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.

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.

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.

Work Role Perspectives of Clinical Instructors From Three Countries.

BACKGROUND: Educational institutions partner with health facilities to provide clinical education, but the impact of these partnerships on clinical instructors is rarely examined. METHOD: A cross-sectional study was used to obtain surveys from a convenience sample of clinical instructors (n = 135) working in Israel, Norway, and the United States. The Nursing Clinical Instruction Role Assessment Tool (N-CIRAT) was developed to elicit clinical instructors' perspectives on the importance and nature of their work roles. FINDINGS: The N-CIRAT exhibited good reliability and revealed three different work roles: educator, hospital partner, and patient advocate. The educator work role did not differ by primary employer; it did for the work role of hospital partner (p < .05) and patient advocate (p < .05). Patient advocate work role importance was rated high for all clinical instructors. CONCLUSION: The educator role of clinical nurse educators, including being a role model and encouraging reflection, is universal among clinical instructors.

The Michigan Spine Surgery Improvement Collaborative: a statewide Collaborative Quality Initiative.

OBJECT Given the scrutiny of spine surgery by policy makers, spine surgeons are motivated to demonstrate and improve outcomes, by determining which patients will and will not benefit from surgery, and to reduce costs, often by reducing complications. Insurers are similarly motivated. In 2013, Blue Cross Blue Shield of Michigan (BCBSM) and Blue Care Network (BCN) established the Michigan Spine Surgery Improvement Collaborative (MSSIC) as a Collaborative Quality Initiative (CQI). MSSIC is one of the newest of 21 other CQIs that have significantly improved-and continue to improve-the quality of patient care throughout the state of Michigan. METHODS MSSIC focuses on lumbar and cervical spine surgery, specifically indications such as stenosis, disk herniation, and degenerative disease. Surgery for tumors, traumatic fractures, deformity, scoliosis, and acute spinal cord injury are currently not within the scope of MSSIC. Starting in 2014, MSSIC consisted of 7 hospitals and in 2015 included another 15 hospitals, for a total of 22 hospitals statewide. A standardized data set is obtained by data abstractors, who are funded by BCBSM/BCN. Variables of interest include indications for surgery, baseline patient-reported outcome measures, and medical history. These are obtained within 30 days of surgery. Outcome instruments used include the EQ-5D general health state score (0 being worst and 100 being the best health one can imagine) and EQ-5D-3 L. For patients undergoing lumbar surgery, a 0 to 10 numeric rating scale for leg and back pain and the Oswestry Disability Index for back pain are collected. For patients undergoing cervical surgery, a 0 to 10 numeric rating scale for arm and neck pain, Neck Disability Index, and the modified Japanese Orthopaedic Association score are collected. Surgical details, postoperative hospital course, and patient-reported outcome measures are collected at 90-day, 1-year, and 2-year intervals. RESULTS As of July 1, 2015, a total of 6397 cases have been entered into the registry. This number reflects 4824 eligible cases with confirmed surgery dates. Of these 4824 eligible cases, 3338 cases went beyond the 120-day window and were considered eligible for the extraction of surgical details, 90-day outcomes, and adverse events. Among these 3338 patients, there are a total of 2469 lumbar cases, 862 cervical cases, and 7 combined procedures that were entered into the registry. CONCLUSIONS In addition to functioning as a registry, MSSIC is also meant to be a platform for quality improvement with the potential for future initiatives and best practices to be implemented statewide in order to improve quality and lower costs. With its current rate of recruitment and expansion, MSSIC will provide a robust platform as a regional prospective registry. Its unique funding model, which is supported by BCBSM/BCN, will help ensure its longevity and viability, as has been observed in other CQIs that have been active for several years.

A rural, community-based suicide awareness and intervention program.

Suicide is a prominent public health issue in rural Australia and specifically in Tasmania, which has one of the highest suicide rates in the country. The Community Response to Eliminating Suicide (CORES) program was developed in rural Tasmania in response to a significant number of suicides over a short period of time. CORES is unique in that it is both a community-based and gatekeeper education model. CORES aims to build and empower communities to take ownership of suicide prevention strategies. It also aims to increase the individual community member's interpersonal skills and awareness of suicide risks, while building peer support and awareness of suicide prevention support services within the community itself. Pre- and post-test surveys after the CORES 1-day suicide awareness and intervention program (SAIP) showed significant increases in levels of comfort and confidence in discussing suicide with those who may be contemplating that action. CORES builds community capital through establishing new connections within communities. Establishment of local executive groups, funding and SAIP are key activities of successful CORES programs in communities around Australia. Over half of the initial leaders are still actively involved after a decade, which reflects positively on the quality and outcomes of the program. This study supports CORES as a beneficial and feasible community-based suicide intervention program for rural communities.

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.

The development and validation of the major life changing decision profile (MLCDP).

BACKGROUND: Chronic diseases may influence patients taking major life changing decisions (MLCDs) concerning for example education, career, relationships, having children and retirement. A validated measure is needed to evaluate the impact of chronic diseases on MLCDs, improving assessment of their life-long burden. The aims of this study were to develop a validated questionnaire, the "Major Life Changing Decision Profile" (MLCDP) and to evaluate its psychometric properties. METHODS: 50 interviews with dermatology patients and 258 questionnaires, completed by cardiology, rheumatology, nephrology, diabetes and respiratory disorder patients, were analysed for qualitative data using Nvivo8 software. Content validation was carried out by a panel of experts. The first version of the MLCDP was completed by 210 patients and an iterative process of multiple Exploratory Factor Analyses and item prevalence was used to guide item reduction. Face validity and practicability was assessed by patients. RESULTS: 48 MLCDs were selected from analysis of the transcripts and questionnaires for the first version of the MLCDP, and reduced to 45 by combination of similar themes. There was a high intraclass correlation coefficient (0.7) between the 13 members of the content validation panel. Four more items were deleted leaving a 41-item MLCDP that was completed by 210 patients. The most frequently recorded MLCDs were decisions to change eating habits (71.4%), to change smoking/drinking alcohol habits (58.5%) and not to travel or go for holidays abroad (50.9%).Factor analysis suggested item number reduction from 41 to 34, to 29, then 23 items. However after taking into account item prevalence data as well as factor analysis results, 32 items were retained. The 32-item MLCDP has five domains education (3 items), job/career (9), family/relationships (5), social (10) and physical (5). The MLCDP score is expressed as the absolute number of decisions that have been affected. CONCLUSIONS: The 32-item (5 domains) MLCDP has been developed as an easy to complete generic tool for use in clinical practice and for quality of life and epidemiological research. Further validation is required.

The role of diazepam loading for the treatment of alcohol withdrawal syndrome in hospitalized patients.

BACKGROUND: Alcohol withdrawal accounts for a significant amount of hospital admissions and can quickly progress to the development of delirium tremens (DTs), seizures, and death. Rapid identification and management of alcohol withdrawal syndrome (AWS) is vital and can be managed with a number of different treatment strategies. Diazepam loading is a treatment strategy that utilizes the pharmacokinetics of this agent to achieve a rapid reduction in symptoms followed by sustained benefit over a period of days. OBJECTIVE: The purpose of this review is to evaluate the role of diazepam loading for AWS. METHODS: A literature search of four databases-Pubmed, PsychInfo, Biosis, and Embase-was conducted to identify publications between 1960 and August 2011 that described the use of diazepam loading for the treatment of AWS. Eight trials, both open-label and controlled trials were identified. Only four randomized controlled-trials (RCTs) have been published and they are reviewed in this paper. RESULTS: Included trials of hospitalized inpatients found that diazepam loading provided rapid symptom relief as well as reduced the incidence of seizures and duration of DTs. In patients diagnosed with severe DTs, rapidly administered doses of diazepam produced a quick calming effect. While no adverse events resulting from diazepam loading were noted, no formal assessment tool was used to evaluate its safety. Larger randomized controlled-trials are needed to better evaluate safety outcomes. CONCLUSIONS: Diazepam loading is an effective treatment option for hospitalized patients experiencing AWS. Diazepam loading uses the concept of symptom-triggered therapy, a mainstay of current AWS treatment, while exploiting its prolonged elimination half-life and eliminating the need for additional pharmacologic therapy. Studies reviewed found diazepam loading significantly improved a number of important outcomes in AWS, including time in DTs, compared to traditional treatment strategies.

Sustaining engineering codes of ethics for the twenty-first century.

How much responsibility ought a professional engineer to have with regard to supporting basic principles of sustainable development? While within the United States, professional engineering societies, as reflected in their codes of ethics, differ in their responses to this question, none of these professional societies has yet to put the engineer's responsibility toward sustainability on a par with commitments to public safety, health, and welfare. In this paper, we aim to suggest that sustainability should be included in the paramountcy clause because it is a necessary condition to ensure the safety, health, and welfare of the public. Part of our justification rests on the fact that to engineer sustainably means among many things to consider social justice, understood as the fair and equitable distribution of social goods, as a design constraint similar to technical, economic, and environmental constraints. This element of social justice is not explicit in the current paramountcy clause. Our argument rests on demonstrating that social justice in terms of both inter- and intra-generational equity is an important dimension of sustainability (and engineering). We also propose that embracing sustainability in the codes while recognizing the role that social justice plays may elevate the status of the engineer as public intellectual and agent of social good. This shift will then need to be incorporated in how we teach undergraduate engineering students about engineering ethics.

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.

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.

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.

Chemistry of aqueous silica nanoparticle surfaces and the mechanism of selective peptide adsorption.

Control over selective recognition of biomolecules on inorganic nanoparticles is a major challenge for the synthesis of new catalysts, functional carriers for therapeutics, and assembly of renewable biobased materials. We found low sequence similarity among sequences of peptides strongly attracted to amorphous silica nanoparticles of various size (15-450 nm) using combinatorial phage display methods. Characterization of the surface by acid base titrations and zeta potential measurements revealed that the acidity of the silica particles increased with larger particle size, corresponding to between 5% and 20% ionization of silanol groups at pH 7. The wide range of surface ionization results in the attraction of increasingly basic peptides to increasingly acidic nanoparticles, along with major changes in the aqueous interfacial layer as seen in molecular dynamics simulation. We identified the mechanism of peptide adsorption using binding assays, zeta potential measurements, IR spectra, and molecular simulations of the purified peptides (without phage) in contact with uniformly sized silica particles. Positively charged peptides are strongly attracted to anionic silica surfaces by ion pairing of protonated N-termini, Lys side chains, and Arg side chains with negatively charged siloxide groups. Further, attraction of the peptides to the surface involves hydrogen bonds between polar groups in the peptide with silanol and siloxide groups on the silica surface, as well as ion-dipole, dipole-dipole, and van-der-Waals interactions. Electrostatic attraction between peptides and particle surfaces is supported by neutralization of zeta potentials, an inverse correlation between the required peptide concentration for measurable adsorption and the peptide pI, and proximity of cationic groups to the surface in the computation. The importance of hydrogen bonds and polar interactions is supported by adsorption of noncationic peptides containing Ser, His, and Asp residues, including the formation of multilayers. We also demonstrate tuning of interfacial interactions using mutant peptides with an excellent correlation between adsorption measurements, zeta potentials, computed adsorption energies, and the proposed binding mechanism. Follow-on questions about the relation between peptide adsorption on silica nanoparticles and mineralization of silica from peptide-stabilized precursors are raised.

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.