Fluoxetine exerts anti-inflammatory effects on human epidermal keratinocytes and suppresses their endothelin release.

Fluoxetine is a safe antidepressant with remarkable anti-inflammatory actions; therefore, we aimed to investigate its effects on immortalized (HaCaT) as well as primary human epidermal keratinocytes in a polyinosinic-polycytidylic acid (p(I:C))-induced inflammatory model. We found that a non-cytotoxic concentration (MTT-assay, CyQUANT-assay) of fluoxetine significantly suppressed p(I:C)-induced expression and release of several pro-inflammatory cytokines (Q-PCR, cytokine array, ELISA), and it decreased the release of the itch mediator endothelins (ELISA). These effects were not mediated by the inhibition of the NF-κB or p38 MAPK pathways (western blot), or by the suppression of the p(I:C)-induced elevation of mitochondrial ROS production (MitoSOX Red labeling). Instead, unbiased activity profiling revealed that they were most likely mediated via the inhibition of the phosphoinositide 3-kinase (PI3K) pathway. Importantly, the PI3K-inhibitor GDC0941 fully mimicked the effects of fluoxetine (Q-PCR, ELISA). Although fluoxetine was able to occupy the binding site of GDC0941 (in silico molecular docking), and exerted direct inhibitory effect on PI3K (cell-free PI3K activity assay), it exhibited much lower potency and efficacy as compared to GDC0941. Finally, RNA-Seq analysis revealed that fluoxetine deeply influenced the transcriptional alterations induced by p(I:C)-treatment, and exerted an overall anti-inflammatory activity. Collectively, our findings demonstrate that fluoxetine exerts potent anti-inflammatory effects, and suppresses the release of the endogenous itch mediator endothelins in human keratinocytes, most likely via interfering with the PI3K pathway. Thus, clinical studies are encouraged to explore whether the currently reported beneficial effects translate in vivo following its topical administration in inflammatory and pruritic dermatoses.

Nurses' Perceptions of Caring at Work: Mixed-Methods Study, Quantitative Report.

OBJECTIVES: Study objectives were to explore nurses' perceptions of self-care, co-worker, and leader caring within healthcare work environments and assess reliability of 3 Watson Caritas Scores. BACKGROUND: Assessing caring in an organization where Watson's Theory of Human Caring guides nursing practice offers insight into the professional practice environment. METHOD: This study reports quantitative data from mixed-methods descriptive, cross-sectional survey of 1307 RNs at a large healthcare system. RESULTS: Mean scores were self = 5.46, co-worker = 5.39, and leader score = 5.53, and median scores were >5.6 (range, 1-7). All scales had a positive and significant correlation to likelihood to recommend the organization, with the largest being feeling cared for by leaders. Internal reliability of the 3 scales was ≥0.9. CONCLUSION: Nurse perceptions of caring may influence the organization's reputation. Assessing the perception of caring among nursing staff after the introduction and enculturation of this framework is needed. Results support psychometric value for 3 Watson Caritas Scores.

Biochar Benefits Green Infrastructure: Global Meta-Analysis and Synthesis.

Urbanization has degraded ecosystem services on a global scale, and cities are vulnerable to long-term stresses and risks exacerbated by climate change. Green infrastructure (GI) has been increasingly implemented in cities to improve ecosystem functions and enhance city resilience, yet GI degradation or failure is common. Biochar has been recently suggested as an ideal substrate additive for a range of GI types due to its favorable properties; however, the generality of biochar benefits the GI ecosystem function, and the underlying mechanisms remain unclear. Here, we present a global meta-analysis and synthesis and demonstrate that biochar additions pervasively benefit a wide range of ecosystem functions on GI. Biochar applications were found to improve substrate water retention capacity by 23% and enhance substrate nutrients by 12-31%, contributing to a 33% increase in plant total biomass. Improved substrate physicochemical properties and plant growth together reduce discharge water volume and improve discharge water quality from GI. In addition, biochar increases microbial biomass on GI by ∼150% due to the presence of biochar pores and enhanced microbial growth conditions, while also reducing CO2 and N2O emissions. Overall results suggest that biochar has great potential to enhance GI ecosystem functions as well as urban sustainability and resilience.

Year-round monitoring of chloride releases from three zero-exfiltration permeable pavements and an asphalt parking lot.

Winter deicers, though essential for maintaining safe pavement conditions in winter, increase chloride (Cl-) concentrations in receiving water bodies above recommended environmental guidelines. Zero-exfiltration or lined permeable pavement is an important technological innovation for controlling particulate-bound pollutants at the source. As stormwater does not infiltrate into the ground, soluble pollutants like Cl- are ultimately discharged into receiving water bodies. Our aim was to examine Cl- concentrations in effluents from three zero-exfiltration permeable pavement cells (Permeable Interlocking Concrete Pavement (PICP), Pervious Concrete (PC), Porous Asphalt (PA)) and compare them with runoff from a Conventional Asphalt (ASH) cell. The study conducted at a parking lot in St. Catharines, Ontario, Canada, from January 2016 to May 2017 observed that the permeable pavements provided only temporary attenuation of Cl- during winter but exhibited a quick release during spring melt. Cl- concentrations and loadings were different for each permeable pavement system in terms of timing and magnitude. Cl- concentration in ASH runoff frequently had very high spikes (21,780 mg/L); however, the median winter Cl- concentration in ASH runoff was lower than Cl- levels in the permeable pavements' effluents and later declined drastically after spring melt, but in few instances, was above the chronic water quality guideline (120 mg/L). The average event mean concentration (EMC) of Cl- was 1600 and 120 mg/L in the permeable pavements' effluents during salting and non-salting season, respectively. In one year, each permeable pavement system released approximately 67-81 kg of Cl- with significant differences being observed in Cl- loads between the 2016 and 2017 seasons. Therefore, a multi-year data collection and monitoring plan captured the variability in winter conditions. The study provided insights into the behaviour, retention and release of Cl- from traditional and permeable hardscape surfaces and possible avenues for Cl- attenuation, source control and aquatic habitat conservation.

Biochar granulation, particle size, and vegetation effects on leachate water quality from a green roof substrate.

Biochar, due to its favourable physiochemical properties, has been promoted as an ideal substrate additive on green roofs, with potential benefits to hydrological function. However, biochar is susceptible to water erosion, which may result in biochar loss and water pollution. The use of granulated biochars or biochars in large particle sizes could potentially alleviate biochar erosion loss, but effects on leachate quality have not been investigated. Also, biochar type and particle size influence plant performance, and effects on discharge quality may vary with vegetation. We assessed the effects of unprocessed and granulated biochars at five (0.25-0.5 mm, 0.5-1 mm, 1-2 mm, 2-2.8 mm, 2.8-4 mm) and four (1-2 mm, 2-2.8 mm, 2.8-4 mm, and 4-6.3 mm) particle size ranges, respectively, on leachate quality on a typical green roof substrate, with presence and absence of vegetation (Agastache foeniculum - a drought-tolerant native forb). We evaluated integrated leachate quality using the CCME Water Quality Index (WQI). Unprocessed biochars reduced nutrient leaching due to increased water retention capacity (WRC) and total porosity. In contrast, granulated biochars, although showing less pronounced mitigation of nutrient leaching, reduced total suspended solids (TSS) and improved WQI in leachate due to enhanced plant performance. In addition, small biochar particles better reduced nutrient leaching and particle loss than large biochar particles, possibly due to increased WRC and formation of water-stable aggregates. The presence of vegetation generally reduced the leaching of nutrients and TSS, consistent with plant nutrient uptake and root substrate stabilization. However, plant biomass was correlated with increased total N leaching, likely due to litter inputs and rapid litter decomposition. We conclude that applications of granulated biochars may best improve discharge quality from green roofs through sorption effects and by enhancing plant performance.

Exploring nurses' perceptions of the barriers and facilitators that influence acceptance and use of remote visual monitoring technology.

AIM: Describe nurses' perceptions of the barriers and facilitators that influence acceptance and use of remote visual monitoring technology. BACKGROUND: Research has shown remote visual monitoring to be a useful patient safety intervention, yet nurses underutilize the technology. METHODS: Using a qualitative descriptive study design, we completed a conventional content analysis of focus group feedback from two nurse leader groups and two direct care nurse groups (n = 13 participants) to explore factors influencing nurses' perceptions and utilization of remote visual monitoring. RESULTS: Five main themes were identified: (1) Contextual human factors that impact nurse acceptance; (2) facilitators and barriers related to remote visual monitoring's functionality; (3) nurse leaders' role in maintaining device availability and efficient use; (4) nurse leaders' role in promoting adoption of the technology; and (5) nurse leaders' role in valuing nursing professional judgement. CONCLUSION: Findings indicate that nurse leaders can play a crucial role in direct care nurses' acceptance and use of remote visual monitoring technology. IMPLICATIONS FOR NURSING MANAGEMENT: In an era of limited staffing resources, remote visual monitoring has the potential to increase patient safety and decrease workload demands. Nurse leaders should identify barriers and facilitators to their nursing team's use of remote visual monitoring to promote the acceptance and use of technology that increases patient safety and cost-effectiveness of care.

Trace Organic Contaminant Transfer and Transformation in Bioretention Cells: A Field Tracer Test with Benzotriazole.

Bioretention cells can effectively infiltrate stormwater runoff and partly remove conventional water contaminants. A field tracer injection experiment in a conventionally designed bioretention cell was used to investigate the fate of benzotriazole, a model trace organic contaminant, during and between runoff events. Moderate (29%) benzotriazole load reductions were measured during the 6 h long injection experiment. The detection of 1-methyl benzotriazole, hydroxy benzotriazole, and methoxy benzotriazole provided in situ evidence of some rapid benzotriazole microbial transformation during the tracer test and more importantly between the events. The detection of benzotriazole alanine and benzotriazole acetyl alanine also showed fast benzotriazole phytotransformation to amino acid conjugates during the tracer test and suggests further transformation of phytotransformation products between events. These data provide conclusive full-scale evidence of benzotriazole microbial and phytotransformation in bioretention cells. Non-target chemical analysis revealed the presence of a diverse range of trace organic contaminants in urban runoff and exiting the bioretention cell, including pesticides and industrial, household, and pharmaceutical compounds. We have demonstrated the in situ potential of urban green infrastructure such as bioretention cells to eliminate polar trace organic contaminants from stormwater. However, targeted design and operation strategies, for example, hydraulic control and the use of soil amendments, should be incorporated for improved bioretention cell performance for such compounds.

Determining the Sources of Variance in the Preparation of Analytical Standards for Chromatographic Analysis of a Lyophilized Peptide Drug Substance by Nested ANOVA Statistical Analysis.

Synthetic peptides used as therapeutic medicines is continuing to grow as an area of focus within the pharmaceutical industry due to specificity and potency. As such, quality control areas need to continue to advance their capabilities to ensure that appropriate analyses are being performed, and that the data generated are both accurate and precise. One area which poses a significant challenge compared with traditional small molecule drug products is having a highly robust, low variability method of quantifying the assay of the active substance. As many peptide therapeutics are formulated as liquid drug products for injection and preparation procedures to make these samples amenable to traditional chromatographic analysis are inherently low variability (i.e., a simple dilution), potential sources of variance derived from the preparation of the analytical standards used to quantify the assay of the product must be investigated. Here, a fully nested ANOVA experimental design was utilized to examine this process. Such a design allowed for multiple variables to be interrogated as well as the potential interplay of such differences. It was determined that sonication of the standards contributed the most variance, while the balance used and scale on which the standard preparation procedure was performed also contributed significantly. Finally, different procedures for introducing the material into a coulometric Karl Fischer (KF) titration device to quantify the water content of the drug substance were compared and showed that indirect quantification by anhydrous methanol extraction is a significantly more variable method than using an Oven KF autosampler.

MVA vaccine encoding CMV antigens safely induces durable expansion of CMV-specific T cells in healthy adults.

Attenuated poxvirus modified vaccinia Ankara (MVA) is a useful viral-based vaccine for clinical investigation, because of its excellent safety profile and property of inducing potent immune responses against recombinant (r) antigens. We developed Triplex by constructing an rMVA encoding 3 immunodominant cytomegalovirus (CMV) antigens, which stimulates a host antiviral response: UL83 (pp65), UL123 (IE1-exon4), and UL122 (IE2-exon5). We completed the first clinical evaluation of the Triplex vaccine in 24 healthy adults, with or without immunity to CMV and vaccinia virus (previous DryVax smallpox vaccination). Three escalating dose levels (DL) were administered IM in 8 subjects/DL, with an identical booster injection 28 days later and 1-year follow-up. Vaccinations at all DL were safe with no dose-limiting toxicities. No vaccine-related serious adverse events were documented. Local and systemic reactogenicity was transient and self-limiting. Robust, functional, and durable Triplex-driven expansions of CMV-specific T cells were detected by measuring T-cell surface levels of 4-1BB (CD137), binding to CMV-specific HLA multimers, and interferon-γ production. Marked and durable CMV-specific T-cell responses were also detected in Triplex-vaccinated CMV-seronegatives, and in DryVax-vaccinated subjects. Long-lived memory effector phenotype, associated with viral control during CMV primary infection, was predominantly found on the membrane of CMV-specific and functional T cells, whereas off-target vaccine responses activating memory T cells from the related herpesvirus Epstein-Barr virus remained undetectable. Combined safety and immunogenicity results of MVA in allogeneic hematopoietic stem cell transplant (HCT) recipients and Triplex in healthy adults motivated the initiation of a placebo-controlled multicenter trial of Triplex in HCT patients. This trial was registered at www.clinicaltrials.gov as #NCT02506933.

UV Disinfection of Wastewater and Combined Sewer Overflows.

Municipal wastewater contains bacteria, viruses, and other pathogens that adversely affect the environment, human health, and economic activity. One way to mitigate these effects is a final disinfection step using ultraviolet light (UVL). The advantages of UVL disinfection, when compared to the more traditional chlorine, include no chlorinated by-products, no chemical residual, and relatively compact size. The design of most UV reactors is complex. It involves lamp selection, power supply design, optics, and hydraulics. In general, medium pressure lamps are more compact, powerful, and emit over a wider range of light than the more traditional low pressure lamps. Low pressure lamps, however, may be electrically more efficient. In UV disinfection, the fraction of surviving organisms (e.g. E. coli) will decrease exponentially with increasing UV dose. However, the level of disinfection that can be achieved is often limited by particle-associated organisms. Efforts to remove or reduce the effects of wastewater particles will often improve UV disinfection effectiveness. Regrowth, photoreactivation, or dark repair after UV exposure are sometimes cited as disadvantages of UV disinfection. Research is continuing in this area, however there is little evidence that human pathogens can photoreactivate in environmental conditions, at doses used in wastewater treatment. The UV disinfection of combined sewer overflows, a form of wet weather pollution, is challenging and remains largely at the research phase. Pre-treatment of combined sewer overflows (CSOs) with a cationic polymer to induce fast settling, and a low dose of alum to increase UV transmittance, has shown promise at the bench scale.

Stormwater quality of spring-summer-fall effluent from three partial-infiltration permeable pavement systems and conventional asphalt pavement.

This study examined the spring, summer and fall water quality performance of three partial-infiltration permeable pavement (PP) systems and a conventional asphalt pavement in Ontario. The study, conducted between 2010 and 2012, compared the water quality of effluent from two Interlocking Permeable Concrete Pavements (AquaPave(®) and Eco-Optiloc(®)) and a Hydromedia(®) Pervious Concrete pavement with runoff from an Asphalt control pavement. The usage of permeable pavements can mitigate the impact of urbanization on receiving surface water systems through quantity control and stormwater treatment. The PP systems provided excellent stormwater treatment for petroleum hydrocarbons, total suspended solids, metals (copper, iron, manganese and zinc) and nutrients (total-nitrogen and total-phosphorus) by reducing event mean concentrations (EMC) as well as total pollutant loadings. The PPs significantly reduced the concentration and loading of ammonia (NH4(+)+NH3), nitrite (NO2(-)) and organic-nitrogen (Org-N) but increased the concentration and loading of nitrate (NO3(-)). The PP systems had mixed performances for the treatment of phosphate (PO4(3-)). The PP systems increased the concentration of sodium (Na) and chloride (Cl) but EMCs remained well below recommended levels for drinking water quality. Relative to the observed runoff, winter road salt was released more slowly from the PP systems resulting in elevated spring and early-summer Cl and Na concentrations in effluent. PP materials were found to introduce dissolved solids into the infiltrating stormwater. The release of these pollutants was verified by additional laboratory scale testing of the individual pavement and aggregate materials at the University of Guelph. Pollutant concentrations were greatest during the first few months after construction and declined rapidly over the course of the study.

Biochar and vegetation effects on discharge water quality from organic-substrate green roofs.

Green roofs have been increasingly used to improve stormwater management, but poor vegetation performance on roof systems, varying with vegetation type, can degrade discharge quality. Biochar has been suggested as an effective substrate additive for green roofs to improve plant performance and discharge quality. However, research on the effects of biochar and vegetation on discharge quality in the long term is lacking and the underlying mechanisms involved are unclear. We examined the effects of biochar amendment and vegetation on discharge quality on organic-substrate green roofs with pre-grown sedum mats and direct-seeded native plants for three years and investigated the key factors influencing discharge quality. Sedum mats reduced the leaching of nutrients and particulate matter by 6-64% relative to native plants, largely due to the higher initial vegetation cover of the former. Biochar addition to sedum mat green roofs resulted in the best integrated water quality due to enhanced plant cover and sorption effects. Structural equation modeling revealed that nutrient leaching was primarily influenced by rainfall depth, time, vegetation cover, and substrate pH. Although biochar-amended sedum mats showed better discharge quality from organic-substrate green roofs, additional ecosystem services may be provided by native plants, suggesting future research to optimize plant composition and cover and biochar properties for sustainable green roofs.

Chronic carvedilol treatment partially reverses the right ventricular failure transcriptional profile in experimental pulmonary hypertension.

Right ventricular failure (RVF) is the most frequent cause of death in patients with pulmonary arterial hypertension (PAH); however, specific therapies targeted to treat RVF have not been developed. Chronic treatment with carvedilol has been shown to reduce established maladaptive right ventricle (RV) hypertrophy and to improve RV function in experimental PAH. However, the mechanisms by which carvedilol improves RVF are unknown. We have previously demonstrated by microarray analysis that RVF is characterized by a distinct gene expression profile when compared with functional, compensatory hypertrophy. We next sought to identify the effects of carvedilol on gene expression on a genome-wide basis. PAH and RVF were induced in male Sprague-Dawley rats by the combination of VEGF-receptor blockade and chronic hypoxia. After RVF was established, rats were treated with carvedilol or vehicle for 4 wk. RNA was isolated from RV tissue and hybridized for microarray analysis. An initial prediction analysis of carvedilol-treated RVs showed that the gene expression profile resembled the RVF prediction set. However, a more extensive analysis revealed a small group of genes differentially expressed after carvedilol treatment. Further analysis categorized these genes in pathways involved in cardiac hypertrophy, mitochondrial dysfunction, and protein ubiquitination. Genes encoding proteins in the cardiac hypertrophy and protein ubiquitination pathways were downregulated in the RV by carvedilol, while genes encoding proteins in the mitochondrial dysfunction pathway were upregulated by carvedilol. These gene expression changes may explain some of the mechanisms that underlie the functional improvement of the RV after carvedilol treatment.

How children use drawing to regulate their emotions.

We examined two ways in which drawing may function to elevate mood in children-venting (expressing negative feelings) and distraction (expressing something unrelated to the negative feelings). We examined the effectiveness of drawing as an emotion regulator when drawing is used to vent versus distract (Study 1) and tested whether the effects found are specific to the activity of creating one's own drawing or generalisable to a drawing activity in which children had to copy another's drawing (Study 2). To induce a negative mood, we asked children to think of a disappointing event. Mood was assessed before and after the assigned activity. In both studies, mood improved significantly more in the distract than in the vent or copy condition. Study 1 demonstrates that drawing improves mood in children via distraction and not via venting. Study 2 demonstrates that this effect is specific to a drawing task in which an image is freely constructed. When a copying task is used, the effect disappears.

Assessing the potential for restoration of surface permeability for permeable pavements through maintenance.

Permeable pavements (PPs) have been in use as stormwater management systems in Canada and the United States for over 20 years. After years of exposure to sediment and debris build-up, surface clogging reduces the infiltration of stormwater and inhibits the hydraulic and environmental functions of the pavement. Removal of surface material has been shown to restore infiltration but the majority of studies have been limited to small-scale testing. This paper presents the results of small- and full-sized equipment testing aimed at restoring surface permeability, including the first testing of regenerative-air and vacuum-sweeping streetsweepers in Ontario. Maintenance achieved partial restoration of PP surface permeability. Post-treatment surface infiltration rates displayed large spatial variability, highlighting that localized conditions throughout the pavement have a confounding influence on the overall effectiveness of maintenance. The impact of maintenance may be improved by establishing regular cleaning intervals and developing instructional guidelines for pavement owners and equipment operators.

Clinical evaluation of safety and immunogenicity of PADRE-cytomegalovirus (CMV) and tetanus-CMV fusion peptide vaccines with or without PF03512676 adjuvant.

BACKGROUND: It has been reported that cytomegalovirus (CMV) pp65-specific T cells can protect hematopoietic cell transplant (HCT) recipients from CMV complications. Two candidate CMV peptide vaccines composed of the HLA A*0201 pp65(495-503) cytotoxic CD8(+) T-cell epitope fused to 2 different universal T-helper epitopes (either the synthetic Pan DR epitope [PADRE] or a natural Tetanus sequence) were clinically evaluated for safety and ability to elicit pp65 T cells in HLA A*0201 healthy volunteers. METHODS: Escalating doses (0.5, 2.5, 10 mg) of PADRE or Tetanus pp65(495-503) vaccines with (30 adults) or without (28 adults) PF03512676 adjuvant were administered by subcutaneous injection every 3 weeks for a total of 4 injections. RESULTS: No serious adverse events were reported, although vaccines used in combination with PF03512676 had enhanced reactogenicity. Ex vivo responses were detected by flow cytometry exclusively in volunteers who received the vaccine coadministered with PF03512676. In addition, using a sensitive in vitro stimulation system, vaccine-elicited pp65(495-503) T cells were expanded in 30% of volunteers injected solely with the CMV peptides and in all tested subjects receiving the vaccines coinjected with PF03512676. CONCLUSIONS: Acceptable safety profiles and vaccine-driven expansion of pp65(495-503) T cells in healthy adults support further evaluation of CMV peptide vaccines combined with PF03512676 in the HCT setting. CLINICAL TRIALS REGISTRATION: NCT00722839.

Stimulation of Potent Humoral and Cellular Immunity via Synthetic Dual-Antigen MVA-Based COVID-19 Vaccine COH04S1 in Cancer Patients Post Hematopoietic Cell Transplantation and Cellular Therapy.

Hematopoietic cell transplantation (HCT) and chimeric antigen receptor (CAR)-T cell patients are immunocompromised, remain at high risk following SARS-CoV-2 infection, and are less likely than immunocompetent individuals to respond to vaccination. As part of the safety lead-in portion of a phase 2 clinical trial in patients post HCT/CAR-T for hematological malignancies (HM), we tested the immunogenicity of the synthetic modified vaccinia Ankara-based COVID-19 vaccine COH04S1 co-expressing spike (S) and nucleocapsid (N) antigens. Thirteen patients were vaccinated 3-12 months post HCT/CAR-T with two to four doses of COH04S1. SARS-CoV-2 antigen-specific humoral and cellular immune responses, including neutralizing antibodies to ancestral virus and variants of concern (VOC), were measured up to six months post vaccination and compared to immune responses in historical cohorts of naïve healthy volunteers (HV) vaccinated with COH04S1 and naïve healthcare workers (HCW) vaccinated with the FDA-approved mRNA vaccine Comirnaty® (Pfizer, New York, NY, USA). After one or two COH04S1 vaccine doses, HCT/CAR-T recipients showed a significant increase in S- and N-specific binding antibody titers and neutralizing antibodies with potent activity against SARS-CoV-2 ancestral virus and VOC, including the highly immune evasive Omicron XBB.1.5 variant. Furthermore, vaccination with COH04S1 resulted in a significant increase in S- and N-specific T cells, predominantly CD4+ T lymphocytes. Elevated S- and N-specific immune responses continued to persist at six months post vaccination. Furthermore, both humoral and cellular immune responses in COH04S1-vaccinated HCT/CAR-T patients were superior or comparable to those measured in COH04S1-vaccinated HV or Comirnaty®-vaccinated HCW. These results demonstrate robust stimulation of SARS-CoV-2 S- and N-specific immune responses including cross-reactive neutralizing antibodies by COH04S1 in HM patients post HCT/CAR-T, supporting further testing of COH04S1 in immunocompromised populations.

Evaluation of a coping kit for children with challenging behaviors in a pediatric hospital.

This study attempted to answer the question, "Do nurses perceive coping kits to be effective at meeting the needs of hospitalized children with developmental disabilities who are at increased risk for challenging behaviors?" A cross-sectional post-test survey study design was used, with a convenience sample of 24 registered nurses at a Midwestern free-standing children's hospital. A coping kit with simple communication cards, social script book, and distraction items (toys) was developed to enhance communication and distract children with developmental disabilities (including autism spectrum disorder) undergoing procedures in the hospital. A modified version of Hudson's (2006) intervention effectiveness survey was used to measure the nurse's perception of the effectiveness of the coping kit. Nurses perceived the coping kits to be effective for decreasing their patient's anxiety, calming the child's behavior, and increasing cooperation during procedures. The nurse can develop a plan of care that includes a coping kit to help gain cooperation with the hospitalized child with challenging behaviors.

Biochar granulation enhances plant performance on a green roof substrate.

Green roofs have been widely promoted as a means to enhance ecosystem services in cities, but roofs present a harsh growing environment for plants. Biochar is suggested to be a highly beneficial substrate additive for green roof systems due to its low weight, high nutrient and water retention capacity, and recalcitrance. However, biochar is susceptible to wind and water erosion, which may result in biochar loss and negative environmental impacts. Applications of biochar as large particles or in granulated form may mitigate biochar erosion potential, but relevant data on plant performance and substrate properties are lacking. We examined the effects of granulated and conventional biochars at a range of particle sizes on plant performance of the drought-tolerant forb Agastache foeniculum. We found that granulated biochar strongly enhanced plant growth, reproduction, and physiological status, acting to neutralize pH and enhance water retention capacity of the substrate. In contrast, although conventional biochar reduced substrate bulk density and enhanced substrate total porosity and water retention capacity, it suppressed plant growth. Our results also suggest that granulated biochar at intermediate particle sizes (2-2.8 mm) best enhanced plant performance. We conclude that use of granulated biochars on green roofs can strongly promote plant performance while increasing water infiltration and retention.