is suitable for predicting the EGSB's COD removal efficiency.

Ablation of hypothalamic AgRP (Agouti-related protein) neurons is known to lead to fatal anorexia, whereas their activation stimulates voracious feeding and suppresses other motivational states including fear and anxiety. Despite the critical role of AgRP neurons in bidirectionally controlling feeding, there are currently no therapeutics available specifically targeting this circuitry. The melanocortin-3 receptor (MC3R) is expressed in multiple brain regions and exhibits sexual dimorphism of expression in some of those regions in both mice and humans. MC3R deletion produced multiple forms of sexually dimorphic anorexia that resembled aspects of human anorexia nervosa. However, there was no sexual dimorphism in the expression of MC3R in AgRP neurons, 97% of which expressed MC3R. Chemogenetic manipulation of arcuate MC3R neurons and pharmacologic manipulation of MC3R each exerted potent bidirectional regulation over feeding behavior in male and female mice, whereas global ablation of MC3R-expressing cells produced fatal anorexia. Pharmacological effects of MC3R compounds on feeding were dependent on intact AgRP circuitry in the mice. Thus, the dominant effect of MC3R appears to be the regulation of the AgRP circuitry in both male and female mice, with sexually dimorphic sites playing specialized and subordinate roles in feeding behavior. Therefore, MC3R is a potential therapeutic target for disorders characterized by anorexia, as well as a potential target for weight loss therapeutics.