Challenges in Disseminating Evidence-Based Health Promotion Programs in Faith Community Settings: What We Need to Include.

BACKGROUND: Effective dissemination of information about evidence-based programs (EBPs) is essential for promoting health equity. Faith-based and other community organizations have difficulty locating EBPs for implementation in their settings. A research team engaged in a systematic search to identify a menu of EBPs that could be offered to African American FBOs as part of a community-engaged implementation study. Methods. A four-stage process was developed to search for EBPs meeting seven inclusion criteria for dissemination in faith-based organizations (FBOs). Criteria included relevance to identified health disparity topics, endorsement on a federal website, free access to downloadable program materials, facilitator guidance, no requirements for health care providers, and culturally relevant materials for African American communities. RESULTS: Nineteen government websites were searched. Sixty-six potential EBPs were identified. Six EBPs met all inclusion criteria. DISCUSSION: The search for EBPs that met seven criteria for implementation in African American FBOs demonstrated challenges that have been described in the literature. Researchers encountered a lack of standardized terminology for identifying EBPs on federal websites, frequent requirement for health care providers or clinics and/or fees for training and materials. FBOs are supportive and safe places to offer EBPs to promote health, and EBPs need to be designed and disseminated to meet the needs and preferences of FBOs. Including members of FBOs and others in the community in EBP development, design, and dissemination, such as searchable health promotion EBP registries, can increase the likelihood that effective programs intended to address health disparities are readily accessible to FBOs for implementation.

Effects of nonnutritive sugar inclusion in laboratory diets and attracticidal spheres on survivorship and mobility of 2 Dipteran species, Rhagoletis pomonella (Diptera: Tephritidae) and Drosophila suzukii (Diptera: Drosophilidae).

Native apple maggot fly, Rhagoletis pomonella, and invasive spotted-wing drosophila, Drosophila suzukii, are key pests of apple and small fruit, respectively, in the United States. Both species are typically managed with standard insecticide applications. However, interest in alternative strategies that result in insecticide reductions has led to evaluations of nonnutritive sugars as toxicants for Drosophila species and development of attracticidal spheres for both species. Here, we evaluated the survivorship of R. pomonella and D. suzukii when provided with standard diets that substituted saccharin, sucralose, aspartame, erythritol, dextrose, or mannitol for the sucrose component and compared them with standard diets and water-only controls for up to 15 days. Presence of erythritol and mannitol significantly decreased survivorship of R. pomonella and erythritol significantly decreased the survivorship of D. suzukii. However, mobility trials following a 2 h exposure to aqueous solutions of each sugar treatment resulted in no strong impact on either species. Survivorship after 30 min exposure to erythritol or mannitol alone, or in combination with varying concentrations of sucrose (serving as a phagostimulant) at 30 min and 24 h were evaluated for both species. Only D. suzukii survivorship was affected with decreased survivorship on erythritol:sucrose solutions of 20:0% and 15:5% for 24 h. Based on all results, erythritol appeared most promising, and was integrated into attracticidal spheres as a toxicant but even at the highest concentration, survivorship remained unaffected for either species, thus making this nonnutritive sugar impractical and ineffective as a toxicant substitute in attracticidal spheres.

Pathway to Trust: A Middle-Range Theory.

Background and Purpose: Trust is interpersonal, between two people, or institutional, in an institution or profession such as nursing. The patient developing interpersonal trust with the nurse is fundamental to nursing care. The purpose of this study was to develop a middle-range theory of interpersonal trust development in the nurse-patient relationship. Methods: The middle-range theory Pathway to Trust was synthesized from three grounded theory studies on the development of trust in the nurse-patient relationship with hospitalized patients. One study was conducted with English-speaking Mexican American adults, a second study with Spanish-speaking Mexican American adults, and the third study with non-Hispanic adults. The three models were synthesized into an empirically based middle-range theory of how interpersonal trust develops between the hospitalized patient and the nurse. Results: The Pathway to Trust has a beginning, middle, and end phase. At the beginning, the patient is vulnerable, relying on the nurse. In the middle, the nurse enters focused and available to the patient, perceived as caring about the patient. In the end, the patient develops trust, feeling comfortable with the nurse. A key consequence of trust is the patient allowing the nurse to help and confiding in the nurse. If the trust does not develop, the patient may avoid the nurse and not ask for help which is a patient safety concern. Implications for Practice: The Pathway to Trust is useful for advancing nursing practice, education, and research globally. Developing trust with the patient impacts patient safety and quality of care.

Prevalence of Substance Abuse Among Trauma Patients in Rural West Virginia.

BACKGROUND:  Substance abuse poses considerable clinical, economic, and social challenges. West Virginia is hailed as the epicenter of the substance abuse in the United States, the prevalence and pattern of different trauma mechanisms in a rural context or in patients with different forms of substance abuse remain unclear. OBJECTIVE:  We performed the following analysis to understand the prevalence of substance abuse in patients with different trauma mechanisms in the rural setting with high substance abuse in the West Virginia. METHODS:  We performed a cross-sectional retrospective analysis of adult trauma patients (motor vehicle, fall, assault, firearm suicide, brawl/rape and machinery) hospitalized in two tertiary care hospitals in West Virginia between 2006 and 2016. We identified all patients who had a urine drug screen (UDS) test and extracted the data related to the substance and trauma. RESULTS:  Among 8734 patients screened using UDS, 5940 (68.1%) patients were tested positive for the substance. Opiates, alcohol, benzodiazepines, and cannabis were the four most common substances identified in trauma victims. In all instances, the prescribed drug was less than 20%. Fatal outcome was observed in 366 patients in the sample, with 44% (n=162) testing positive for UDS, 12% (n=45) testing positive for only alcohol, and 15% (n=56) testing positive for both alcohol and UDS. Regarding the trauma mechanism, the motor vehicle accident (MVA) was the most prominent with a clear association of substance abuse with fatal outcome. CONCLUSION:  The most prevalent trauma mechanism was a MVA, with a strong link between drug usage and mortality. Due to the high incidence of positive substance abuse screens, UDS tests may need to be more widely implemented in trauma in the West Virginia region. The findings of this study might help in establishing regional or national policies to reduce acute substance abuse.

Door-in-door-out times for patients with large vessel occlusion ischaemic stroke being transferred for endovascular thrombectomy: a Victorian state-wide study.

Background: Time to reperfusion is an important predictor of outcome in ischaemic stroke from large vessel occlusion (LVO). For patients requiring endovascular thrombectomy (EVT), the transfer times from peripheral hospitals in metropolitan and regional Victoria, Australia to comprehensive stroke centres (CSCs) have not been studied. Aims: To determine transfer and journey times for patients with LVO stroke being transferred for consideration of EVT. Methods: All patients transferred for consideration of EVT to three Victorian CSCs from January 2017 to December 2018 were included. Travel times were obtained from records matched to Ambulance Victoria and the referring centre via Victorian Stroke Telemedicine or hospital medical records. Metrics of interest included door-in-door-out time (DIDO), inbound journey time and outbound journey time. Results: Data for 455 transferred patients were obtained, of which 395 (86.8%) underwent EVT. The median DIDO was 107 min (IQR 84-145) for metropolitan sites and 132 min (IQR 108-167) for regional sites. At metropolitan referring hospitals, faster DIDO was associated with use of the same ambulance crew to transport between hospitals (75 (63-90) vs 124 (99-156) min, p<0.001) and the administration of thrombolysis prior to transfer (101 (79-133) vs 115 (91-155) min, p<0.001). At regional centres, DIDO was consistently longer when patients were transported by air (160 (127-195) vs 116 (100-144) min, p<0.001). The overall door-to-door time by air was shorter than by road for sites located more than 250 km away from the CSC. Conclusion: Transfer times differ significantly for regional and metropolitan patients. A state-wide database to prospectively collect data on all interhospital transfers for EVT would be helpful for future study of optimal transport mode at regional sites and benchmarking of DIDO across the state.

Survival and development of Lycorma delicatula (Hemiptera: Fulgoridae) on common secondary host plants differ by life stage under controlled conditions.

Host range assessment for emerging invasive insects is a vital step toward fully defining the issues the insect may pose. Spotted lanternfly (SLF) is an invasive species that is rapidly expanding its presence in the United States. The primary hosts facilitating this spread are tree of heaven, a plant from SLF's native range, and the economically important winegrape. Black walnut is also implicated as an important and common host plant. This study investigated the survival and development of SLF on diets that included a variety of crop host plants in the presence or absence of tree of heaven. The following plant species, 'Honeycrisp' apple, 'Reliance' peach, silver maple, and tree of heaven were paired with winegrape or black walnut throughout the study. SLF had strong development and high survival on a diet of winegrape alone, and winegrape or black walnut paired with tree of heaven. Survival parameters were reduced with all other plant pairings. In particular, SLF in the winegrape and peach diet treatment did not develop past the third nymphal instar. A second experiment evaluated the survival of early and late instar nymphs and adult SLF life stages on three specialty crops - 'Cascade' hops, muscadine grapes, and kiwifruit over a two-week period. Nymphs survived longer than adults, with survival of first and second instar nymphs on hops not differing from the control tree of heaven treatment. The adult stage survived best on kiwi and muscadine grape. Our results show tree of heaven and winegrape were the only single plant diets evaluated that are sufficient for complete SLF development, while other host plants may require additional host or hosts of sufficient nutritional quality for SLF survival.

A systematic review of the health and health care of rural sexual and gender minorities in the UK, USA, Canada, Australia and New Zealand.

INTRODUCTION: Lesbian, gay, bisexual, transgender, intersex, queer, and people with a diversity of sexual and gender identities (LGBTIQ+) residing in rural contexts may face additional challenges to attaining wellbeing, yet a comprehensive understanding of these experiences is lacking. The purpose of the systematic review is to address this knowledge gap. The aims of the review are to progress understanding about rural LGBTIQ+ communities with regard to wellbeing, healthcare access and experience, and barriers and facilitators to health care. METHODS: Peer-reviewed literature was searched in PubMed, Academic Search Premier, CINAHL, and PsychInfo databases, while grey literature was searched using Google Advanced Search. Documents produced between 2015 and 2020 in the USA, Canada, Australia, New Zealand, and UK were eligible and reference lists were screened. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were adhered to. Relevant data were extracted and synthesized. The quality of the peer-reviewed literature and grey literature was assessed using the Mixed Methods Appraisal Tool and the Authority, Accuracy, Coverage, Objectivity, Date, Significance checklist, respectively. At each stage of the study selection process, a second author reviewed a sample of 10% of the articles and documents to ensure consistent application of the inclusion criteria. Consultation within the team was used to resolve any discrepancies encountered. RESULTS: The 297 unique peer-reviewed returned records were screened, with 69 full texts assessed for eligibility, resulting in the inclusion of 42 articles. The initial result of 2785 grey documents were similarly screened, resulting in the inclusion of 12 documents. Overall, the included literature was deemed to be of good quality. Synthesis of data resulted in the reporting of findings concerning mental, physical, and sexual wellbeing; healthcare access and experiences with care; and barriers and facilitators to health care for various communities in rural areas. The findings showed rural LGBTIQ+ communities shared many of the health concerns of non-rural LGBTIQ+ communities, as well as encountering similar issues and barriers to the receipt of high-quality appropriate care. However, the evidence also indicates an array of nuanced challenges for communities in rural areas such as a lack of available appropriate providers, and financial and practical barriers concerning the need to travel to obtain the services needed. The intersection of rurality and LGBTIQ+ identity was especially pronounced for rural LGBTIQ+ elders facing potential isolation in the context of declining mobility, service providers experiencing high demand and isolation from professional networks, and for LGBTIQ+ populations negotiating the complexities of disclosure in interactions with health professionals. The latter three findings in particular extend on the existing knowledge base. CONCLUSION: Investment is needed in the design, trialling, and evaluation of tailored models of care, which account for the specific challenges encountered in providing services to rural LGBTIQ+ communities. Such models, should also harness identified facilitators for rural LGBTIQ+ wellbeing, including the use of online technologies. Dedicated study is merited to inform policy and practice for aged care services in rural areas. Further, the development and implementation of strategies to support rural health service providers is warranted.

Taking the Time: Developing Trust with the Hospitalized Patient.

Background and Purpose: Interpersonal trust is trust between two people and is an important component of the nurse-patient relationship in the hospital setting. Interpersonal trust entails good will, familiarity, risk, power imbalance, and vulnerability. This grounded theory study was undertaken to explain how interpersonal trust develops with the nurse from the perspective of the hospitalized adults. Methods: Face-to-face interviews were conducted with 20 hospitalized adults in their private hospital room. Data analysis was conducted concurrently with data collection using constant comparison. Results: The resulting model had six categories within the core category Taking the Time which reflected nursing presence. The beginning phase had two categories reflecting the patient Feeling Vulnerable and Relying on the Nurse. The middle phase had three categories reflecting the nurse Having a Positive Vibe, Seeing Me as a Person and Caring About Me. The endpoint of developing trust was the patient Feeling Comfortable. Patients perceived the nurse as in control of trust development in the hospital setting. Implications for Practice: The nurse conveying a positive attitude was a principal facilitator to trust development. A barrier to trust development was the nurse seeing the patient as a checklist and not as a person. When trust was established, the patient was more willing to ask questions. When trust did not develop, the patient avoided the nurse and attempted to complete activities on their own such as ambulating to the bathroom. The nurse taking the time and establishing trust contributes to safe patient care.

Granulocyte colony stimulating factor (G-CSF)-induced aortitis in a patient undergoing adjuvant chemotherapy for breast cancer.

Granulocyte colony stimulating factor (G-CSF) is used to prevent febrile neutropenia post chemotherapy. Usually well tolerated with minimal side effects but aortitis is an extremely rare side effect previously reported. A 64-year-old woman treated with adjuvant chemotherapy including G-CSF for left breast cancer was admitted with fevers, neutropenia and markedly raised inflammatory markers after 7 days of her first cycle. Initially diagnosed with neutropenic sepsis, she did not respond to broad spectrum antibiotics with subsequent CT imaging revealing marked periaortic inflammatory changes consistent with aortitis and periaortitis. Extensive investigations for other causes of large vessel vasculitis were negative and G-CSF was the only causative factor. She rapidly responded to steroids with almost complete resolution of inflammatory changes on repeat imaging within 4 weeks and no recurrence on tapering of steroids. This diagnosis must be considered in patients presenting with fever and raised inflammatory markers post G-CSF treatment.

Survivorship and Development of the Invasive Lycorma delicatula (Hemiptera: Fulgoridae) on Wild and Cultivated Temperate Host Plants.

The invasive spotted lanternfly, Lycorma delicatula, (White Hemiptera: Fulgoridae) continues to spread throughout the Eastern United States. This species exhibits a broad host range, with tree of heaven, Ailanthus altissima (Mill.) Swingle, commonly referred to as the preferred host. Here, we evaluated 2-wk survivorship of early nymphal instars, late nymphal instars, and adult L. delicatula on single diets of ten wild and cultivated hosts: tree of heaven; apple, Malus domestica; peach, Prunus persica; black cherry, P. serotina Ehrh; black locust, Robinia pseudoacacia L.; black walnut, Juglans nigra L.; common hackberry Celtis occidentalis L.; mulberry Morus alba L.; sugar maple Acer saccharum Marshall; white oak, Quercus alba L.. Among them, early and late instars had significantly greater survivorship on tree of heaven and black walnut and adults had greatest survivorship on tree of heaven. Additionally, we evaluated development and survivorship of L. delicatula from newly hatched nymphs to adulthood on single diets of tree of heaven, black walnut, grapevine, apple, and peach, and mixed diets of tree of heaven plus one other host. Single host diets that supported L. delicatula development to adulthood were tree of heaven and black walnut. Interestingly, mixed diets also supported development, and reduced development time to adults by up to 12% compared with the single tree of heaven diet. Our results suggest that within agroecosystems and across landscapes, L. delicatula can develop on single hosts such as tree of heaven, but also on multiple host plants, yielding adults earlier in the growing season.

Development of rearing methodology for the invasive Spotted Lanternfly, Lycorma delicatula (Hemiptera: Fulgoridae).

Lycorma delicatula, White (Hemiptera: Fulgoridae), spotted lanternfly, is a univoltine, phloem-feeding, polyphagous and invasive insect in the USA. Although a primary host for this species is Ailanthus altissima, tree of heaven, L. delicatula also feeds on a wide range of hosts important to the USA including cultivated grapevines. Due to the need for classical or augmentative biological control programs to reduce impacts of L. delicatula across invaded areas, we developed a laboratory-based rearing protocol for this invasive species. Here, we evaluated the use of A. altissima apical meristems, epicormic shoots, and fresh foliage cut from A. altissima as a food source for rearing newly hatched L. delicatula. On these sources of plant material <20% of L. delicatula developed into adults and no oviposition occurred. However, when young, potted A. altissima trees were used as a food source, >50% of L. delicatula nymphs developed to the adult stage under natural daylengths and temperatures ranging from 20-25°C. The addition of wild grapevine, Vitis riparia, did not increase survivorship or reduce development time. To elicit mating and oviposition, adults were provided with A. altissima logs as an oviposition substrate and maintained under shortened daylengths and reduced nighttime temperatures (12L:12D and 24°C:13°C). This resulted in 2.12 egg masses deposited per female, which was 4× more than when adults were maintained in standard rearing conditions (16L:8D and 25°C). Based on these experiments, we present a protocol for reliably rearing L. delicatula under laboratory and/or greenhouse conditions.

Did introducing Twitter and digital professionalism as an assessed element of the nursing curriculum impact social media related incidence of 'Fitness to Practise': 12-year case review.

Many educators argue for the benefits of nursing students engaging with social media but some have concerns about inappropriate use. In 2014, we introduced Digital Professionalism, a mandatory curriculum innovation including assessed Twitter use, for nursing but not midwifery students. British nursing students who display unprofessional behaviour are subject to 'Fitness to Practise' hearings. We aimed to use routinely collected data to see if inappropriate social media use had increased from introducing Twitter to the curriculum. We used data (2008-2019) on Fitness to Practise cases for nine completing cohorts comprising 4398 nursing and 338 midwifery students. We compared annual Fitness to Practise incidence rates related to social media between cohorts with and without mandatory Twitter. There was no difference in the number of nursing students involved with social media cases before (7/2636 (0.3%)), and after (10/1762 (0.6%)) the introduction of Twitter. Nursing students, after introduction of Twitter, were no more likely than midwifery students (no introduction of Twitter), to misuse social media. Fitness to Practise hearings related to social media were highly infrequent. Our study supports the argument that benefits for most nursing students of introducing professional use of social media are not negated by increased inappropriate use.

Lessons of the month: Over-the-counter antacids causing hypercalcaemia: The emergence of calcium-alkali syndrome.

We present the case of a woman who was found to have severe hypercalcaemia, staghorn calculus formation and renal impairment from the long-standing ingestion of calcium carbonate antacids from a supermarket outlet. The dosage was reported to be approximately 1,800 mg of elemental calcium each day which would constitute only a marginal increase on the recommended intake for daily elemental calcium. Furthermore, she was concomitantly taking a prescribed anti-hypertensive medication that may have exacerbated the hypercalcaemia and subsequent renal calcification. While calcium-alkali syndrome is well documented, it can be overlooked by clinicians as the predominant cause of hypercalcaemia, especially if a thorough drug history is not actively sought. This is particularly important as calcium carbonate products are increasingly being purchased as over-the-counter remedies for dyspepsia management as well as osteoporosis prevention. Explicit product labelling regarding limiting duration usage, potential drug interactions and risk of calcification is therefore recommended.

Student midwives' perception of the growth assessment protocol (GAP): Preparation for clinical practice.

Fetal growth restriction is a major complication of pregnancy and increases the risk of stillbirth. Midwives screen for fetal wellbeing by measuring the symphysis fundal height to detect growth restriction, which can present in a low risk pregnancy or occur late in gestational age. The detection, surveillance and onward referral of these pregnancies are the responsibility of all midwives. To prevent avoidable stillbirth due to restricted fetal growth and to ensure safe, evidence based practice, the Perinatal Institute developed the Growth Assessment Protocol (GAP). A qualitative study using semi-structured interviews was conducted to explore 2nd year student midwives' perception of the GAP training and its impact on their clinical practice. Data was analysed and four main themes were identified using interpretative phenomenological analysis. The findings from the study show that the participants viewed the GAP training as 'authentic' and commented on the alignment with contemporary practice for the detection and surveillance of at risk pregnancies. The findings suggest that GAP training for pre-registration student midwives has the potential to provide a sustainable workforce, prepared to meet the World Health Organisation's global strategy for eliminating avoidable stillbirth by 2030.

Vibrational Spectroscopy: A Valuable Screening and Diagnostic Tool for Obstetric Disorders?

Preeclampsia (PE) is a common obstetric disorder typically affecting 2-8% of all pregnancies and can lead to several adverse obstetric outcomes for both mother and fetus with the greatest burden of severe outcomes in low middle-income countries (LMICs), therefore, screening for PE is vital. Globally, screening is based on maternal characteristics and medical history which are nonspecific for the disorder. In 2004, the World Health Organization acknowledged that no clinically useful test was able to predict the onset of PE, which prompted a universal search for alternative means of screening. Over the past decade or so, emphasis has been placed on the use of maternal characteristics in conjunction with biomarkers of disease combined into predictive algorithms, however these are yet to transition into the clinic and are cost prohibitive in LMICs. As a result, the screening paradigm for PE remains unchanged. It is evident that novel approaches are needed. Vibrational spectroscopy, specifically Raman spectroscopy and Fourier-transform infrared spectroscopy (FTIR), could provide better alternatives suited for implementation in low resource settings as no specialized reagents are required for conventional approaches and there is a drive to portable platforms usable in both urban and rual community settings. These techniques are based on light scattering and absorption, respectively, allowing detailed molecular analysis of samples to produce a unique molecular fingerprint of diseased states. The specificity of vibrational spectroscopy might well make it suited for application in other obstetric disorders such as gestational diabetes mellitus and obstetric cholestasis. In this review, we summarize current approaches sought as alternatives to current screening methodologies and introduce how vibrational spectroscopy could offer superior screening and diagnostic paradigms in obstetric care. Additionally, we propose a real benefit of such tools in LMICs where limited resources battle the higher prevalence of obstetric disorders.

An Educational Tool for Promoting Transitional Health Care Planning by Nurses From the Hospital to the Community.

Although nurses are an invaluable component of successful health care transition, a large gap exists on methods to educate future health care professionals regarding roles and necessary transition components. The Transitional Nursing History tool introduces prelicensure students to transitional health care planning needs and the essential roles of nurses. The Transitional Nursing History tool provides experiential student learning, promotes understanding of determinants of health influences on transitional planning needs, and encourages active student engagement. Students report increased recognition of the value of transitional health care planning and actively apply the concepts in other clinical settings.

Community treatment orders increase community care and delay readmission while in force: Results from a large population-based study.

OBJECTIVE: There is debate about the effectiveness of community treatment orders in the management of people with a severe mental illness. While some case-control studies suggest community treatment orders reduce hospital readmissions, three randomised controlled trials find no effects. These randomised controlled trials measure outcomes over a longer period than the community treatment order duration and assess the combined effectiveness of community treatment orders both during and after the intervention. This study examines the effectiveness of community treatment orders in a large population-based sample, restricting observation to the period under a community treatment order. METHODS: All persons ( n = 5548) receiving a community treatment order in New South Wales, Australia, over the period 2004-2009 were identified. Controls were matched using a propensity score based on demographic, clinical and prior care variables. A baseline period equal to each case's duration of treatment was constructed. Treatment effects were compared using zero-inflated negative binomial regression, adjusting for demographics, clinical characteristics and pre-community treatment order care. RESULTS: Compared to matched controls, people on community treatment orders were less likely to be readmitted (odds ratio = 0.90, 95% confidence interval = [0.84, 0.97]) and had a significantly longer time to their first readmission (incidence rate ratio = 1.47, 95% confidence interval = [1.36, 1.58]), fewer hospital admissions (incidence rate ratio = 0.90, 95% confidence interval = [0.84, 0.96]) and more days of community care (incidence rate ratio = 1.55, 95% confidence interval = [1.51, 1.59]). Increased community care and delayed first admission were found for all durations of community treatment order care. Reduced odds of readmission were limited to people with 6 months or less of community treatment order care, and reduced number of admissions and days in hospital to people with prolonged (>24 months) community treatment order care. CONCLUSION: In this large population-based study, community treatment orders increase community care and delay rehospitalisation while they are in operation. Some negative findings in this field may reflect the use of observation periods longer than the period of active intervention.

A coupled forage-grazer model predicts viability of livestock production and wildlife habitat at the regional scale.

Informed management of livestock on rangelands underpins both the livelihoods of communities that depend on livestock for sustenance, and the conservation of wildlife that often depend on livestock-dominated landscapes for habitat. Understanding spatial patterns of rangeland productivity is therefore crucial to designing global development strategies that balance social and environmental benefits. Here we introduce a new rangeland production model that dynamically links the Century ecosystem model with a basic ruminant diet selection and physiology model. With lightweight input data requirements that can be met with global sources, the model estimates the viability of broad livestock management decisions, and suggests possible implications of these management decisions for grazing wildlife. Using minimal field data, the new rangeland production model enables the reliable estimation of cattle stocking density; this is an important predictor of the viability of livestock production and forage available for grazing wildlife.

Host community heterogeneity and the expression of host specificity in avian haemosporidia in the Western Cape, South Africa.

Similar patterns of parasite prevalence in animal communities may be driven by a range of different mechanisms. The influences of host heterogeneity and host-parasite interactions in host community assemblages are poorly understood. We sampled birds at 27 wetlands in South Africa to compare four hypotheses explaining how host community heterogeneity influences host specificity in avian haemosporidia communities: the host-neutral hypothesis, the super-spreader hypothesis, the host specialist hypothesis and the heterogeneity hypothesis. A total of 289 birds (29%) were infected with Plasmodium, Haemoproteus and/or Leucocytozoon lineages. Leucocytozoon was the most diverse and generalist parasite genus, and Plasmodium the most conservative. The host-neutral and host specialist hypotheses received the most support in explaining prevalence by lineage (Leucocytozoon) and genus (Plasmodium and Haemoproteus), respectively. We observed that haemosporidian prevalence was potentially amplified or reduced with variation in host and/or parasitic taxonomic levels of analysis. Our results show that Leucocytozoon host abundance and diversity was influential to parasite prevalence at varying taxonomic levels, particularly within heterogeneous host communities. Furthermore, we note that prevalent mechanisms of infection can potentially act as distinct roots for shaping communities of avian haemosporidia.

Trust Development With the Spanish-Speaking Mexican American Patient: A Grounded Theory Study.

Interpersonal trust between patient and nurse is important in patient-centered care. Trust development may be more difficult if the patient and nurse do not speak the same language. In this grounded theory study, Spanish-speaking Mexican American adults ( n = 20) hospitalized on a medical-surgical or obstetric unit in the Midwestern United States were interviewed. Through data analysis, a model of how trust develops between nurse and patient revealed eight categories and the core category Caring for Me Well Even When Not Understanding Me. The beginning phase had four categories: Asking for Help, Bothering, Communicating, and Understanding. The middle phase had two categories: Platicando (chatting) and Being Available. The end point category was Having Trust, and outcomes were Feeling Comfortable and Feeling Supported. The language barrier was a hindrance to trust development but the nurse's way of being (personality) was more important. Therefore, the patient did develop trust with nurses who did not speak Spanish.