RESUMO
Species are often expected to shift their distributions either poleward or upslope to evade warming climates and colonise new suitable climatic niches. However, from 18-years of fixed transect monitoring data on 88 species of butterfly in the midwestern United States, we show that butterflies are shifting their centroids in all directions, except towards regions that are warming the fastest (southeast). Butterflies shifted their centroids at a mean rate of 4.87 km year-1. The rate of centroid shift was significantly associated with local climate change velocity (temperature by precipitation interaction), but not with mean climate change velocity throughout the species' ranges. Species tended to shift their centroids at a faster rate towards regions that are warming at slower velocities but increasing in precipitation velocity. Surprisingly, species' thermal niche breadth (range of climates butterflies experience throughout their distribution) and wingspan (often used as metric for dispersal capability) were not correlated with the rate at which species shifted their ranges. We observed high phylogenetic signal in the direction species shifted their centroids. However, we found no phylogenetic signal in the rate species shifted their centroids, suggesting less conserved processes determine the rate of range shift than the direction species shift their ranges. This research shows important signatures of multidirectional range shifts (latitudinal and longitudinal) and uniquely shows that local climate change velocities are more important in driving range shifts than the mean climate change velocity throughout a species' entire range.
Assuntos
Distribuição Animal , Evolução Biológica , Borboletas , Mudança Climática , Animais , Borboletas/fisiologia , Filogenia , Meio-Oeste dos Estados UnidosRESUMO
Black sexual minority men who have sex with men (MSM) in the United States are at disparate risk for contracting HIV infection, but pre-exposure prophylaxis (PrEP) use is suboptimal. Social network methods were used to recruit a community sample of racial minority MSM and transgender women (TGW) in two Midwestern US cities. 250 PrEP-eligible (HIV-negative) participants completed measures assessing current and intended PrEP use; demographic characteristics; PrEP knowledge, attitudes, norms, stigma, and self-efficacy; and structural barriers to PrEP. Multivariate analyses established predictors of current and intended PrEP use. Only 12% of participants reported currently using PrEP, which was associated with greater PrEP knowledge and not having a main partner, with trends for greater PrEP use by younger participants and those with partners living with HIV. Among participants not currently on PrEP, strength of PrEP use intentions was associated with higher PrEP knowledge, PrEP descriptive social norms, and PrEP use self-efficacy. This study is among few to directly compare Black who have adopted PrEP with those who have not. Its findings underscore the potential benefits of employing social network approaches for strengthening PrEP use peer norms, increasing PrEP knowledge and self-efficacy, and optimizing PrEP uptake among racial minority MSM and TGW.
Assuntos
Negro ou Afro-Americano , Infecções por HIV , Conhecimentos, Atitudes e Prática em Saúde , Homossexualidade Masculina , Profilaxia Pré-Exposição , Pessoas Transgênero , Humanos , Masculino , Profilaxia Pré-Exposição/estatística & dados numéricos , Adulto , Pessoas Transgênero/estatística & dados numéricos , Pessoas Transgênero/psicologia , Homossexualidade Masculina/estatística & dados numéricos , Homossexualidade Masculina/psicologia , Homossexualidade Masculina/etnologia , Infecções por HIV/prevenção & controle , Infecções por HIV/etnologia , Negro ou Afro-Americano/estatística & dados numéricos , Negro ou Afro-Americano/psicologia , Feminino , Meio-Oeste dos Estados Unidos , Pessoa de Meia-Idade , Adulto Jovem , Fármacos Anti-HIV/uso terapêutico , Estigma Social , Minorias Sexuais e de Gênero/estatística & dados numéricos , Minorias Sexuais e de Gênero/psicologia , Parceiros Sexuais/psicologia , Adolescente , AutoeficáciaRESUMO
The present study tested the hypothesis that verbal labels support category induction by providing compact hypotheses. Ninety-seven 4- to 6-year-old children (M = 63.2 months; 46 female, 51 male; 77% White, 8% more than one race, 4% Asian, and 3% Black; tested 2018) and 90 adults (M = 20.1 years; 70 female, 20 male) in the Midwestern United States learned novel categories with features that were easy (e.g., "red") or difficult (e.g., "mauve") to name. Adults (d = 1.06) and-to a lesser extent-children (d = 0.57; final training block) learned categories composed of more nameable features better. Children's knowledge of difficult-to-name color words predicted their learning for categories with difficult-to-name features. Rule-based category learning may be supported by the emerging ability to form verbal hypotheses.
Assuntos
Aprendizagem , Aprendizagem Verbal , Adulto , Humanos , Masculino , Feminino , Criança , Meio-Oeste dos Estados UnidosRESUMO
BACKGROUND: Lack of physical activity is a concern for children across diverse backgrounds, particularly affecting those in rural areas who face distinct challenges compared to their urban counterparts. Community-derived interventions are needed that consider the unique context and additional physical activity barriers in under-resourced rural settings. Therefore, a prospective pre-post pilot/feasibility study of Hoosier Sport was conducted over 8-weeks with 6th and 7th grade children in a low-socioeconomic rural middle school setting. The primary objective of the present study was to assess trial- and intervention-related feasibility indicators; and the secondary objective was to collect preliminary assessment data for physical activity levels, fitness, psychological needs satisfaction, and knowledge of physical activity and nutrition among participating youth. METHODS: This prospective 8-week pilot/feasibility study took place in the rural Midwestern United States where twenty-four middle school students participated in a mixed-methods pre-post intervention during physical education classes. The intervention included elements like sport-based youth development, individualized goal setting, physical activity monitoring, pedometer usage, and health education. Data were collected at baseline (T1) and post-intervention (T3), with intermediate measures during the intervention (T2). Qualitative data were integrated through semi-structured interviews. Analytical methods encompassed descriptive statistics, correlations, repeated measures ANOVA, and thematic analysis. RESULTS: Key findings indicate robust feasibility, with intervention-related scores (FIM, AIM, and IAM) consistently surpassing the "good" threshold and 100% retention and recruitment success. Additionally, participants showed significant physical performance improvement, shifting from the 25th to the 50th percentile in the 6-minute walk test (p < 0.05). Autonomy and competence remained high, reflecting positive perceptions of program practicality. Nutrition knowledge, initially low, significantly improved at post-intervention (p < 0.01), highlighting the efficacy of targeted nutritional education in Hoosier Sport. CONCLUSIONS: This study pioneers a community-engaged model for physical activity intervention in under-resourced rural settings. Positive participant feedback, coupled with improvements in physical fitness and psychosocial factors, highlights the potential of the co-design approach. The findings offer valuable insights and a practical template for future community-based research, signaling the promising impact of such interventions on holistic well-being. This research lays the foundation for subsequent phases of the ORBIT model, emphasizing collaborative, community-driven approaches to address the complex issue of declining physical activity levels among adolescents.
Assuntos
Exercício Físico , Estudos de Viabilidade , População Rural , Humanos , Projetos Piloto , Masculino , Exercício Físico/psicologia , Criança , Feminino , Adolescente , Estudos Prospectivos , Promoção da Saúde/métodos , Meio-Oeste dos Estados Unidos , Avaliação de Programas e Projetos de Saúde , Educação Física e TreinamentoRESUMO
OBJECTIVES: Little is known about the early stress experiences of parents of infants with serious life-limiting/life-threatening conditions during the initial months after discharge from hospital. The aim of the study was to measure change, and predictors of change, in parenting stress at the time of transition from hospital to home (T1) with a medically fragile infant, and after a 3-month period (T2). METHODS: Parents of infants identified as meeting ≥ 1 palliative care referral criterion were recruited in a Midwestern United States tertiary pediatric hospital (2012-2014) within 2 weeks of hospital discharge. A repeated measures design was used to assess change on a validated parenting stress inventory over the two timepoints (T1 and T2). Fifty-two parents (61 infants) participated at T1 and 44 (85%) at T2. RESULTS: On discharge (T1) stress was moderately high 3 months post discharge (T2) overall and domain-specific stress scores improved, except stress related to parent role functioning and participation in their child's medical care. Independent predictors of improvement in overall parenting stress scores (T2-T1) were being a younger parent and having experienced prior pregnancy-related loss. CONCLUSIONS FOR PRACTICE: The time of discharge from hospital to home is often stressful for parents of medically fragile infants. Improvements were found during the first 3 months at home, but improvement was minimal for stress related to role function and providing medical care. Past experience with pregnancy-related loss and being younger were associated with improvement in stress across theoretical domains. Screening for stress should be included as part of routine pre- and post-neonatal intensive care unit discharge psychosocial assessments of parents caring for infants with serious illness to ensure their unique support needs continue to be met over time.
What is already known about the topic? Stress in parents of sick infants is well-documented in the post-birth hospitalization period. Early management of parent stress after a child is born with a life-limiting/life-threatening condition is critical in promoting healthy infant attachment and development.What this study adds? Parents of medically fragile infants experience notable stress during the initial months at home. Pre-hospital discharge attention to medical and psychosocial characteristics of infants and parents may help health care teams anticipate post-discharge parenting challenges and facilitate personalized home support strategies aimed at minimizing parent stress and poor parentchild outcomes.
Assuntos
Assistência ao Convalescente , Alta do Paciente , Recém-Nascido , Lactente , Feminino , Gravidez , Humanos , Criança , Pais/psicologia , Unidades de Terapia Intensiva Neonatal , Meio-Oeste dos Estados Unidos , Poder Familiar/psicologiaRESUMO
A prevailing paradigm suggests that species richness increases with area in a decelerating way. This ubiquitous power law scaling, the species-area relationship, has formed the foundation of many conservation strategies. In spatially complex ecosystems, however, the area may not be the sole dimension to scale biodiversity patterns because the scale-invariant complexity of fractal ecosystem structure may drive ecological dynamics in space. Here, we use theory and analysis of extensive fish community data from two distinct geographic regions to show that riverine biodiversity follows a robust scaling law along the two orthogonal dimensions of ecosystem size and complexity (i.e., the dual scaling law). In river networks, the recurrent merging of various tributaries forms fractal branching systems, where the prevalence of branching (ecosystem complexity) represents a macroscale control of the ecosystem's habitat heterogeneity. In the meantime, ecosystem size dictates metacommunity size and total habitat diversity, two factors regulating biodiversity in nature. Our theory predicted that, regardless of simulated species' traits, larger and more branched "complex" networks support greater species richness due to increased space and environmental heterogeneity. The relationships were linear on logarithmic axes, indicating power law scaling by ecosystem size and complexity. In support of this theoretical prediction, the power laws have consistently emerged in riverine fish communities across the study regions (Hokkaido Island in Japan and the midwestern United States) despite hosting different fauna with distinct evolutionary histories. The emergence of dual scaling law may be a pervasive property of branching networks with important implications for biodiversity conservation.
Assuntos
Biodiversidade , Ecossistema , Rios , Animais , Peixes/fisiologia , Fractais , Mapeamento Geográfico , Japão , Meio-Oeste dos Estados Unidos , Modelos Biológicos , Especificidade da EspécieRESUMO
Soil erosion in agricultural landscapes reduces crop yields, leads to loss of ecosystem services, and influences the global carbon cycle. Despite decades of soil erosion research, the magnitude of historical soil loss remains poorly quantified across large agricultural regions because preagricultural soil data are rare, and it is challenging to extrapolate local-scale erosion observations across time and space. Here we focus on the Corn Belt of the midwestern United States and use a remote-sensing method to map areas in agricultural fields that have no remaining organic carbon-rich A-horizon. We use satellite and LiDAR data to develop a relationship between A-horizon loss and topographic curvature and then use topographic data to scale-up soil loss predictions across 3.9 × 105 km2 of the Corn Belt. Our results indicate that 35 ± 11% of the cultivated area has lost A-horizon soil and that prior estimates of soil degradation from soil survey-based methods have significantly underestimated A-horizon soil loss. Convex hilltops throughout the region are often completely denuded of A-horizon soil. The association between soil loss and convex topography indicates that tillage-induced erosion is an important driver of soil loss, yet tillage erosion is not simulated in models used to assess nationwide soil loss trends in the United States. We estimate that A-horizon loss decreases crop yields by 6 ± 2%, causing $2.8 ± $0.9 billion in annual economic losses. Regionally, we estimate 1.4 ± 0.5 Pg of carbon have been removed from hillslopes by erosion of the A-horizon, much of which likely remains buried in depositional areas within the fields.
Assuntos
Carbono/análise , Produtos Agrícolas/crescimento & desenvolvimento , Ecossistema , Solo/química , Zea mays/crescimento & desenvolvimento , Meio-Oeste dos Estados UnidosRESUMO
OBJECTIVE: This study surveyed the use of community-based resource facilitation (RF) services by ethnic minority survivors of traumatic brain injury (TBI) living in the Midwestern United States. METHOD: Past records of RF use by survivors of TBI were reviewed. Demographics and patterns of RF use across 3 ethnic groups were documented. Reported barriers to community integration related to ethnic identity were identified using Chi-square test of independence. RESULTS: Ethnic minority survivors were less likely to use RF services than white survivors. Caucasian women and men utilized RF services at similar rates, whereas more African American men and Latina women used RF services. Caucasians received information about RF from a greater variety of sources than ethnic minority survivors. Ethnic identity was significantly associated with greater reported needs for TBI awareness. CONCLUSIONS: A pattern of differential RF use by survivors from ethnic minority groups was noted, suggesting potential socio-cultural influences on help-seeking behavior after TBI. These factors should be considered to develop more accessible and equitable strategies of RF service referral and support. Future investigations of cultural perspectives of TBI and injury-related services may improve understanding of the likelihood and necessity of community-based RF service use by diverse populations.
Assuntos
Lesões Encefálicas Traumáticas , Humanos , Lesões Encefálicas Traumáticas/etnologia , Lesões Encefálicas Traumáticas/psicologia , Masculino , Feminino , Adulto , Meio-Oeste dos Estados Unidos/epidemiologia , Pessoa de Meia-Idade , Grupos Minoritários/estatística & dados numéricos , Adulto Jovem , Hispânico ou Latino/estatística & dados numéricos , Hispânico ou Latino/psicologia , População Branca/estatística & dados numéricos , Sobreviventes/psicologia , Adolescente , Negro ou Afro-Americano/estatística & dados numéricos , Negro ou Afro-Americano/psicologia , IdosoRESUMO
Schools are a critical setting to promote healthy youth development through the provision of evidence-based programs (EBPs), yet preventive EBPs in schools are underutilized. The Exploration, Preparation, Implementation, Sustainment (EPIS) framework highlights numerous factors that may influence program adoption during the Exploration phase and progress monitoring during the Implementation phase. However, no research has systematically and simultaneously identified the factors that influence school administrators' decision-making during these important processes. We conducted semi-structured interviews with 24 school administrators in the Midwestern region of the U.S. to understand how they weigh various considerations that inform their adoption and progress monitoring of prevention programs. Results indicated that school administrators consider five separate factors during the adoption decision, prioritized in the following order: need for the program, school community buy-in, contextual fit, resources, and program characteristics (including the evidence-base). Further, administrators consider five indicators to monitor program performance, prioritized as follows: intervention fidelity, quantitative and qualitative data that determine if the identified need was met, school community buy-in, resource consumption, and program characteristics. Implications for prevention scientists and suggestions for future research are discussed.
Assuntos
Tomada de Decisões , Humanos , Instituições Acadêmicas , Entrevistas como Assunto , Prática Clínica Baseada em Evidências , Feminino , Masculino , Serviços de Saúde Escolar/organização & administração , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Adolescente , Meio-Oeste dos Estados UnidosRESUMO
BACKGROUND: Depression is a major source of morbidity but often goes undiagnosed. Broader screening is recommended, and pharmacists could contribute. OBJECTIVES: This study aimed to assess the feasibility of community pharmacy depression and anxiety screening and describe the medication-related problems (MRPs) identified, pharmacist interventions, and provider responses for high-risk patients. METHODS: This pilot was conducted between October 2022 and January 2023 at an independently owned community pharmacy in the Midwest United States. Patients aged 18-45 years with ready prescriptions were identified through weekly reports, and tags were placed on prescription bags. A convenience sample of patients fluent in English were offered the Patient Health Questionnaire (PHQ2) and Generalized Anxiety Disorder (GAD2), with follow-up PHQ9 and GAD7 for at-risk individuals. High-risk individuals met with the pharmacist for consultation and recommendations were discussed. Descriptive statistics were calculated for participant demographics, questionnaire responses, MRPs, and provider responses. Patient profiles were examined 2 months after the workup to identify medication changes. RESULTS: A total of 29 patients volunteered to be screened for anxiety and depression; of these, 41% scored in the high-risk category for depression or anxiety and met with the pharmacist for the consultation. The pharmacist identified multiple MRPs. The most common was the need for additional therapy and inadequate dosages. Patients were reluctant for the pharmacist to follow up with their prescriber and were unreachable for telephone follow-up. Profiles reviewed 2 months after assessment showed half of the at-risk patients had one or more mental health medication changes. CONCLUSION: Community pharmacists may have a role in the screening and management of patient mental health, although there were challenges with screening uptake and follow-up. The pharmacist identified multiple MRPs for this high-risk group for which greater routine monitoring and follow-up may be beneficial. More work seems needed to engage both patients and prescribers.
Assuntos
Ansiedade , Serviços Comunitários de Farmácia , Depressão , Programas de Rastreamento , Farmacêuticos , Papel Profissional , Humanos , Adulto , Feminino , Masculino , Serviços Comunitários de Farmácia/organização & administração , Pessoa de Meia-Idade , Depressão/diagnóstico , Depressão/tratamento farmacológico , Projetos Piloto , Ansiedade/tratamento farmacológico , Ansiedade/diagnóstico , Programas de Rastreamento/métodos , Adulto Jovem , Adolescente , Inquéritos e Questionários , Meio-Oeste dos Estados Unidos , Estudos de ViabilidadeRESUMO
Introduction: To examine telehealth use in chronic care management and disparity reduction among the aging population. Methods: This longitudinal cohort study compared the changes in chronic care quality measures among patients with and without telehealth visits during the COVID-19 pandemic relative to patients in the previous years and by patient sociodemographic subgroup. Participants were Medicare fee-for-service beneficiaries 65 years or older from an Accountable Care Organization in the Midwest United States. Three utilization-based measures included having 2+ A1C tests, breast cancer screening, and depression screening. Three outcome-based measures included A1C control, blood pressure control, and depression diagnosis. Results: During the study period, the pandemic cohort experienced 5-17 percentage points' decrease in utilization-based measures (e.g., 2+ A1C tests 63.9% vs. 51.1%; OR [95% confidence intervals] = 0.35 [0.34-0.36]) from baseline relative to the control cohort. The outcome-based measures also significantly decreased but at smaller magnitudes (3-5 percentage points). About 51.5% patients had at least one telehealth visit. The utilization-based measures for these patients were significantly higher than those without any telehealth visit (e.g., 2+ A1C 57.1% vs. 51.1%, p < 0.01). However, the outcome-based measures were comparable. Patients from historically underserved groups had a larger decline in health care outcomes than their counterparts. Among patient with at least one telehealth visit, these disparities were no longer significant. Discussions: Telehealth was associated with less negative impact of the pandemic and better performance in chronic care management, but more for utilization-based measures and less for outcome-based measures. Telehealth was also associated with less disparities in care outcomes.
Assuntos
COVID-19 , Medicare , Telemedicina , Humanos , Telemedicina/estatística & dados numéricos , Idoso , Feminino , COVID-19/epidemiologia , Masculino , Estados Unidos , Estudos Longitudinais , Doença Crônica/terapia , Medicare/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , SARS-CoV-2 , Idoso de 80 Anos ou mais , Pandemias , Meio-Oeste dos Estados UnidosRESUMO
BACKGROUND/AIMS: Athletic trainers are often the point person when sports-related traumatic dental injuries (TDIs) occur. The aim of this study was to assess knowledge levels of the management of TDIs among athletic trainers in the Midwest United States, as well as evaluate variables that may influence knowledge levels. MATERIAL AND METHODS: A survey was sent to athletic trainers licensed in Minnesota, Nebraska, and Iowa. The survey included 28 multiple-choice and fill in the blank questions split into three sections. The three sections included background, emergency management of TDIs, and opinion questions. RESULTS: Of the participants, 100% recalled receiving medical first aid training. However, only 71% recalled receiving formal training on emergency management of dental injuries. Although 75% were confident in managing a dental injury, over 63% of participants scored less than 70% in the knowledge score section. Majority of the participants (98.4%) reported that they believe training on the management of TDIs is important. Athletic trainers working with contact sports were more likely to have experienced managing TDIs more recently than those working in noncontact sports. CONCLUSIONS: This study shows the gaps in knowledge among athletic trainers pertaining to management of TDIs and emphasizes the importance of sports community having adequate education on emergency management of such dental injuries.
Assuntos
Traumatismos em Atletas , Conhecimentos, Atitudes e Prática em Saúde , Traumatismos Dentários , Humanos , Traumatismos Dentários/terapia , Traumatismos em Atletas/terapia , Feminino , Masculino , Adulto , Inquéritos e Questionários , Pessoa de Meia-Idade , Tratamento de Emergência , Meio-Oeste dos Estados UnidosRESUMO
PURPOSE: Increasing racial and ethnic diversity in U.S. nursing facilities has necessitated the provision of more culturally competent care. This study explored the cultural challenges in providing palliative care from the perspective of certified nursing assistants (CNAs) and nurses in nursing facilities. METHOD: A thematic analysis approach was used to examine data from semi-structured interviews with 12 CNAs and 11 nurses from six nursing facilities in a U.S. Midwestern state. RESULTS: Four themes emerged from the data: Cultural Needs Expressed by Residents, Cultural Needs Expressed by Family Members, Accommodating Residents' Cultural Needs, and Organizational Responses to Cultural Competency Challenges. CONCLUSION: Results highlighted the training variations on diversity and cultural competency issues and the varying cultural competency levels possessed by staff. To support residents' culture-related needs, staff need education and support. Organizations can provide foundational resources for this diversity of cultural expression, including providing more culturally diverse programming facilities. [Journal of Gerontological Nursing, 50(7), 35-41.].
Assuntos
Competência Cultural , Assistentes de Enfermagem , Cuidados Paliativos , Humanos , Assistentes de Enfermagem/educação , Assistentes de Enfermagem/psicologia , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Casas de Saúde , Meio-Oeste dos Estados Unidos , Assistência à Saúde Culturalmente CompetenteRESUMO
BACKGROUND: Experiencing symptoms of traumatic stress may be the cost of caring for trauma patients. Emergency nurses caring for trauma patients are at risk for traumatic stress reactions. OBJECTIVE: This study explored the stress and coping behaviors experienced by emergency nurses who provide trauma care. METHODS: Focus groups were held at three urban trauma centers in the Midwestern United States: a Level I pediatric trauma center, a Level I adult trauma center, and a Level III adult trauma center. Data were collected between December 2009 and March 2010. Data analysis was guided by the principles of grounded theory. Line-by-line coding and constant comparative analysis techniques were used to identify recurring constructs. RESULTS: A total of 48 emergency nurses participated. Recurring constructs emerged in the data analysis and coding, revealing four major themes: care of the trauma patient, professional practice, personal life, and support. CONCLUSIONS: Nurse job engagement, burnout, and professional and personal relationships are influenced by trauma patient care. The study's resulting themes of care of the trauma patient, professional practice, personal life, and support resulted in the development of the "trauma nursing is a continual experience theory" that can be used as a framework to address these effects. Intentional support and timely interventions based on this new theory can help mitigate the effects of traumatic stress experienced by trauma nurses.
Assuntos
Adaptação Psicológica , Enfermagem em Emergência , Grupos Focais , Teoria Fundamentada , Recursos Humanos de Enfermagem Hospitalar , Pesquisa Qualitativa , Centros de Traumatologia , Humanos , Feminino , Adulto , Masculino , Pessoa de Meia-Idade , Meio-Oeste dos Estados Unidos , Recursos Humanos de Enfermagem Hospitalar/psicologia , Enfermagem em Ortopedia e Traumatologia , Esgotamento Profissional/psicologia , Ferimentos e Lesões/enfermagem , Ferimentos e Lesões/psicologiaRESUMO
BACKGROUND: Early administration of antibiotics in the presence of open fractures is critical in reducing infections and later complications. Current guidelines recommend administering antibiotics within 60 min of patient arrival to the emergency department, yet trauma centers often struggle to meet this metric. OBJECTIVES: This study aims to evaluate the impact of a nurse-initiated evidence-based treatment protocol on the timeliness of antibiotic administration in pediatric patients with open fractures. METHODS: A retrospective pre-post study of patients who met the National Trauma Data Standard registry inclusion criteria for open fractures of long bones, amputations, or lawn mower injuries was performed at a Midwestern United States Level II pediatric trauma center. The time of patient arrival and time of antibiotic administration from preimplementation (2015-2020) to postimplementation (2021-2022) of the protocol were compared. Patients transferred in who received antibiotics at an outside facility were excluded. RESULTS: A total of N = 73 participants met the study inclusion criteria, of which n = 41 were in the preimplementation group and n = 32 were in the postimplementation group. Patients receiving antibiotics within 60 min of arrival increased from n = 24/41 (58.5%) preimplementation to n = 26/32 (84.4%) postimplementation (p< .05). CONCLUSIONS: Our study demonstrates that initiating evidence-based treatment orders from triage helped decrease the time from arrival to time of antibiotic administration in patients with open fractures. We sustained improvement for 24 months after the implementation of our intervention.
Assuntos
Antibacterianos , Fraturas Expostas , Centros de Traumatologia , Humanos , Fraturas Expostas/enfermagem , Fraturas Expostas/tratamento farmacológico , Estudos Retrospectivos , Antibacterianos/administração & dosagem , Masculino , Criança , Feminino , Pré-Escolar , Protocolos Clínicos , Adolescente , Tempo para o Tratamento/normas , Fatores de Tempo , Meio-Oeste dos Estados UnidosRESUMO
Enhanced rock weathering (ERW) is a carbon dioxide removal (CDR) strategy for combating climate change. The CDR potentials of ERW have been assessed at the process and national/global levels, but the environmental and economic implications of ERW have not been fully quantified for U.S. applications with real-world supply chain considerations. This study develops an optimization-based, integrated life cycle assessment and techno-economic analysis framework for ERW, which is demonstrated by a case study applying mining waste to croplands in the Midwestern U.S. The case study explores maximum transportation distances for intermodal transportation at varied mineral CDR yields and costs, informing supply chain design for economically viable ERW. ERW costs (US$45 to 472/tonne of net CO2e captured) and cradle-to-farm gate GHG emissions (41 to 359 kg CO2e/tonne of CO2e captured) are estimated based on a range of CDR yields and by transportation distances to and from two Midwest port destinations: Chicago and Duluth. Our sensitivity analysis identifies CDR yields, and transportation modes and distances as driving factors for result variations. Our study reveals the importance of ERW supply chain design and provides an example of U.S. CDR implementation. Our framework and findings can be applied to other regional ERW projects.
Assuntos
Dióxido de Carbono , Mudança Climática , Animais , Meio-Oeste dos Estados Unidos , Chicago , Estágios do Ciclo de VidaRESUMO
In 1987, the United States Environmental Protection Agency recommended installing a mitigation system when the indoor concentration of radon, a well-known carcinogenic radioactive gas, is at or above 148 Bq/m3. In response, tens of millions of short-term radon measurements have been conducted in residential buildings over the past three decades either for disclosure or to initially evaluate the need for mitigation. These measurements, however, are currently underutilized to assess population radon exposure in epidemiological studies. Based on two relatively small radon surveys, Lawrence Berkeley National Laboratory developed a state-of-the-art national radon model. However, this model only provides coarse and invariant radon estimations, which limits the ability of epidemiological studies to accurately investigate the health effects of radon, particularly the effects of acute exposure. This study involved obtaining over 2.8 million historical short-term radon measurements from independent laboratories. With the use of these measurements, an innovative spatial random forest (SRF) model was developed based on geological, architectural, socioeconomical, and meteorological predictors. The model was used to estimate monthly community-level radon concentrations for ZIP Code Tabulation Areas (ZCTAs) in the northeastern and midwestern regions of the United States from 2001 to 2020. Via cross-validation, we found that our ZCTA-level predictions were highly correlated with observations. The prediction errors declined quickly as the number of radon measurements in a ZCTA increased. When ≥15 measurements existed, the mean absolute error was 24.6 Bq/m3, or 26.5% of the observed concentrations (R2 = 0.70). Our study demonstrates the potential of the large amount of historical short-term radon measurements that have been obtained to accurately estimate longitudinal ZCTA-level radon exposures at unprecedented levels of resolutions and accuracy.
Assuntos
Poluentes Radioativos do Ar , Poluição do Ar em Ambientes Fechados , Monitoramento de Radiação , Radônio , Estados Unidos , Radônio/análise , Poluentes Radioativos do Ar/análise , Poluição do Ar em Ambientes Fechados/análise , Algoritmo Florestas Aleatórias , Meio-Oeste dos Estados Unidos , HabitaçãoRESUMO
Tar spot, caused by Phyllachora maydis, is an emerging disease of corn in the United States. Stromata of P. maydis are sometimes surrounded by necrotic lesions known as fisheyes and were previously reported to be caused by the fungus Microdochium maydis. The association of M. maydis with fisheye lesions has not been well documented outside of initial descriptions from the early 1980s. The objective of this work was to assess and identify Microdochium-like fungi associated with necrotic lesions surrounding P. maydis stromata using a culture-based method. In 2018, corn leaf samples with fisheye lesions associated with tar spot stromata were collected from 31 production fields across Mexico, Illinois, and Wisconsin. Cultures of pure isolates collected from Mexico believed to be M. maydis were included in the study. A total of 101 Microdochium/Fusarium-like isolates were obtained from the necrotic lesions, and 91% were identified as Fusarium spp., based on initial ITS sequence data. Multi-gene (ITS, TEF1-α, RPB1, and RPB2) phylogenies were constructed for a subset of 55 isolates; Microdochium, Cryptostroma, and Fusarium reference sequences were obtained from GenBank. All the necrotic lesion isolates clustered within Fusarium lineages and were phylogenetically distinct from the Microdochium clade. All Fusarium isolates from Mexico belonged to the F. incarnatum-equiseti species complex, whereas >85% of the U.S. isolates grouped within the F. sambucinum species complex. Our study suggests that initial reports of M. maydis were misidentifications of resident Fusarium spp. [Formula: see text] Copyright © 2023 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license.
Assuntos
Fusarium , Zea mays , México , Doenças das Plantas , Meio-Oeste dos Estados Unidos , Illinois , Fusarium/genéticaRESUMO
Schools are the most common site to implement evidence-based prevention programs and practices (EBPs) to improve behavioral and mental health outcomes among children and adolescents. Research has highlighted the critical role of school administrators in the adoption, implementation, and evaluation of such EBPs, focusing on the factors they should consider during the adoption decision and the behaviors needed for successful implementation. However, scholars have only recently begun to focus on the de-adoption or de-implementation of low-value programs and practices to make room for evidence-based alternatives. This study introduces escalation of commitment as a theoretical framework for understanding why school administrators may stick with ineffective programs and practices. Escalation of commitment is a robust decision-making bias in which people feel compelled to continue with a course of action even when performance indicators suggest it is not going well. Using grounded theory methodology, we conducted semi-structured interviews with 24 building- and district-level school administrators in the Midwestern United States. Results suggested that escalation of commitment occurs when administrators attribute the underlying causes of poor program performance not to the program itself but instead to issues related to implementation, leadership, or the limitations of the performance indicators themselves. We also identified a variety of psychological, organizational, and external determinants that accentuate administrators' continuance of ineffective prevention programs. Based on our findings, we highlight several contributions to theory and practice.
Assuntos
Emoções , Instituições Acadêmicas , Criança , Adolescente , Humanos , Meio-Oeste dos Estados UnidosRESUMO
Adolescents' ethnic-racial identity (ERI) exploration, resolution, and affirmation inform their approach and avoidance attitudes toward intergroup contact, but the potential mechanisms through which this occurs have been underexplored. Given the evidence that adolescents with higher ERI exploration, resolution, and affirmation also report higher self-esteem, and self-esteem is theorized to facilitate openness to intergroup contact, the current study explored the role of self-esteem as a mediator of the relation between adolescents' ERI and their intergroup contact attitudes. Participants were 4606 adolescents (Mage = 16.35, SD = 1.16; 37.5% White, 27.1% Black, 20.7% Latinx, 11.7% Asian American, 3% Native American) from the U.S. Southwest and Midwest. The three waves of data were collected between March 2017 and March 2018. Results from longitudinal multigroup path models indicated that across all ethnic-racial groups there were positive direct relations between Wave 1 (W1) ERI resolution and W2 self-esteem (7 months later). In turn, W2 self-esteem was positively related to W3 approach attitudes (12 months later) and negatively related to W3 avoidance attitudes. The relations between ERI resolution and both approach and avoidance attitudes were fully mediated by self-esteem across all ethnic-racial groups. Notably the baseline values (W1) of all mediation and outcome variables (W2, W3) were included, suggesting that ERI resolution at baseline predicted increases in self-esteem, which predicted subsequent increases in approach attitudes and decreases in avoidance attitudes. ERI exploration and affirmation were not significant predictors of later self-esteem or contact attitudes. These findings suggest that of the three dimensions of ERI examined, resolution is the primary driver of the increases in self-esteem that inform adolescents' attitudes towards interaction with ethnic-racial outgroup members.