Development and first-stage validation of a digital version of the Digit Symbol Substitution test for use in assessing cognitive function in older people with diabetes.

AIMS: To describe the development and report the first-stage validation of a digital version of the digit symbol substitution test (DSST), for assessment of cognitive function in older people with diabetes. MATERIALS AND METHODS: A multidisciplinary team of experts was convened to conceptualize and build a digital version of the DSST and develop a machine-learning (ML) algorithm to analyse the inputs. One hundred individuals with type 2 diabetes (aged ≥ 60 years) were invited to participate in a one-time meeting in which both the digital and the pencil-and-paper (P&P) versions of the DSST were administered. Information pertaining to demographics, laboratory measurements, and diabetes indices was collected. The correlation between the digital and P&P versions of the test was determined. Additionally, as part of the validation process, the performance of the digital version in people with and without known risk factors for cognitive impairment was analysed. RESULTS: The ML model yielded an overall accuracy of 89.1%. A strong correlation was found between the P&P and digital versions (r = 0.76, p < 0.001) of the DSST, as well as between the ML model and the manual reading of the digital DSST (r = 0.99, p < 0.001). CONCLUSIONS: This study describes the development of and provides first-stage validation data for a newly developed digital cognitive assessment tool that may be used for screening and surveillance of cognitive function in older people with diabetes. More studies are needed to further validate this tool, especially when self-administered and in different clinical settings.

Cost effectiveness of home care versus hospital care: a retrospective analysis.

BACKGROUND: Increased utilization of health services due to population growth affects the allocation of national resources and budgets. Hence, it is important for national policy. Home hospitalization is one of the solutions for dealing with the growing demand for hospital beds and reducing the duration of hospitalization and its costs. It is gradually becoming part of the regular care in many health systems, yet, studies on the economic aspects of Community-Based Home Hospitalization (CBHH) implementation in Israel are few. The aim of this study is to examine costs of CBHH in comparison to costs of inpatient hospital care in the Israeli public health system. METHODS: Retrospective data was collected using document research in databases. A review of the costs of patients in CBHH at Maccabi Healthcare Services (MHS) was conducted. A total of 3374 patients were included in this study: 1687 patients who were in CBHH, and 1687 age- and sex-matched patients who were hospitalized in an internal department (the control group). The study population included the patients admitted to CBHH from January 2018 to July 2020, and patients admitted to internal medicine departments during the same period. RESULTS: The number of hospitalizations during the follow up period were statistically significantly lower in the CBHH group compared with the control group (M = 1.18, SD = 0.56 vs. M = 1.61, SD = 1.29, p < 0.001). In addition, the mean number of hospitalization days was also statistically significantly lower for 4.3 (SD = 4.5) for CBHH patients compared to the control group (M = 4.3 days, SD = 4.5 vs. M = 7.5 days, SD = 10.3, p < 0.001). Furthermore, the mean cost per day was statistically significantly higher for inpatient hospitalization compared to CBHH (M = 1829.1, SD = 87.5 vs. M = 783.2, SD = 178.3, p < 0.001). Older patients, patients with diabetes and patients hospitalized in hospitals had a higher number of hospitalization days. CONCLUSIONS: The costs of CBHH seem to be lower than those of inpatient care. Managing CBHH is characterized by constantly measuring financial feasibility that would be an impetus for further development of this service.

Converting qualitative data into quantitative values using a matched mixed-methods design: A new methodological approach.

BACKGROUND: Quantifying qualitative data as part of mixed-methods research (MMR) can add to the study results' analysis. Comparable results may reinforce the conclusions, while differences hold an opportunity for an in-depth discussion. To date, there is little guidance for researchers seeking to quantify their qualitative data. OBJECTIVES: Describing conversion of qualitative data to quantitative values, comparison with matched questionnaire results, discussing the benefits of this process and the matched MMR design. METHODS: We describe in detail how qualitative data from 46 interviews were converted into quantitative values (i.e., quantitative-qualitative values, QQVs) using MMR design, enabling a comparison of results from interviews and questionnaires obtained from the same participants. This process was embedded in a larger MMR study on family-caregivers caring for people-with-end-stage-dementia conducted between the years 2020-2021. RESULTS: A QQV was generated for three main themes and compared to the questionnaires' scores regarding the same topics. There were no significant differences between the scores regarding 'satisfaction with nurses and physicians care', and 'discussion with nurses and physicians about end-of-life care'. However, for 'burden', the QQV score was significantly higher than the questionnaires' score. DISCUSSION: We described how to use a matched MMR design to produce and compare QQV from interviews with questionnaire scores. This methodology may allow further valuable discussion if the results are either similar or not, and for better integration and easier presentation of the results. Comparable results can reinforce the conclusions from both parts of the MMR study, while differences hold an opportunity for an in-depth discussion regarding their meaning and context. Although we claim that this methodology can be embedded in the MMR structure and contribute significantly to the discussion's depth, it by no means replaces the traditional MMR design. PATIENT AND PUBLIC CONTRIBUTION: No patient or public contribution.

Expanding nurses' authority - Physicians' and nurses' attitudes.

AIM: To examine and compare the attitudes of physicians and registered nurses regarding extending nurses' authority. DESIGN: This was a comparative quantitative study, which used a questionnaire that examined the attitudes of nurses and physicians regarding expanding nurses' authority. METHODS: The study comprised a sample of 134 nurses (62.7%) and physicians (37.3%), who filled out the self-report questionnaire that included sociodemographic data and questions designed to examine the participants' attitudes and perceptions on expanding nurses' authority. The general reliability of the questionnaire was Cronbach's α = 0.931. Participants were sampled through the convenience-snowball method. RESULTS: Differences were found between the attitudes of physicians and nurses to expanding nurses' authority. Nurses tended to be in favor, whereas physicians tended to be against (t(86.29) = 7.713; p < 0.05). Nurses' attitudes are also more positive specifically to procedures related to drug administration (t(132) = 6.894; p < 0.05) and resuscitation (t(132) = 2.974; p < 0.05), compared to physicians. CONCLUSIONS: Nurses have more positive attitudes toward expanding nurses' authority than physicians do, specifically toward drug administration and resuscitation. Further study is proposed to identify factors which affect the physician-nurse relationship and attitudes on a large scale through a qualitative study.

Perception of the image of the nursing profession and its relationship with quality of care.

BACKGROUND: Good quality of care (QOC) is related to high recovery rates, fewer mistakes, and better outcomes in general. The perception of the nursing profession (NP) among nurses has many social and professional implications, and it is important to understand the implications regarding their QOC. The aim of the study was to examine whether there is a relationship between the self-image of nursing and the nurses' QOC, and whether men and women differ in their nursing image (NI). METHODS: A cross-sectional study applied among nursing teams employed in various inpatient wards: An online questionnaire was distributed and included (1) Sociodemographic details; (2) Image of the nursing profession; and (3) Nurses' perception of their nursing care quality. RESULTS: The results show a significant positive relationship between the NI perception among nurses and their perceptions of the QOC they provide. No sex differences were found between male and female nurses. CONCLUSION: This study highlights the correlation between the NP's self-image and self-reported QOC. Health policy makers should build national programs that improve the image of nursing among nursing teams, and create an empowering and positive working environment, which would most probably improve the quality of nursing care.

A cross-sectional study on preferred employment settings of final-year nursing students in Israel.

BACKGROUND: Despite the growing demand for community nurses, their number remains relatively low. We examined perceptions of final-year nursing students regarding their preferred work setting after graduation and the factors affecting their choice. METHODS: A cross-sectional survey using a structured questionnaire was developed specifically for this study. The questionnaire was distributed among fourth-year students from all nursing training frameworks across Israel. RESULTS: Of 281 respondents (76.6% women, average age, 29.3 years), most (80.9%) preferred working in hospitals, while 5% preferred community settings; 14% were undecided. Students' knowledge on hospital nurses' tasks was greater compared to their knowledge on community nurses' tasks. Moreover, hospital nurses' tasks were perceived as more important than those of community nurses. The contribution of clinical placement in hospital nursing was perceived as significantly more meaningful than the contribution of clinical placement in community nursing. The vast majority of students (94.3%) stated that they would prefer to undergo a hospital nursing internship. A significant correlation was noted between students' clinical placement, the exposure to community nursing roles, and the perception of the community nurse's role: clinical placements that were perceived as a positive experience led to a more positive perception of community nurses' roles. CONCLUSIONS: Nursing students' perception of community nursing is based upon limited information which does not reflect community nurses' actual role and work.

Mate Value Discrepancy and Mate Retention Behaviors of Self and Partner.

OBJECTIVE: This study investigated the relationship between perceived mate value discrepancy (i.e., the difference between an individual's mate value and their partner's mate value) and perceived frequency of mate retention performed by an individual relative to his or her partner. METHOD: In two studies, participants in long-term, exclusive, sexual, heterosexual relationships reported their own, and their partner's, mate value and mate retention. Samples included 899 community members (Study 1) and 941 students and community members (Study 2). RESULTS: In Study 1, we documented that individuals with higher self-perceived short-term mate value, and who perceive their partner to have lower (vs. higher) short-term mate value, perform less frequent Benefit-Provisioning mate retention, controlling for the partner's Benefit-Provisioning mate retention. In Study 2, we documented that individuals who perceive that they could less easily replace their partner, and who perceive their partner could more (vs. less) easily replace them, perform more frequent mate retention (Benefit-Provisioning and Cost-Inflicting), controlling for the partner's mate retention. CONCLUSION: These results highlight the importance of assessing perceived discrepancies in mate value (notably, regarding the replaceability of self and partner with another long-term mate) and perceived mate retention behaviors of self, relative to partner, between men and women in long-term relationships.

Men's Benefit-Provisioning Mate Retention Behavior Mediates the Relationship Between Their Agreeableness and Their Oral Sex Behaviors.

Men perform oral sex on their romantic partner as part of a broader benefit-provisioning mate retention strategy and men higher in Agreeableness are especially likely to provision their partner with benefits. The current research explored whether men's benefit-provisioning mate retention behavior mediated the relationship between their Agreeableness and their oral sex behaviors in their long-term romantic relationship. Men (n = 346) in a committed, sexual, heterosexual relationship completed the Mate Retention Inventory-a 104-item instrument that assesses the frequency with which they performed various mate retention behaviors during the past month, a 40-item personality inventory, and reported on a questionnaire their interest in and the time they spent performing oral sex on their romantic partner during their most recent sexual encounter with her. The results indicated that men higher in Agreeableness reported greater interest in and spent more time performing oral sex on their partner, and that their benefit-provisioning mate retention behaviors partially mediated these relationships. The current research is the first to investigate the relationship between personality dimensions and oral sex behaviors and adds to a growing body of research documenting that mate retention strategies influence sexual behavior.

The myth of the myth of martyrdom.

Lankford asserts that suicide terrorism is attributable to suicidality. We argue in this commentary that this assertion is not well supported theoretically or empirically. In addition, we suggest that failure to acknowledge religious beliefs as motivationally causal for suicide terrorism may place innocent people at risk of murder in the service of political correctness and multiculturalism.

Nurses' Attitudes and Perceptions Regarding Suicidal Patients: A Quasi-Experimental Study of Depression Management Training.

Suicide prevention is a priority globally. Community nurses are on the frontline of healthcare, and thus well placed to identify those at risk of suicide and act to prevent it. However, they are often ill-equipped to do so. This study examines whether depression management training for nurses may also help them manage suicide-risk patients. METHOD: This quasi-experimental study used a questionnaire that included a randomly assigned textual case vignette, measures related to patient descriptions portrayed in the vignette, and demographic and clinical/training information. The participants were 139 Israeli nurses who were mostly Jewish, Israeli-born, and married women working as community nurses. Almost half had completed depression management training (DMT) in their routine work. RESULTS: Nurses who completed depression management training were more likely than non-trainees to query the patient regarding mental status and suicide plans and were more likely to refer them to appropriate further treatment. The graduate nurses also reported higher self-competence and more positive attitudes regarding their ability to assess depression and suicide risk than nurses who had not received depression management training. DISCUSSION: The results highlight the importance of depression management training, as suicide assessment and referral are among the major steps to suicide prevention.

The Quality of Telenursing-Israeli Nursing Staff's Perceptions.

BACKGROUND: The outbreak of the COVID-19 pandemic has increased telemedicine and telenursing services worldwide, developed this innovative treatment's potential, and emphasized its importance. The constraints imposed by the pandemic breached regulatory, psychological, and organizational obstructions among both patients and caretakers. Community and hospital nursing services were forced to deal with a new reality, to provide remote care solutions for bedridden chronic patients, as the need for this grew exponentially. Despite the increase of telemedicine in recent years, so far no research in Israel has investigated the nursing staff's perceptions of the quality of the care provided through telenursing. OBJECTIVE: To assess nurses' perceptions of the quality of the care provided through telenursing compared to face-to-face nursing. METHOD: A quantitative cross-sectional study among 227 male and female nurses in Israel. The questionnaire included demographic questions, and the five measures of quality of care: concern and empathy for the patient, professional treatment, response to treatment, educated use of resources, and patients' sense of security. RESULTS: Significant differences were found between nurses' perceptions of telenursing and face-to-face nursing. The quality of face-to-face nursing was perceived as more positive than that of telenursing, in general, as were the individual measures of care quality such as providing professional treatment, response to treatment, and patients' sense of security. CONCLUSIONS: Although telemedicine has increased significantly in recent years, nursing staff still perceived the quality of care and follow-up of face-to-face nursing as more positive. It is important to continue to monitor nurses' perceptions and attitudes towards the strengths of these two treatment methods, not only in crisis situations, but among wider populations, and to investigate the factors that could influence these perceptions.

Public Perceptions and Attitudes on the Image of Nursing in the Wake of COVID-19.

BACKGROUND: The COVID-19 pandemic in recent years has given nursing teams a unique place in this war, and an opportunity to change public opinion. The perceptions have the power to affect the users of health services, the nurses' performance, health policy, and even the choice to become a nurse. AIM: To examine the relationship between the public's perceptions and attitudes to the nursing profession compared with other healthcare professions, and to examine the relationship with the image of nursing in the wake of the COVID-19 pandemic. DESIGN AND METHODS: This study is a cross-sectional study, with a descriptive correlational design. Specifically, 80 respondents, men and women aged 18-75, joined a survey consisting of an anonymous questionnaire. RESULTS: A positive relationship was found between the public's perceptions and attitudes to nursing compared with other professions and the image of nursing in the wake of COVID-19, so the more positive public opinion was, the more positive the image of nursing would be. CONCLUSION: In the wake of COVID-19, the public's opinion and perception of the nursing profession compared to other professions and their attitudes to nurses are more positive. It is important to continue to explore which factors most affected and changed the image of nursing during the pandemic, and to design strategies to preserve the improved image of nursing among the public on an ongoing basis.

Addressing the second victim phenomenon in Israeli health care institutions.

BACKGROUND: The 'second victim' phenomenon (SVP) refers to practitioners who experience a negative physical or emotional response, as well as a professional decline, after participating or witnessing an adverse event. Despite the Israeli Ministry of Health's implementation of specific protocols regarding the overall management of adverse events in health organizations over the past decade, there is limited knowledge regarding healthcare managers' perceptions of the 'second victim' occurrence. METHODS: A phenomenological qualitative approach was used to identify an accurate view of policy. Fifteen senior risk manager/and policy makers were interviewed about their knowledge and perceptions of the 'second victim'. Topics addressed included reporting mechanisms of an adverse event, the degree of organizational awareness of 'second victim', and identifying components of possible intervention programs and challenges to implementing those programs. RESULTS: Examining current procedures reveals that there is limited knowledge about uniform guidance for health care organizations on how to identify, treat, or prevent SVP among providers. The employee support programs that were offered were sporadic in nature and depended on the initiative of a direct manager or the risk manager. CONCLUSIONS: Currently, there is little information or organizational discussion about the possible negative effects of AE on healthcare practitioners. To provide overall medical care that is safe and effective for patients, the health system must also provide a suitable response to the needs of the medical provider. This could be achieved by establishing a national policy for all healthcare organizations to follow, raising awareness of the possible occurrence of SVP, and creating a standard for the subsequent identification, treatment and future prevention for providers who may be suffering.

The Dilemma of Compulsory Vaccinations-Ethical and Legal Considerations.

The high childhood vaccination coverage in Israel leads to a low rate of morbidity from the diseases against which the vaccination in administered. However, during the COVID-19 pandemic, children's immunization rates declined dramatically due to closures of schools and childcare services, lockdowns, and guidelines for physical distancing. In addition, parents' hesitancy, refusals, and delays in adhering to routine childhood immunizations seem to have increased during the pandemic. A decline in routine pediatric vaccine administration might indicate that the entire population faces increased risks for outbreaks of vaccine-preventable diseases. Throughout history, vaccines have raised questions about their safety, efficacy, and need among adults and parents who feared or hesitated to vaccinate their children. Objections derive from various ideological and religious reasons or concerns about the possible inherent dangers. Mistrust in the government and/or economic or political interests also raise concerns among parents. The importance of providing vaccines to maintain public health, as opposed to the autonomy of the individuals over their body and their children, raises ethical questions. In Israel, there is no legal obligation to get vaccinated. It is imperative to find a decisive solution to this situation without delay. Furthermore, where democratically one's principles are sacred and where one's autonomy over one's body is also unquestionable, such a legal solution would not only be unacceptable but also rather impossible to enforce. It seems that some reasonable balance between the necessity to preserve public health and our democratic principles should apply.

Nurses' Silence: Understanding the Impacts of Second Victim Phenomenon among Israeli Nurses.

INTRODUCTION: The 'second victim' phenomenon, (SVP) refers to a health professional who was involved in an adverse event (AE) and continues to suffer from the event to the detriment of personal and professional functioning. The second victims' natural history of recovery model predicts stages of the phenomenon from AE occurrence until the 'moving on' stage and serves as a suitable structure for many organizational support programs worldwide. PURPOSE: Using the second victims' natural history of recovery model to examine the impact of the SVP on Israeli nurses, with a specific focus on the organizational support they felt they required compared with the support they felt that they had received from their organizations. METHODS: Fifteen in-depth interviews were conducted, using a semi-structured questionnaire, among nurses who had experienced the SVP. The interviews were recorded subject to the interviewees' consent, transcribed, and analyzed using thematic content analysis. FINDINGS: Throughout all six stages of recovery, all interviewees reported physical and emotional manifestations following exposure to an AE, regardless of the type of event or severity. They also reported difficulty in emotion regulation, as well as damage to functioning and overall quality of life. Most of the nurse interviewees reported a need to share the events with someone, but, despite this desire to receive appropriate support, almost none of them proactively requested help from a professional source, nor did their organizational management initiate proactive support. This lack of referral for further assistance is possibly explained through limited awareness of the SVP as a valid response to an AE, a perceived lack of legitimacy to receive organizational support, and personal barriers that accompany the phenomenon. CONCLUSIONS: Appropriate organizational support, offered proximal to an AE as well as over time, is essential for the nurse, the patient, and the organization. Personal barriers, together with limited awareness, may challenge the identification and provision of appropriate assistance. Hence, it is important to address the phenomenon as part of the general organizational policy to improve the quality of care and patient safety.

Relationship between cognitive function in individuals with diabetic foot ulcer and mortality.

BACKGROUND: Diabetic foot ulcer (DFU) is a common diabetes mellitus (DM) complication. Individuals with DM and a DFU achieved significantly lower scores in cognitive tests than those without a DFU. We investigated whether baseline cognitive function in individuals with a DFU is a determinant of mortality. METHODS: A prospective study using data collected during a case-control study conducted in 2010-2012 whereby 90 participants with a DFU (mean age at baseline 58.28 ± 6.95 years, 75.6% male) took the paper and pencil and the NeuroTrax battery of cognitive tests. Depression was assessed, and the DFU status was evaluated. In 2020, information pertaining to participants' vital status (dead/alive) was collected and the relationship between baseline cognitive status and vital status was assessed. RESULTS: During a median follow-up of 6.8 years (range 0.2-9.5), 39 participants died (43.3%). Individuals alive vs. those who had died during follow-up had a higher global cognitive score at baseline (92.16 ± 10.95 vs. 87.18 ± 12.24, p = 0.045), but increased risk was not found. Individuals who were alive vs. those who had died during follow-up had statistically significantly higher baseline executive function, reaction time and digit symbol substitution test results. However, after adjustment for glycosylated hemoglobin (HbA1c), microvascular and macrovascular complications, no relationship between cognitive tests and mortality remained significant. CONCLUSIONS: The higher mortality rate among people with type 2 DM and a DFU was not significant after adjustment for HbA1c, micro- and macrovascular complications. There may be common pathophysiological pathways to both DM complications and cognitive impairment, which may contribute to increased mortality. Further studies are warranted.

Primary Care Physicians' Perceptions on Nurses' Shared Responsibility for Quality of Patient Care: A Survey.

Nurses are key players in primary care in Israel and in the efforts to improve its quality, yet a survey conducted among primary care physicians (PCPs) in 2010 indicated that 40% perceived the contribution of nurses to primary care quality as moderate to very small. In 2020, we conducted a cross-sectional survey using self-report questionnaires among PCPs employed by health plans to examine the change in PCPs' perceptions on nurses' responsibility and contributions to quality of primary care between 2010 and 2020. Four-hundred-and-fifty respondents completed the questionnaire in 2020, as compared to 605 respondents in 2010. The proportion of PCPs who perceive that nurses share the responsibility for improving the quality of medical care increased from 74% in 2010 to 83% in 2020 (p < 0.01). Older age, males, self-employment status, and board certification in family medicine independently predicted reduced PCP perception regarding nurses' responsibility for quality-of-care. PCPs who believed that nurses contribute to quality of practice were 7.2 times more likely to perceive that nurses share the responsibility for quality-of-care. The study showed that over the past decade there was an increase in the extent to which PCPs perceive nurses as significant partners in improving quality of primary care.

Obstacles Preventing Public Health Nurses from Discussing Children's Overweight and Obesity with Parents.

We examined how well-baby care nurses perceive communication with parents regarding their children's obesity and identified main communication barriers. Pediatric obesity is a significant public health concern, and health care personnel are among the first to detect overweight and the first to offer assistance to parents. Yet, research suggests that when nurses identify a weight problem in children, they may have trouble initiating this discussion. This qualitative study, using semi-structured interviews with 20 public health nurses, addressed potential obstacles nurses face when discussing young children's weight. Lack of time and workload were the most significant barriers to meaningful conversation with parents. Instructing parents toward a healthy lifestyle, while specifically relating to the child's weight, is perceived as part of the nurse's role, but execution was flawed. Trust and good communication between the nurse and parents are seen as critical ingredients to provide future guidance around a child's weight. Nurses want parents to feel comfortable to discuss children's weight problems, but are worried that such a discussion may impair previously established trust. Nurses should receive comprehensive training to address childhood obesity, including specific communication skills to implement when discussing this stigmatized and sensitive topic.

Identifying Cardiovascular Risk Profiles Clusters among Mediterranean Adolescents across Seven Countries.

Cardiovascular diseases (CVDs) are the number one cause of death globally and are partially due to the inability to control modifiable lifestyle risk factors. The aim of this study was to analyze the profiles of adolescents from seven Mediterranean countries (Greece, Israel, Italy, Macedonia, Malta, Portugal, Spain) according to their modifiable lifestyle risk factors for CVD (overweight/obesity, physical activity, smoking, alcohol consumption). The sample consisted of 26,110 adolescents (52.3% girls) aged 11, 13, and 15 years who participated in the Health Behavior in School-aged Children (HBSC) survey in 2018 across the seven countries. Sociodemographic characteristics (sex, age, country of residence, socioeconomic status) and CVD modifiable lifestyle risk factors (overweight/obesity, physical activity, smoking, alcohol consumption) were recorded. A two-step cluster analysis, one-way analysis of variance, and chi-square test were performed. Four different cluster groups were identified: two low-risk groups (64.46%), with risk among those with low physical activity levels; moderate-risk group (14.83%), with two risk factors (unhealthy weight and low physical activity level); and a high-risk group (20.7%), which presented risk in all modifiable lifestyle risk factors. Older adolescents reported a higher likelihood of being in the high-risk group. Given that the adolescence period constitutes an important time for interventions aimed at CVD prevention, identifying profiles of moderate- and high-risk adolescents is crucial.

A genome-wide screen for essential yeast genes that affect telomere length maintenance.

Telomeres are structures composed of repetitive DNA and proteins that protect the chromosomal ends in eukaryotic cells from fusion or degradation, thus contributing to genomic stability. Although telomere length varies between species, in all organisms studied telomere length appears to be controlled by a dynamic equilibrium between elongating mechanisms (mainly addition of repeats by the enzyme telomerase) and nucleases that shorten the telomeric sequences. Two previous studies have analyzed a collection of yeast deletion strains (deleted for nonessential genes) and found over 270 genes that affect telomere length (Telomere Length Maintenance or TLM genes). Here we complete the list of TLM by analyzing a collection of strains carrying hypomorphic alleles of most essential genes (DAmP collection). We identify 87 essential genes that affect telomere length in yeast. These genes interact with the nonessential TLM genes in a significant manner, and provide new insights on the mechanisms involved in telomere length maintenance. The newly identified genes span a variety of cellular processes, including protein degradation, pre-mRNA splicing and DNA replication.