Assessing the impact of piercing-sucking pests on greenhouse-grown industrial hemp (Cannabis sativa L.).

Cannabis sativa or hemp, defined as <0.3% total tetrahydrocannabinol (THC), is a specialty crop in the United States, of particular interest among growers in the southeastern United States to replace tobacco production. Tetranychus urticae (twospotted spider mite), Aculops cannabicola (hemp russet mite), Polyphagotarsonemus latus (broad mites), and Phorodon cannabis (cannabis aphids) are considered the most significant pests in greenhouse grown hemp. Mite and aphid injury can cause cupping and yellowing of leaves, resulting in leaf drop, and reduced flower and resin production. We sought to understand the effects of feeding by T. urticae and Myzus persicae (green peach aphid), as a proxy for P. cannabis, on the concentration of economically significant cannabinoids through a series of experiments on greenhouse grown plants. First, we compared the variability of chemical concentrations in samples collected from individual plants versus pooled samples from 5 plants, and found that chemical concentrations in single plants were similar to those in pooled plant samples. Next, we compared chemical concentrations prior to arthropod infestation and post infestation. When evaluating the mite feeding damage in 2020, cannabinoids in plants infested with high densities of T. urticae increased more slowly than in uninfested control plants or plants infested with low T. urticae densities. In 2021, the concentration of tetrahydrocannabinol did not differ significantly between treatments. Cannabidiol increased more slowly in plants with low T. urticae densities when compared to uninfested controls but did not differ from the high T. urticae densities 14 days after infestation.

Racial and ethnic variation in presentation and outcomes of high-grade soft tissue sarcoma at a Southeastern United States comprehensive cancer center.

BACKGROUND: High-grade soft tissue sarcoma is rare and associated with poor prognosis. This study examines racial and ethnic variation in presentation and outcomes at a Southeastern US cancer center. METHODS: Among an institutional cohort of patients seen between January 2016-December 2021, racial and ethnic differences were evaluated using chi-squared tests, Kaplan Meier curves, and Cox proportional hazards models. RESULTS: There were 295 patients (71 â€‹% Non-Hispanic White, 24 â€‹% Black, 3 â€‹% Hispanic White, 2 â€‹% Other). Black representation was greater than national cohorts (24 â€‹% vs. 12 â€‹%). Histological subtype varied by race/ethnicity (p â€‹= â€‹0.007). Adjusting for histology and stage, survival was worse for Black vs. White patients (HR 1.71, 95 â€‹% CI 1.07-2.76) and those with metastatic disease (5.47, 3.54-8.44). In non-metastatic patients, survival differences for Black vs. White patients were attenuated by receipt of multi-modal treatment (1.53, 0.82-2.88). CONCLUSION: Observed racial disparities in survival of high-grade sarcoma may be addressed by early, multidisciplinary management.

Linking Electronic Health Records to the American Community Survey: Feasibility and Process.

Objectives. To assess linkages of patient data from a health care system in the southeastern United States to microdata from the American Community Survey (ACS) with the goal of better understanding health disparities and social determinants of health in the population. Methods. Once a data use agreement was in place, a stratified random sample of approximately 200 000 was drawn of patients aged 25 to 74 years with at least 2 visits between January 1, 2016, and December 31, 2019. Information from the sampled electronic health records (EHRs) was transferred securely to the Census Bureau, put through the Census Person Identification Validation System to assign Protected Identification Keys (PIKs) as unique identifiers wherever possible. EHRs with PIKs assigned were then linked to 2001-2017 ACS records with a PIK. Results. PIKs were assigned to 94% of the sampled patients. Of patients with PIKs, 15.5% matched to persons sampled in the ACS. Conclusions. Linking data from EHRs to ACS records is feasible and, with adjustments for differential coverage, will advance understanding of social determinants and enhance the ability of integrated delivery systems to reflect and affect the health of the populations served. (Am J Public Health. 2022;112(6):923-930. https://doi.org/10.2105/AJPH.2022.306783).

Holistic aboveground ecological productivity efficiency modeling using data envelopment analysis in the southeastern U.S.

Aboveground net primary productivity (ANPP) of an ecosystem is among the most important metrics of valued ecosystem services. Measuring the efficiency scores of ecological production (ESEP) based on ANPP using relevant variables is valuable for identifying inefficient sites. The efficiency scores computed by the Data Envelopment Analysis (DEA) may be influenced by the number of input variables incorporated into the models and two DEA settings-orientations and returns-to-scales (RTSs). Therefore, the objectives were threefold to: (1) identify soil-environmental variables relevant to ANPP, (2) assess the sensitivity of ESEP to the number of input variables and DEA settings, and (3) assess local management relations with ESEP. The ANPP rates were calculated for pine forests in the southeastern U.S. where 10 management types were used. This was followed by an all-relevant variable selection technique based on 696 variables that cover biotic, pedogenic, climatic, geological, and topographical factors. Five minimal-optimal variable selection techniques were further applied to create five parsimonious sets that contain a different number of variables used as DEA inputs. After setting ANPP as the output variable, two DEA orientations (input/output) and six RTS were applied to compute ESEP. The variable selection methods succeeded in objectively identifying the major factors relevant to ANPP variation. The site index showed the highest correlation with ANPP (r = 0.39), while various precipitation factors were negatively correlated (r = - 0.15~ - 0.29, p < 0.01). Parsimonious ESEP models observed a decrease in score variances as the number of input variables increased. Various RTS produced similar scores across orientations. Of the DEA settings, an output orientation with decreasing RTS produced the most progressive ESEP with large variation. Results also suggested that macro- and micronutrient fertilization is the best combination of management strategies to achieve high ESEP. This holistic benchmark approach can be applied to other ecological functions in diverse regions.

Holistic Nurse Practitioner Care Including Promotion of Shared Decision-Making.

The purpose of this quantitative, descriptive, exploratory study was to gauge the degree to which nurse practitioners (NPs) incorporate holistic nursing values in their care, with a special focus on shared decision-making (SDM), using the Nurse Practitioner Holistic Caring Instrument (NPHCI), an investigator-developed scale. A single open-ended question inviting free-text comment was also included, soliciting participants' views on the holistic attributes of their care. A convenience sample of NPs (n = 573) was recruited from a southeastern U.S. state Board of Nursing's (BON) publicly available list of licensed NPs. Results suggest that NPs do indeed perceive their care to be holistic, and that they routinely incorporate elements of SDM in their care. Highest scores were accorded to listening, taking time to talk to patients, knowledge of physical condition, soliciting patient input in care decisions, considering how other areas of a patient's life may affect their medical condition, and attention to "what matters most" to the patient. Age, gender, level of education, practice specialty, and location were also associated with inclusion of holistic care. Free-text responses revealed that NPs value holistic care and desire to practice holistically, but identify "lack of time" to incorporate or practice holistic care as a barrier.

Health and nutrition of loggerhead sea turtles (Caretta caretta) in the southeastern United States.

Loggerhead sea turtles (Caretta caretta) are opportunistic carnivores that feed primarily on benthic invertebrates and fish. Sea turtle rehabilitation requires provision of a species-specific, balanced diet that supplies nutrition similar to that of a wild diet; this can be challenging because free-ranging loggerheads' diets vary depending on their life stage and geographic location, with predominant prey species dictated by local availability. The goal of this study was to better understand the nutritional needs of subadult and adult loggerheads in rehabilitation. This was accomplished by conducting a retrospective survey of stomach contents identified during gross necropsy of 153 deceased loggerheads that stranded in coastal Georgia, USA. A total of 288 different forage items were identified; the most frequently observed prey items belong to the subphylum Crustacea (N = 131), followed by bony fish (Osteichthyes; N = 45), gastropod mollusks (N = 40), bivalve mollusks (N = 23), and Atlantic horseshoe crabs (Limulus polyphemus; N = 15). The proportions of certain prey items differed significantly with turtle size; adult turtles ate proportionately more gastropods (p = 0.001), and subadults ate proportionately more fish (p = 0.01). Stomach contents information was used to determine common local prey items (blue crab, cannonball jellyfish, horseshoe crab, whelk), which were evaluated for nutritional content. Additionally, we compared hematology and plasma biochemistry profiles (including proteins, trace minerals, and vitamins) between four cohorts of loggerhead turtles, including free-ranging subadults and adults, nesting females, and loggerheads undergoing rehabilitation. This information was applied to inform a regionally specific, formulated diet for tube feeding, and a supplement containing vitamins and minerals for captive loggerheads, to more closely approximate the nutritional content of their natural diet. Assessing the regional and temporal variability in loggerhead diets is an important component in their effective conservation because resultant data can be used to help understand the impacts of environmental perturbations on benthic food webs.

Harnessing the electronic health record to advance integrated care.

INTRODUCTION: Integrated health care is utilized in primary care clinics to meet patients' physical, behavioral, and social needs. Current methods to collect and evaluate the effectiveness of integrated care require refinement. Using informatics and electronic health records (EHR) to distill large amounts of clinical data may help researchers measure the impact of integrated care more efficiently. This exploratory pilot study aimed to (a) determine the feasibility of using EHR documentation to identify behavioral health and social care components of integrated care, using social work as a use case, and (b) develop a lexicon to inform future research using natural language processing. METHOD: Study steps included development of a preliminary lexicon of behavioral health and social care interventions to address basic needs, creation of an abstraction guide, identification of appropriate EHR notes, manual chart abstraction, revision of the lexicon, and synthesis of findings. RESULTS: Notes (N = 647) were analyzed from a random sample of 60 patients. Notes documented behavioral health and social care components of care but were difficult to identify due to inconsistencies in note location and titling. Although the interventions were not described in detail, the outcomes of screening, referral, and brief treatment were included. The integrated care team frequently used EHR to share information and communicate. DISCUSSION: Opportunities and challenges to using EHR data were identified and need to be addressed to better understand the behavioral health and social care interventions in integrated care. To best leverage EHR data, future research must determine how to document and extract pertinent information about integrated team-based interventions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Insights From Rapid Deployment of a "Virtual Hospital" as Standard Care During the COVID-19 Pandemic.

BACKGROUND: Pandemics disrupt traditional health care operations by overwhelming system resource capacity but also create opportunities for care innovation. OBJECTIVE: To describe the development and rapid deployment of a virtual hospital program, Atrium Health hospital at home (AH-HaH), within a large health care system. DESIGN: Prospective case series. SETTING: Atrium Health, a large integrated health care organization in the southeastern United States. PATIENTS: 1477 patients diagnosed with coronavirus disease 2019 (COVID-19) from 23 March to 7 May 2020 who received care via AH-HaH. INTERVENTION: A virtual hospital model providing proactive home monitoring and hospital-level care through a virtual observation unit (VOU) and a virtual acute care unit (VACU) in the home setting for eligible patients with COVID-19. MEASUREMENTS: Patient demographic characteristics, comorbid conditions, treatments administered (intravenous fluids, antibiotics, supplemental oxygen, and respiratory medications), transfer to inpatient care, and hospital outcomes (length of stay, intensive care unit [ICU] admission, mechanical ventilation, and death) were collected from electronic health record data. RESULTS: 1477 patients received care in either the AH-HaH VOU or VACU or both settings, with a median length of stay of 11 days. Of these, 1293 (88%) patients received care in the VOU only, with 40 (3%) requiring inpatient hospitalization. Of these 40 patients, 16 (40%) spent time in the ICU, 7 (18%) required ventilator support, and 2 (5%) died during their hospital admission. In total, 184 (12%) patients were ever admitted to the VACU, during which 21 patients (11%) required intravenous fluids, 16 (9%) received antibiotics, 40 (22%) required respiratory inhaler or nebulizer treatments, 41 (22%) used supplemental oxygen, and 24 (13%) were admitted as an inpatient to a conventional hospital. Of these 24 patients, 10 (42%) required ICU admission, 1 (3%) required a ventilator, and none died during their hospital admission. LIMITATION: Generalizability is limited to patients with a working telephone and the ability to comply with the monitoring protocols. CONCLUSION: Virtual hospital programs have the potential to provide health systems with additional inpatient capacity during the COVID-19 pandemic and beyond. PRIMARY FUNDING SOURCE: Atrium Health.

Native and Edible Ornamental Plant Congeners Enhance Ecosystem Services Through Key Pest Avoidance and Multifunctionality in Residential Landscapes.

Tea scale, Fiorinia theae Green (Hemiptera: Diaspididae), has long been one of the most important pests of Ilex and Camellia plants, particularly in the southeastern United States. This exotic armored scale insect reduces host plant health and function, and often requires insecticide use, which poses risks to nontarget organisms. While the use of Ilex (Aquifoliales: Aquifoliaceae) and Camellia (Ericales: Theaceae) spp. as landscape ornamentals for aesthetic function is firmly established, we have a poor understanding of species-level susceptibility to F. theae. Additionally, two species, Ilex vomitoria Ait. and Camellia sinensis (L.) O. Kuntze are emerging tisane- and tea-producing commodities in the region, respectively. We propose that these consumable plants may be well-suited alternatives to their traditionally used ornamental congeners in residential landscapes where they may provide enhanced ecosystem services. However, the potential impact of key pests, like F. theae, on these species should be evaluated to anticipate pest pressure that may undermine or offset benefits. In this study, we examine six species within the known host range of tea scale, comparing nonnative I. cornuta Lindl. 'Dwarf Burford,' C. japonica L., C. sasanqua Thunb., and C. sinensis, along with native I. opaca Ait. and I. vomitoria. We found that plant species show a wide range of susceptibility to F. theae and associated damage, with the two native Ilex species and tea-producing C. sinensis displaying the least susceptibility. By reducing the impact of a key pest and considering other ecosystem service traits, these results may help guide more sustainable plant selection decisions where the goal is to integrate native and edible plants into residential landscapes.

Peppermint Oil: Evaluating Efficacy on Nausea in Patients Receiving Chemotherapy in the Ambulatory Setting.

BACKGROUND: Nausea is one of the most commonly reported side effects in patients receiving chemotherapy. Patients who experience nausea during chemotherapy may also experience depression, metabolic imbalances, dehydration, decreased ability to function, and treatment delays, which can ultimately affect outcomes. OBJECTIVES: This study aimed to determine the efficacy of a cool damp washcloth with peppermint essential oil versus a cool damp washcloth alone on the self-reported intensity of nausea in patients receiving chemotherapy in the outpatient ambulatory setting. METHODS: 79 adult patients receiving chemotherapy were recruited from an outpatient ambulatory infusion center in the southeastern United States. Patients were separated into two groups (no scent and peppermint) and asked to rate the intensity of their chemotherapy-induced nausea at pre- and postintervention using the Baxter Retching Faces pictorial scale. FINDINGS: The results demonstrated that the use of peppermint oil was effective in decreasing the intensity of nausea experienced by patients compared to a cool washcloth alone.

The Effectiveness of Charge Nurse Training on Leadership Style and Resiliency.

OBJECTIVE: The study objective was to investigate a charge nurse pilot training program as an effective, evidence-based training modality to improve leadership style and resiliency. BACKGROUND: Leadership is inherent and necessary in the charge nurse role. Little published research about charge nurse leadership training programs exists. METHODS: A pre-post design, with intervention and comparison groups, was conducted at an integrated healthcare system. A random sample of charge nurses was selected to pilot a standardized charge nurse leadership training program including in-person learning to foster leadership skills and nurture resiliency. RESULTS: The sample included 19 control participants and 22 intervention participants. Significant improvement was noted in transformational, transactional, leadership outcomes, and resiliency from preintervention to postintervention for the all subjects. Of the 22 intervention participants, the training elicited higher satisfaction with leadership behavior, followed by effectiveness and their ability to motivate. Charge nurses who attended training had higher resiliency scores pre-post intervention. CONCLUSION: The charge nurse pilot training was an effective program that led to improved leadership style and resiliency.

Religion, Spirituality, and Risk of End-Stage Kidney Disease Among Adults of Low Socioeconomic Status in the Southeastern United States.

BACKGROUND: Religiosity, encompassing spirituality and religious practices, is associated with reduced disease incidence among individuals of low socioeconomic status and who self-identify as Black. We hypothesized that religiosity associates with reduced end-stage kidney disease (ESKD) risk among Black but not White adults of low socioeconomic status. DESIGN: Cox models of religiosity and ESKD risk in 76,443 adults. RESULTS: Black adults reporting high spirituality had reduced ESKD risk after adjusting for demographic characteristics [Hazard Ratio (HR) .82 (95% Confidence Interval (CI)) (.69-.98)], depressive symptoms, social support, and tobacco use [HR .81 (CI .68-.96)]. When clinical covariates were added, associations between spirituality and ESKD were slightly attenuated and lost significance [HR .85 (CI .68-1.06)]. Associations were not demonstrated among White adults. CONCLUSIONS: Spirituality associates with reduced ESKD risk among Black adults of low socioeconomic status independent of demographic, psychosocial, and behavioral characteristics. Effect modification by race was not statistically significant.

Perceptions of Spiritual Care Education, Competence, and Barriers in Providing Spiritual Care Among Registered Nurses.

Purpose: The purpose of the study was to explore registered nurses' (RNs) perceptions of their spiritual care competence (SCC), preparedness, and barriers to providing spiritual care and frequency of provision of spiritual care. Additionally, the study aimed to examine associations between spiritual care education, preparedness, competence, and frequency. Method: A descriptive, cross-sectional study included demographic questions, the Spiritual Care Competency scale, the Nurses' Spiritual Care Therapeutics scale, the Spiritual Care Practice questionnaire subscale II, and three open-ended questions. Findings: This online survey was completed by 391 RNs enrolled in postlicensure programs at a public state university in southeastern United States. A majority of participants reported not feeling prepared to provide spiritual care. There were strong associations between receiving spiritual care education in prelicensure programs or at work, and self-reported feelings of preparedness, as well as overall SCC. The level of SCC was positively correlated with spiritual care frequency and number of years working as an RN. Conclusions: The results of this study highlight the need for spiritual care education in prelicensure programs as well as on the job training for RNs.

Examining the interplay of micro-break durations and activities for employee recovery: A mixed-methods investigation.

On a given workday, employees spend time at work doing tasks that are not work-related, potentially using these micro-breaks (i.e., short breaks that are less than 10 min) to attempt to recover depleted psychological resources such as energy and attention. However, most work break and recovery research has focused on how individuals recover from work during formal nonwork time with longer or unspecified time durations (e.g., lunch breaks, evenings, vacations), limiting theoretical and empirical understanding of whether employees can experience recovery within the workday via brief micro-breaks. In the current investigation, we first conducted interviews from 16 shift workers at a Fortune 500 company to develop research questions about how micro-breaks impact psychological resources and recovery experiences. We then used a randomized experiment with a sample of undergraduate students (n = 232) to test the impact of micro-break durations and activities on the recovery of psychological resources (i.e., energy and attention) and recovery experiences. Results show that some, but not all, micro-break conditions can help employees recover back to their baseline (i.e., prework task) levels of psychological resources following a micro-break. Overall, this experiment provides stronger levels of causal inference about the recovery process and presents new ideas regarding how micro-break durations influence well-being via psychological resource recovery. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Food intake of folate, folic acid and other B vitamins with lung cancer risk in a low-income population in the Southeastern United States.

PURPOSE: We prospectively examined associations of lung cancer risk with food intake of B vitamins involved in one-carbon metabolism and the use of folic acid-containing supplements among a low-income population of black and white adults in the Southeastern US. METHODS: Within the Southern Community Cohort Study, we included 1064 incident lung cancer cases among 68,236 participants aged 40-79 years at study enrollment. Food intake and the use of folic acid-containing supplements were assessed using a validated food frequency questionnaire at study enrollment. Multivariate Cox regression was used to estimate hazards ratios (HRs) and the 95% confidence intervals (CIs). RESULTS: Folate and/or folic acid intake from food were not associated with lung cancer risk; HRs (95% CI) for highest compared with lowest quartile were 1.08 (0.91-1.29) for total dietary folate, 1.00 (0.84-1.19) for food folate, and 1.09 (0.91-1.30) for food folic acid, respectively. Similarly, no associations were observed after stratifying by sex, race and smoking status, except for a positive association with total dietary folate intake among black women (HR 1.46, 95% CI 1.04-2.05 for the highest quartile compared with the lowest quartile, P trend = 0.02). Neither the use of folic acid-containing supplements nor food intake of vitamin B6, vitamin B12 and riboflavin were associated with lung cancer risk. CONCLUSIONS: Our findings do not support a protective effect of folate or folic acid for lung cancer prevention in a low-income population of black and white adults in the Southeastern US. Our finding of a positive association with total dietary folate intake among black women needs to be interpreted with caution and replicated in other studies.

The Use of Prayer During Life-Threatening Illness: A Connectedness to God, Inner-Self, and Others.

To explore how prayers were used as expressions of spirituality among community-dwelling African Americans in response to life-threatening illness. Fifty-eight older African American adults residing in the Southeastern US participated in a qualitative descriptive study. Through prayers, participants requested the strength to endure, protection, healing and expressed gratitude. Prayers were expressions of spirituality through dimensions of connectedness: transpersonally to God or the unseen; intrapersonally to one's inner-self; and, interpersonally to others. Prayers are an important aspect of spirituality and the mental health of older African Americans particularly during serious, life-threatening illness. An understanding of the ways in which prayers are used might enhance the cultural relevance of mental health interventions in this population.

Essential Elements of Song for Grieving Young Adults.

Complications experienced by grieving young adults have developmental, mental, and behavioral components. Music offers opportunities to promote healthy grieving. While song writing has been widely used as an informal therapy for centuries, current researchers are beginning to explore its benefits. There is a noticeable lack of literature regarding the role of music in the grieving process. The aims of this study were to explore the grieving experiences of young adults who had lost a family member or friend, to identify song elements most helpful in promoting healthy grieving, and then to use these findings to compose a piece of music. Fifteen 20- to 23-year-old participants were interviewed about the death of a close friend or family member using a structured interview guide that included questions about their experience with the death and their grief, as well as questions about what song elements might help in grief. These questions included specifics about the song tempo (speed), dynamic (volume), and whether the song should contain lyrics (words). Thematic analysis was used to analyze interviews. Themes derived from the interview that should be relayed in a song included: Grief can include joy and pain together; It will get better; There is value in community; and, It is ok not to be ok For song elements, participants elected a slow tempo, a mixed or soft dynamic, and inclusion of lyrical content. All findings were integrated into a song composition that may help promote healthy grieving.

The Latitudes, Attitudes, and Platitudes of Watershed Phosphorus Management in North America.

Phosphorus (P) plays a crucial role in agriculture as a primary fertilizer nutrient-and as a cause of the eutrophication of surface waters. Despite decades of efforts to keep P on agricultural fields and reduce losses to waterways, frequent algal blooms persist, triggering not only ecological disruption but also economic, social, and political consequences. We investigate historical and persistent factors affecting agricultural P mitigation in a transect of major watersheds across North America: Lake Winnipeg, Lake Erie, the Chesapeake Bay, and Lake Okeechobee/Everglades. These water bodies span 26 degrees of latitude, from the cold climate of central Canada to the subtropics of the southeastern United States. These water bodies and their associated watersheds have tracked trajectories of P mitigation that manifest remarkable similarities, and all have faced challenges in the application of science to agricultural management that continue to this day. An evolution of knowledge and experience in watershed P mitigation calls into question uniform solutions as well as efforts to transfer strategies from other arenas. As a result, there is a need to admit to shortcomings of past approaches, plotting a future for watershed P mitigation that accepts the sometimes two-sided nature of Hennig Brandt's "Devil's Element."

Evaluation of an Innovative, Hospital-Based Volunteer Doula Program.

OBJECTIVE: To evaluate program growth, doula characteristics, patient satisfaction, and characteristics and perceptions of labor and delivery nurses who work with volunteer doulas in a hospital-based volunteer doula program. DESIGN: Descriptive quantitative. SETTING: An academic health center in the southeastern United States with approximately 4,000 births per year. PARTICIPANTS: Participants (N = 519) included volunteer doulas (n = 80), labor and delivery nurses (n = 24), and women who were supported by doulas (n = 415). METHODS: We evaluated program growth by the number of doulas and women supported over time. We developed surveys to evaluate doula characteristics, patient satisfaction, and characteristics and perceptions of labor and delivery nurses who work with volunteer doulas. RESULTS: From 2012 to 2018, the number of Birth Partners doulas increased from 25 to 80. The annual number of women who received intrapartum care from doulas increased from 88 in 2012 to 477 in 2018. Doula characteristics included race, ethnicity, age, student or nonstudent status, and ability to speak Spanish. Of the 1,185 women who received doula support from 2015 to 2018, 415 (35%) responded to the patient satisfaction survey. Most were satisfied with the physical support (n = 379, 97.63%), emotional support (n = 384, 96.88%), doula care (n = 410, 96.34%), and support for family/friends (n = 346, 95.38%). All of the labor and delivery nurses who responded (n = 24, 100%) agreed or strongly agreed that doulas were important members of the maternity care team. CONCLUSION: In this evaluation, we highlight rapid program growth, expansion of services, and demographic characteristics of volunteer doulas; patient satisfaction with doula care; and acceptance of volunteer doulas among nursing staff. The data provided herein can be used to inform future development and guide the implementation of similar volunteer doula programs at other institutions.