The use of Community/Public Health Nursing Competencies during the COVID-19 pandemic.

OBJECTIVES: (1) Ascertain the use of the Quad Council Competencies for Community/Public Health Nursing (QCC-C/PHN) Competencies by community/public health nurses (C/PHNs) during the COVID-19 pandemic; (2) Inform from a systems-level the need to sustain the C/PHN workforce; (3) Assess the C/PHN infrastructure for response capacity. DESIGN: Cross-sectional. Statewide email distribution lists were used for dissemination. SAMPLE: Convenience sample (n = 169) obtained using emailed Qualtrics link with the eligibility criteria of self-identification as a C/PHN who works in the state of Missouri. MEASUREMENTS: Demographic questions included employment sector, nursing education level, years of nursing, and C/PHN experience. Two Likert-type questions and one optional open-text question were created for the eight domains. RESULTS: One hundred sixty-nine participants' data were analyzed. One hundred fifty-four were employed in a local public health agency. Total 63.2% held a bachelor's degree in nursing or higher. The average number of years of nurse experience was 20.84, and C/PHN experience was 9.84. The domain of Communication Skills scored highest and Cultural Competency was the lowest. Three themes emerged from the open-ended questions including vulnerabilities of the public health system. CONCLUSION: Understanding the experiences of C/PHNs in Missouri related to the utilization of QCC-C/PHN competencies informs efforts to strengthen public health infrastructure and target resources to equip Missouri's C/PHNs.

Dual Energy X-Ray Absorptiometry (DXA) Extended Femur Scans to Support Opportunistic Screening for Incomplete Atypical Femoral Fractures: A Short Term in-vivo Precision Study.

BACKGROUND: Atypical femoral fracture (AFF) is documented as a known but rare complication of bisphosphonate use for the treatment of osteoporosis. These present in an incomplete form prior to failure, which results in a complete fracture requiring surgical intervention. Dual energy x-ray absorptiometry (DXA) is the gold standard for the diagnosis of Osteoporosis and for monitoring the response to therapeutic interventions. This provides an opportunity to use routine DXA scans to identify incomplete atypical fractures, which can subsequently be monitored for progression and pre-fracture intramedullary nailing undertaken where necessary. DXA manufacturers have developed extended femur scans to assess and measure the femoral cortex for incipient atypical femoral fractures. The aim of this study was to evaluate the precision errors related to the cortical measurements and for hip bone mineral density using the extended femur setting. METHODOLOGY: A single operator performed duplicate same day in-vivo measurements of the femur in 30 consenting participants, with repositioning between scans, during their visit for routine DXA scanning. The study was performed on a single GE Lunar Prodigy scanner (GE Lunar, Bedford, UK). Root mean squared standard deviation (RMS SD) and coefficient of variation (RMS CV%) were calculated for the cortex measurements known as beaking index (BI) and hip bone mineral density (BMD) measurements. RESULTS: The use of the extended femur scan software yielded an RMS SD (RMS CV%) of 0.011 (1.43%) for the total hip and 0.015 (2.05%) for the femoral neck. The BI measurement RMS SD (RMS CV%) was 0.473 (38.10%) Visual assessment of the femoral cortex discounted all positive BI anomalies as software generated in this dataset. CONCLUSIONS: The use of extended femur scan software did not affect the precision errors of the BMD measurements at the hip when compared to the literature on focused hip scans, however this study is unique with nothing similar being found in the published literature. The BI precision errors were much greater than those seen at the hip and therefore unreliable unless accompanied by visual assessment which is recommended to avoid unnecessary investigation in around one fifth of the scan population.

Incorporating Faith into Ethics Education.

ABSTRACT: Preparing students for ethical situations they will face in practice should be incorporated into nursing curricula, especially programs with a Christian focus. Linking ethical concepts with tenets from Scripture can increase students' confidence in their ability to respond through a biblical worldview to ethical dilemmas in nursing practice. Specific assignments can be geared to help students think critically about the Code of Ethics for Nurses with Interpretive Statements (Code) and biblical responses to ethical situations. Sample assignments are presented for the nine provisions of the Code.

Acoustic Change Complex and Visually Reinforced Infant Speech Discrimination Measures of Vowel Contrast Detection.

OBJECTIVES: To measure the effect of stimulus rate and vowel change direction on the acoustic change complex (ACC) latencies and amplitudes and compare ACC metrics to behavioral measures of vowel contrast detection for infants tested under the age of 1 year. We tested the hypothesis that the direction of spectral energy shift from a vowel change would result in differences in the ACC, owing to the sensitivity of cortical neurons to the direction of frequency change. We evaluated the effect of the stimulus rate (1/s versus 2/s) on the infants' ACC. We evaluated the ACC amplitude ratio's sensitivity (proportion of ACCs present for each change trial) and compared it to perceptual responses obtained using a visually reinforced infant speech discrimination paradigm (VRISD). This report provides normative data from infants for the ACC toward the ultimate goal of developing a clinically useful index of neural capacity for vowel discrimination. DESIGN: Twenty-nine infants, nine females, 4.0 to 11.8 months of age, participated. All participants were born at full term and passed their newborn hearing screens. None had risk factors for hearing or neurologic impairment. Cortical auditory evoked potentials were obtained in response to synthesized vowel tokens /a/, /i/, /o/, and /u/ presented at a rate of 1- or 2/s in an oddball stimulus paradigm with a 25% probability of the deviant stimulus. All combinations of vowel tokens were tested at the two rates. The ACC was obtained in response to the deviant stimulus. The infants were also tested for vowel contrast detection using a VRISD paradigm with the same combinations of vowel tokens used for the ACC. The mean age at the time of the ACC test was 5.4 months, while the mean age at the behavioral test was 6.8 months. RESULTS: Variations in ACC amplitude and latency occurred as a function of the initial vowel token and the contrast token. However, the hypothesis that the direction of vowel (spectral) change would result in significantly larger change responses for high-to-low spectral changes was not supported. The contrasts with /a/ as the leading vowel of the contrast pair resulted in the largest ACC amplitudes than other conditions. Significant differences in the ACC presence and amplitude were observed as a function of rate, with 2/s resulting in ACCs with the largest amplitude ratios. Latency effects of vowel contrast and rate were present, but not systematic. The ACC amplitude ratio's sensitivity for detecting a vowel contrast was greater for the 2/s rate than the 1/s rate. For an amplitude ratio criterion of ≥1.5, the sensitivity was 93% for ACC component P2-N2 at 2/s, whereas at 1/s sensitivity was 70%. VRISD tests of vowel-contrast detection had a 71% hit and a 21% false-positive rate. Many infants who could not reach performance criteria for VRISD had ACC amplitude ratios of ≥2.0. CONCLUSIONS: The ACC for vowel contrasts presented at a rate of 2/s is a robust index of vowel-contrast detection when obtained in typically developing infants under the age of 1 year. The ACC is present in over 90% of infants tested at this rate when an amplitude ratio criterion of ≥1.5 is used to define a response. The amplitude ratio appears to be a sensitive metric for the difference between a control and contrast condition. The ACC can be obtained in infants who do not yet exhibit valid behavioral responses for vowel change contrasts and may be useful for estimating neural capacity for discriminating these sounds.

Participation in Cost-offset Community Supported Agriculture by Low-income Households in the U.S. is Associated with Community Characteristics and Operational Practices.

OBJECTIVE: Subsidized or cost-offset community supported agriculture (CO-CSA) connects farms directly to low-income households and can improve fruit and vegetable intake. This analysis identifies factors associated with participation in CO-CSA. DESIGN: Farm Fresh Foods for Healthy Kids (F3HK) provided a half-price, summer CO-CSA plus healthy eating classes to low-income households with children. Community characteristics (population, socio-demographics, health statistics) and CO-CSA operational practices (share sizes, pick-up sites, payment options, produce selection) are described and associations with participation levels examined. SETTING: Ten communities in New York (NY), North Carolina (NC), Vermont, and Washington states in USA. PARTICIPANTS: Caregiver-child dyads enrolled in spring 2016 or 2017. RESULTS: Residents of micropolitan communities had more education and less poverty than in small towns. The one rural location (NC2) had the fewest college graduates (10%) and most poverty (23%), and poor health statistics. Most F3HK participants were white, except in NC where 45.2% were African American. CO-CSA participation varied significantly across communities from 33% (NC2) to 89% (NY1) of weeks picked-up. Most CO-CSAs offered multiple share sizes (69.2%) and participation was higher than when not offered (76.8% vs. 57.7% of weeks); whereas 53.8% offered a community pick-up location, and participation in these communities was lower than elsewhere (64.7% vs. 78.2% of weeks). CONCLUSION: CO-CSAs should consider offering choice of share size and innovate to address potential barriers such as rural location and limited education and income among residents. Future research is needed to better understand barriers to participation, particularly among participants utilizing community pick-up locations.

Suicidality in Rural College Students: An Integrative Review.

Suicide, as the third leading cause of death among individuals aged 15 to 24 years, is substantially more frequent in non-metropolitan/rural counties, where college/university students may be at particular risk; however, little is known about risk and protective factors and prevention strategies specific to this population. The current integrated review was completed to explore such factors and evidence-based interventions. A systematic literature search was performed, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and using computerized databases, for studies published from 2008 to 2021; nine met inclusion criteria. Data were classified into subgroups, which included risk and protective factors for suicidality, stressors and risk factors for psychological distress, and barriers to psychological help-seeking. Key findings included depression as a risk factor, religiosity as a protective factor, decreased social support as a stressor, and various barriers to help-seeking. No evidence-based interventions for this population have been identified in the literature. Research is needed to explore evidence-based interventions for rural college/university students. [Journal of Psychosocial Nursing and Mental Health Services, 60(9), 15-23.].

Exploring the Role of H-Bonding in Organic Electrochemistry - From Supramolecular Applications to Mechanistic Investigations.

H-bonds can exert a substantial impact on the course of organic electrode reactions due to their ability to stabilize charged intermediates and products formed during these reactions, as well as facilitate proton-coupled electron transfer (PCET) reactions. This has fundamental implications for the mechanism of organic electrode reactions, but also practical impact in supramolecular chemistry and potentially synthetic electrochemistry. My group's main focus has been on the supramolecular applications, using electron transfer to alter the strength of H-bonds to create highly redox-responsive H-bond dimers. Initially we sought to avoid proton transfer because we feared that would lead to irreversible electrochemistry. However, inevitably proton transfer did show up, but, to our surprise, did not lead to irreversible electrochemistry. To explain this, we developed a new mechanism, the "wedge scheme", that shows how H-bonding can facilitate reversible electron and proton transfer. This insight recently led us to a new PCET-based design strategy for the creation of our most highly redox-responsive H-bond dimers yet.

Faculty perspectives on transitioning public health nursing clinical to virtual in response to COVID-19.

The COVID-19 pandemic has highlighted the need for public health nursing as an integral part of a strong public health workforce. However, it has also created challenges in preparing future nurses as much of nursing instruction, including clinical experiences, needed to urgently transition learning to a virtual environment. This paper describes the process faculty experienced during spring 2020 to quickly transition public health nursing clinicals from in-person to virtual learning in response to COVID-19. Further, faculty lessons learned are shared and include the importance of creating a supportive team dynamic, embracing innovation, continuing to engage with community partners, and adapting to meet emerging student needs during the evolving pandemic. The process and lessons learned may act as a guide for other nursing programs as we continue to navigate nursing education during this and future pandemics.

Recruitment and Retention of Occupational Therapy Practitioners and Students of Color: A Qualitative Study.

IMPORTANCE: Matching the demographics of health professionals and patient populations increases access to quality care. However, a consensus has not been reached regarding the most effective strategies for recruitment and retention of diverse practitioners. OBJECTIVE: To answer the question "What are the perceived challenges to and facilitators of the recruitment and retention of occupational therapy practitioners (OTPs) and students of color?" DESIGN: A qualitative interpretive, constructionist design was used. Purposive recruitment that used convenience sampling was conducted at the 2017 American Occupational Therapy Association Annual Conference & Expo and via the National Black Occupational Therapy Caucus Facebook group. Data were collected online from three focus groups and four interviews. SETTING: Online through social media. PARTICIPANTS: The total sample included 5 OTPs and 7 students; 91.7% identified as African-American or Black. OUTCOMES AND MEASURES: Inductive analysis was used to interpret the open-ended questions. After transcription, each interview or focus group transcript was reviewed with Colaizzi's seven-step method of data analysis. RESULTS: Five themes were identified: (1) lack of representation in and knowledge about occupational therapy, (2) feeling like an outsider, (3) need for financial support, (4) individualized mentor-mentee relationships, and (5) connections with national organizations specifically for people of color. CONCLUSIONS AND RELEVANCE: This study identified experiences of OTPs and students of color and how identified barriers can be addressed. Implications for the profession include purposive recruitment, professional development for faculty, provision of mentoring, and financial support. Future research should focus on creation and evaluation of evidence-based strategies for the recruitment and retention of students of color in occupational therapy. WHAT THIS ARTICLE ADDS: This study provided voices of OTPs and students of color regarding challenges and facilitators experienced in the profession. With an accurate understanding of experiences of people of color, effective strategies can be developed to foster their successful transition into the occupational therapy workforce.

An Active-Site Sulfonate Group Creates a Fast Water Oxidation Electrocatalyst That Exhibits High Activity in Acid.

The storage of solar energy in chemical bonds will depend on pH-universal catalysts that are not only impervious to acid, but actually thrive in it. Whereas other homogeneous water oxidation catalysts are less active in acid, we report a catalyst that maintained high electrocatalytic turnover frequency at pH values as low as 1.1 and 0.43 (kcat =1501±608 s-1 and 831±254 s-1 , respectively). Moreover, current densities, related to catalytic reaction rates, ranged from 15 to 50 mA cm-2 mM-1 comparable to those reported for state-of-the-art heterogeneous catalysts and 30 to 100 times greater than those measured for two prominent literature homogeneous catalysts at pH 1.1 and 0.43. The catalyst also exhibited excellent durability when a chemical oxidant was used (CeIV , 7400 turnovers, TOF 0.88 s-1 ). Preliminary computational studies suggest that the unusual active-site sulfonate group acts a proton relay even in strong acid, as intended.

Redox-Responsive H-Bonding: Amplifying the Effect of Electron Transfer Using Proton-Coupled Electron Transfer.

A new strategy to create highly redox-responsive H-bond dimers based on proton-coupled electron transfer is proposed that capitalizes on the importance of secondary H-bonds in determining overall binding strength in H-bond dimers. Electron transfer induced proton transfer across a H-bond can be used to significantly strengthen the overall binding by both creating strong ionic H-bonds and changing the secondary H-bonds from unfavorable to favorable. The viability and potency of this approach are demonstrated with an electroactive DAD (A = H-acceptor, D = H-donor) array, H(MQ+)H, paired with an electroinactive ADA array, O(NH)O. NMR titration of H(MQ+)H with O(NH)O in 0.1 M NBu4PF6/CD2Cl2 gives a Kassoc of 500 M-1, typical of DAD-ADA dimers. However, upon two-electron reduction in 0.1 M NBu4PF6/CH2Cl2, cyclic voltammetry studies indicate a 1.8 × 105 increase in binding strength, corresponding to a very large Kassoc of 9 × 107 M-1. The latter value is typical of DDD-AAA H-bond dimers, consistent with proton transfer across the central H-bond upon reduction.

Loss of Fitness of Mexican H7N3 Highly Pathogenic Avian Influenza Virus in Mallards after Circulating in Chickens.

Outbreaks of highly pathogenic avian influenza (HPAI) virus subtype H7N3 have been occurring in commercial chickens in Mexico since its first introduction in 2012. In order to determine changes in virus pathogenicity and adaptation in avian species, three H7N3 HPAI viruses from 2012, 2015, and 2016 were evaluated in chickens and mallards. All three viruses caused high mortality in chickens when given at medium to high doses and replicated similarly. No mortality or clinical signs and similar infectivity were observed in mallards inoculated with the 2012 and 2016 viruses. However, the 2012 H7N3 HPAI virus replicated well in mallards and transmitted to contacts, whereas the 2016 virus replicated poorly and did not transmit to contacts, which indicates that the 2016 virus is less adapted to mallards. In vitro, the 2016 virus grew slower and to lower titers than did the 2012 virus in duck fibroblast cells. Full-genome sequencing showed 115 amino acid differences between the 2012 and the 2016 viruses, with some of these changes previously associated with changes in replication in avian species, including hemagglutinin (HA) A125T, nucleoprotein (NP) M105V, and NP S377N. In conclusion, as the Mexican H7N3 HPAI virus has passaged through large populations of chickens in a span of several years and has retained its high pathogenicity for chickens, it has decreased in fitness in mallards, which could limit the potential spread of this HPAI virus by waterfowl.IMPORTANCE Not much is known about changes in host adaptation of avian influenza (AI) viruses in birds after long-term circulation in chickens or other terrestrial poultry. Although the origin of AI viruses affecting poultry is wild aquatic birds, the role of these birds in further dispersal of poultry-adapted AI viruses is not clear. Previously, we showed that HPAI viruses isolated early from poultry outbreaks could still infect and transmit well in mallards. In this study, we demonstrate that the Mexican H7N3 HPAI virus after four years of circulation in chickens replicates poorly and does not transmit in mallards but remains highly pathogenic in chickens. This information on changes in host adaptation is important for understanding the epidemiology of AI viruses and the role that wild waterfowl may play in disseminating viruses adapted to terrestrial poultry.

Center of Biomedical Research Excellence in Matrix Biology: Building Research Infrastructure, Supporting Young Researchers, and Fostering Collaboration.

The Center of Biomedical Research Excellence in Matrix Biology strives to improve our understanding of extracellular matrix at molecular, cellular, tissue, and organismal levels to generate new knowledge about pathophysiology, normal development, and regenerative medicine. The primary goals of the Center are to i) support junior investigators, ii) enhance the productivity of established scientists, iii) facilitate collaboration between both junior and established researchers, and iv) build biomedical research infrastructure that will support research relevant to cell-matrix interactions in disease progression, tissue repair and regeneration, and v) provide access to instrumentation and technical support. A Pilot Project program provides funding to investigators who propose applying their expertise to matrix biology questions. Support from the National Institute of General Medical Sciences at the National Institutes of Health that established the Center of Biomedical Research Excellence in Matrix Biology has significantly enhanced the infrastructure and the capabilities of researchers at Boise State University, leading to new approaches that address disease diagnosis, prevention, and treatment. New multidisciplinary collaborations have been formed with investigators who may not have previously considered how their biomedical research programs addressed fundamental and applied questions involving the extracellular matrix. Collaborations with the broader matrix biology community are encouraged.

Evaluation of the Jail-Based Occupational Therapy Transition and Integration Services Program for Community Reentry.

IMPORTANCE: Transition and integration reentry services continue to grow in carceral settings; however, related provision of occupational therapy is limited. OBJECTIVE: To examine the implementation fidelity of an occupational therapy-administered interprofessional reentry program initiated in an urban jail. DESIGN: Retrospective, mixed quantitative and qualitative design. SETTING: Community-based reentry services provided prerelease in a Midwestern urban jail and postrelease in the local St. Louis community. PARTICIPANTS: Occupational therapy practitioners tracking process measures for identifying reentry project feasibility. INTERVENTION: Provision of recruitment, assessment, and skilled occupational therapy services with people held in a short-term jail facility and follow-up during community reentry. OUTCOME AND MEASURES: Detailed logs were analyzed to describe attendance at and duration of sessions. We coded barriers to and facilitators of implementation from weekly team meeting notes and logs using social-ecological categories. RESULTS: Findings indicate that it was feasible to implement prerelease jail-based services (N = 63) because of jail operations and community partnerships (facilitators) and to overcome institutional policies and environmental limitations (barriers). Full 8-wk prerelease programming was completed by 38% (n = 24) of participants, and 52% (n = 33) participated less than 8 wk. All who completed the full prerelease program and transitioned to the community (n = 15) initiated postrelease occupational therapy services. CONCLUSIONS AND RELEVANCE: The iterative feedback provided by process evaluation supported the feasibility of implementing the jail-based Occupational Therapy Transition and Integration Services program. WHAT THIS ARTICLE ADDS: This process evaluation provides evidence that implementation of an occupational therapy-based transition program in an urban jail is feasible.

Effect of Substrate and Bacterial Zeta Potential on Adhesion of Mycobacterium smegmatis.

Bacterial adhesion is described as a multistep process of interactions between microbes and the substrate, beginning with reversible contact, followed by irreversible adhesion. We explore the influence of substrate zeta potential on adhesion of Mycobacterium smegmatis, a nonpathogenic bacterial model for tuberculosis-causing Mycobacterium tuberculosis and a common foulant of reverse osmosis filtration systems. Substrates having a range of zeta potentials were prepared by coating silica with the polycation, poly(diallyldimethyl ammonium chloride) (pDADMAC), by adjusting the pH of alumina, a pH-responsive material, and by coating silica with a hydrophobic self-assembled monolayer coating of octadecyltrichlorosilane. Our observations using these surfaces demonstrated that adhesion of M. smegmatis increased significantly by more than 200% on the silica-pDADMAC system and more than 300% on alumina substrates, as zeta potential became less negative, and that the variation of pH did not affect adhesion on alumina surfaces. Live and heat-killed bacteria were studied to investigate the contribution of biological response to adhesion with respect to zeta potential. While approximately 60% fewer heat-killed M. smegmatis adhered to pDADMAC-coated silica substrates, the trend of significantly increasing adhesion with less negative zeta potential was still observed. These results show the influence of zeta potential on adhesion of M. smegmatis, which is a separate process from that of the biological response. Across the range of substrate surface chemistries, hydrophobicities, and zeta potentials tested, adhesion of M. smegmatis can primarily be controlled by zeta potential. The bacterial zeta potential was not changed by the various experimental conditions and was -28.3 ± 2.4 mV.

Pathobiology of Tennessee 2017 H7N9 low and high pathogenicity avian influenza viruses in commercial broiler breeders and specific pathogen free layer chickens.

In March 2017, H7N9 highly pathogenic avian influenza (HPAI) virus was detected in 2 broiler breeder farms in the state of Tennessee, USA. Subsequent surveillance detected the low pathogenicity avian influenza (LPAI) virus precursor in multiple broiler breeder farms and backyard poultry in Tennessee and neighboring states. The pathogenesis of the H7N9 LPAI virus was investigated in commercial broiler breeders, the bird type mostly affected in this outbreak. Infectivity, transmissibility, and pathogenesis of the H7N9 HPAI and LPAI viruses were also studied in 4-week-old specific pathogen free (SPF) leghorn chickens. The mean bird infectious doses (BID50) for the LPAI isolate was 5.6 log10 mean egg infectious dose (EID50) for broiler breeders and 4.3 log10 EID50 for SPF layer chickens, and no transmission to contact-exposed birds was observed. In both bird types, virus shedding was almost exclusively from the oropharyngeal route. These findings suggest sub-optimal adaptation for sustained transmission with the H7N9 LPAI isolate, indicating that factors other than the birds genetic background may explain the epidemiology of the outbreak. The BID50 for the HPAI isolate in SPF layer chickens was more than 2 logs lower (<2 log10 EID50) than the LPAI isolate. Also, the HPAI virus was shed by both the oropharyngeal and cloacal routes and transmitted to contacts. Greater susceptibility and easier transmission of the H7N9 HPAI virus are features of the HP phenotype that could favor the spread of HPAI over LPAI viruses during outbreaks.

Redox-Responsive Dimerization in a Ferrocene-Ureidopyrimidone Supramolecular Assembly.

Ureidopyrimidones (UPy's) are well-known to dimerize via 4 strong H-bonds in noncompetitive solvents. Although UPy dimers have been widely studied, there are few examples of UPy's containing redox-active groups, and even fewer in which oxidation/reduction has been shown to affect dimerization. In this study, a thorough electrochemical investigation of a UPy with a ferrocene attached to the 6-position of the pyrimidone ring, UPy(Fc), demonstrates that strong and reversible redox-control of dimerization is possible in the UPy system. 1H NMR shows that the reduced UPy(Fc) is fully dimerized under electrochemical conditions in CH2Cl2. Cyclic voltammetry (CV) shows that oxidation of the ferrocene to the ferrocenium converts the dimer to another species with a less positive E1/2, and that reduction of this species reforms the dimer in a chemically reversible fashion. Analysis of the scan rate and concentration dependence of the CV's along with the relative diffusion coefficient measurements strongly suggest that the oxidized form is the monomer. Simulation of the CV data gives a Kdis of 2.1 × 10-6 M in the reduced state and 12 M in the oxidized state. This large redox dependence is likely due to oxidation creating both electrostatic repulsion between monomers and greatly decreasing the H-accepting ability of the pyrimidone.

Registered nurse intent to promote physical activity for hospitalised liver transplant recipients.

AIM: To describe how registered nurse work motivation, attitudes, subjective norm and perceived behavioural control influence intention to promote physical activity in hospitalised adult liver transplant recipients. DESIGN: Descriptive study of clinical registered nurses caring for recipients of liver transplant at a tertiary medical centre. METHODS: Intent to Mobilise Liver Transplant Recipient Scale, Work Extrinsic and Intrinsic Motivation Scale, and demographics were used to explore registered nurses' work motivation, attitudes, subjective norms, perceived behavioural control and intention to promote physical activity of hospitalised adult liver transplant recipients during the acute postoperative phase. Data analysis included demographics, comparison between scale items and analysis of factors predicting intent to mobilise. RESULTS: Factors predictive of intention to promote physical activity after liver transplant included appropriate knowledge to mobilise patients (R2  = .40) and identification of physical activity as nursing staff priority (R2  = .15) and responsibility (R2  = .03). DISCUSSION/IMPLICATIONS FOR NURSING MANAGEMENT: When implementing an early mobilisation protocol after the liver transplant, education on effects of physical activity in the immediate postoperative period are essential to promote implementation in practice. Nursing care environment and leadership must be supportive to ensure mobility is a registered nurse priority and responsibility. Nursing managers can leverage results to implement a mobility protocol.

Pathogenicity and Transmission of H5 and H7 Highly Pathogenic Avian Influenza Viruses in Mallards.

Wild aquatic birds have been associated with the intercontinental spread of H5 subtype highly pathogenic avian influenza (HPAI) viruses of the A/goose/Guangdong/1/96 (Gs/GD) lineage during 2005, 2010, and 2014, but dispersion by wild waterfowl has not been implicated with spread of other HPAI viruses. To better understand why Gs/GD H5 HPAI viruses infect and transmit more efficiently in waterfowl than other HPAI viruses, groups of mallard ducks were challenged with one of 14 different H5 and H7 HPAI viruses, including a Gs/GD lineage H5N1 (clade 2.2) virus from Mongolia, part of the 2005 dispersion, and the H5N8 and H5N2 index HPAI viruses (clade 2.3.4.4) from the United States, part of the 2014 dispersion. All virus-inoculated ducks and contact exposed ducks became infected and shed moderate to high titers of the viruses, with the exception that mallards were resistant to Ck/Pennsylvania/83 and Ck/Queretaro/95 H5N2 HPAI virus infection. Clinical signs were only observed in ducks challenged with the H5N1 2005 virus, which all died, and with the H5N8 and H5N2 2014 viruses, which had decreased weight gain and fever. These three viruses were also shed in higher titers by the ducks, which could facilitate virus transmission and spread. This study highlights the possible role of wild waterfowl in the spread of HPAI viruses. IMPORTANCE: The spread of H5 subtype highly pathogenic avian influenza (HPAI) viruses of the Gs/GD lineage by migratory waterfowl is a serious concern for animal and public health. H5 and H7 HPAI viruses are considered to be adapted to gallinaceous species (chickens, turkeys, quail, etc.) and less likely to infect and transmit in wild ducks. In order to understand why this is different with certain Gs/GD lineage H5 HPAI viruses, we compared the pathogenicity and transmission of several H5 and H7 HPAI viruses from previous poultry outbreaks to Gs/GD lineage H5 viruses, including H5N1 (clade 2.2), H5N8 and H5N2 (clade 2.3.4.4) viruses, in mallards as a representative wild duck species. Surprisingly, most HPAI viruses examined in this study replicated well and transmitted among mallards; however, the three Gs/GD lineage H5 HPAI viruses replicated to higher titers, which could explain the transmission of these viruses in susceptible wild duck populations.