Leadership Perspectives on Nursing Home Operations From Crisis to Control: A Mixed Methods Study.

OBJECTIVES: Nursing home (NH) leaders remain challenged to deliver quality care, despite the COVID-19 transition to an endemic phase. This study describes NH leadership perspectives on preparing and maintaining quality care during times of diminishing resources as experienced through the COVID-19 pandemic to gain insight on how best to support NHs moving forward. DESIGN: This was a cross-sectional, parallel convergent mixed methods study. SETTING AND PARTICIPANTS: This study reports quantitative data from 5001 NHs across 12 states along with qualitative data from a subsample of NH leaders (N = 15). METHODS: Publicly reported survey data were analyzed using descriptive statistics. Individual in-depth interviews with NH leaders conducted at 12-month follow-up were analyzed using inductive thematic coding organized by a guiding framework. Data were integrated using convergent analysis and a joint display. RESULTS: NH leaders (licensed administrators, clinical directors, and managers) reported resident and staff infection rates, and access to resources (such as personal protective equipment and testing supplies) that aligned with national trends. Leaders described their NHs (N = 14; 43% rural; 71% not for profit) to be in varied states of operational readiness (standard, contingency, crisis) to support quality infection prevention and control (IPC) at the transition to the endemic COVID-19 phase. Leadership reported continued challenges in addressing resident and staff vaccinations, securing testing supplies, obtaining financial resources to maintain acceptable levels of personal protective equipment, continued staffing shortages, and issues in implementing isolation practices in current facilities. CONCLUSION AND IMPLICATIONS: NH leaders continue to struggle delivering quality IPC care post-pandemic and require focused support in several areas. Clinical practice guidelines should include IPC practices to prevent the infection and spread of any COVID-19 variant in this endemic phase. Policies should support continued reporting of IPC-related metrics and adequate funding to account for the long-term financial burden NHs face.

Efficacy of Pea Protein Supplementation in Combination with a Resistance Training Program on Muscle Performance in a Sedentary Adult Population: A Randomized, Comparator-Controlled, Parallel Clinical Trial.

Animal-sourced whey protein (WPr) is the most popular protein supplement among consumers and has been shown to improve muscle mass and strength. However, due to allergies, dietary restrictions/personal choices, and growing demand, alternative protein sources are warranted. Sedentary adults were randomized to pea protein (PPr) or WPr in combination with a weekly resistance training program for 84 days. Changes in whole-body muscle strength (WBMS) including handgrip, lower body, and upper body strength, body composition, and product perception were assessed. The safety outcomes included adverse events, vital signs, clinical chemistry, and hematology. There were no significant differences in the change in WBMS, muscle mass, or product perception and likability scores between the PPr and WPr groups. The participants supplemented with PPr had a 16.1% improvement in WBMS following 84 days of supplementation (p = 0.01), while those taking WPr had an improvement of 11.1% (p = 0.06). Both study products were safe and well-tolerated in the enrolled population. Eighty-four days of PPr supplementation resulted in improvements in strength and muscle mass comparable to WPr when combined with a resistance training program in a population of healthy sedentary adults. PPr may be considered as a viable alternative to animal-sourced WPr without sacrificing muscular gains and product enjoyment.

Efficacy of a yeast postbiotic on cold/flu symptoms in healthy children: A randomized-controlled trial.

BACKGROUND: Children attending school/daycare are at high risk of acute respiratory tract infections. EpiCorTM postbiotic, derived from yeast fermentate, has been demonstrated to improve immune function in adults, reducing the incidence of cold/flu-like or allergy symptoms. As such, studies are warranted in children as available pharmaceutical options have unwanted side effects. METHODS: Two-hundred and fifty-six children aged 4-12 years attending school/daycare were randomized to either EpiCor or Placebo for 84 days during the 2022-2023 flu season in Ontario, Canada. The Canadian Acute Respiratory Illness and Flu Scale (CARIFS) and study diary assessed the incidence and severity of cold/flu symptoms and the use of cold/flu medications. Adverse events were recorded. RESULTS: Total CARIFS severity scores, 'sore throat' and 'muscle aches or pains' symptom scores in the EpiCor group were significantly lower compared to Placebo during incidences of cold/flu (P ≤ 0.05). Participants taking Placebo were 1.73 times more likely to use cold/flu medication compared to those receiving EpiCor (P = 0.04). The incidence of cold/flu symptoms was not significantly different between groups. EpiCor was found to be safe and well-tolerated. CONCLUSIONS: EpiCor supplementation resulted in significantly lower cold/flu symptom severity and less cold/flu medication usage than Placebo demonstrating a beneficial effect on immune function in children. IMPACT: Children are at high risk of acquiring cold/flu infections and safe and efficacious mitigating regimens are lacking. Children supplemented daily with 500 mg EpiCorTM postbiotic derived from yeast fermentate had significantly lower overall cold/flu symptom severity, and severity of sore throat and muscle aches or pains over the 84-day supplementation period. EpiCor supplementation resulted in decreased use of traditional cold/flu medication. Daily supplementation with 500 mg of EpiCor for 84 days was safe and well tolerated by healthy children aged 4-12 years attending school or daycare.

Safety and Efficacy of AlphaWave® L-Theanine Supplementation for 28 Days in Healthy Adults with Moderate Stress: A Randomized, Double-Blind, Placebo-Controlled Trial.

BACKGROUND: Prolonged periods of stress may lead to negative health consequences. AlphaWave® L-Theanine was safe and efficacious during an acute stress challenge. However, double-blind, placebo-controlled clinical trials investigating the longer term effects of L-theanine supplementation on stress are warranted. METHODS: Thirty healthy adults (18-65 years) with moderate stress were randomized to AlphaWave® L-Theanine (400 mg L-theanine/day) or placebo (n = 15/group) for 28 days. Stress was assessed by salivary cortisol, Perceived Stress Scale (PSS) and Depression, Anxiety and Stress Scale-21; sleep was assessed by the Healthy People Sleep Quality Index and actigraphy device; cognition was assessed by Computerized Mental Performance Assessment System; mood was assessed by Profile of Mood States. All outcomes were measured at baseline, Days 14 and 28. Safety included vital signs, clinical chemistry, haematology and adverse events (AEs). RESULTS: All AEs were resolved by the end of the study period or upon subsequent follow up, and out of range laboratory values and changes in vital signs were deemed not clinically relevant following AlphaWave® L-Theanine supplementation. Participants supplemented with AlphaWave® L-Theanine had decreases of 12.92% (p = 0.051) and 17.98% (p = 0.04) in PSS scores after 14 and 28 days, respectively, while those on placebo had respective decreases of 9.74% (p = 0.061) and 17.88% (p = 0.009). There were no significant differences between groups for change in salivary cortisol. The AlphaWave® L-Theanine group demonstrated decreased time asleep after 28 days and significantly reduced light sleep after 14 and 28 days compared to placebo (p ≤ 0.040). The AlphaWave® L-Theanine group significantly improved by 21.79% and 21.33% in Stroop test correct reaction time after 14 and 28 days, respectively, while those on placebo improved after 28 days only (p = 0.005). CONCLUSIONS: AlphaWave® L-Theanine supplementation for 28 days was safe and significantly decreased perceived stress significantly decreased perceived stress and light sleep, improved sleep quality and enhanced cognitive attention in the studied population. Larger, randomized controlled trials with longer duration of AlphaWave® L-Theanine supplementation are warranted to reduce inter-individual variability and the potential placebo effect. TRIAL REGISTRATION: ClinicalTrials.gov identifier, NCT05808595.

The Student Voice: Perceptions of Durable Learning.

BACKGROUND: Durable learning is the teaching/learning methods that result in retained knowledge that can be transferred to practice. There is limited research on durable learning in nursing education (NE). PURPOSE: The purpose of this study was to understand the perceptions of how learners acquire and retain knowledge. METHODS: Nursing students and recent graduates were recruited from 2 large universities. Focus groups (n = 7) were audio-recorded, and transcripts were analyzed. RESULTS: Thematic analysis of learners' perceptions revealed (1) effective learner-initiated techniques, (2) effective instructor-initiated techniques, (3) learner-initiated techniques that were not effective, and (4) instructor-initiated techniques in the classroom, clinical practice, and simulation that were not effective. CONCLUSION: Additional research is needed to understand faculty perspectives on durable learning techniques and their effectiveness. Findings from student, graduate, and faculty perspectives will guide the development of a validated, reliable tool to evaluate durable learning in NE.

High sugar diet alters immune function and the gut microbiome in juvenile green iguanas (Iguana iguana).

The present work aimed to study whether a high sugar diet can alter immune responses and the gut microbiome in green iguanas. Thirty-six iguanas were split into four treatment groups using a 2×2 design. Iguanas received either a sugar-supplemented diet or a control diet, and either a lipopolysaccharide (LPS) injection or a phosphate-buffered saline (PBS) injection. Iguanas were given their respective diet treatment through the entire study (∼3 months) and received a primary immune challenge 1 and 2 months into the experiment. Blood samples and cloacal swabs were taken at various points in the experiment and used to measure changes in the immune system (bacterial killing ability, lysis and agglutination scores, LPS-specific IgY concentrations), and alterations in the gut microbiome. We found that a sugar diet reduces bacterial killing ability following an LPS challenge, and sugar and the immune challenge temporarily alters gut microbiome composition while reducing alpha diversity. Although sugar did not directly reduce lysis and agglutination following the immune challenge, the change in these scores over a 24-h period following an immune challenge was more drastic (it decreased) relative to the control diet group. Moreover, sugar increased constitutive agglutination outside of the immune challenges (i.e. pre-challenge levels). In this study, we provide evidence that a high sugar diet affects the immune system of green iguanas (in a disruptive manner) and alters the gut microbiome.

Advance Care Planning: Perspectives of People Living in Prison.

A person-centered approach to advance care planning is recognized as a fundamental need, yet its routine implementation remains a challenge across disparate settings, such as prisons. The purpose of this study was to gain the perspectives of people who are incarcerated about advance care planning. Four focus groups were conducted with people living in 1 men's and 1 women's state prison (n = 26). Handwritten field notes were taken, transcribed, deidentified, and verified before the completion of independent thematic analysis by 2 experienced qualitative researchers. Key themes regarding advance care planning were identified: components of advance care planning, initiation and continuation of advance care planning, barriers to implementing advance care planning, and facilitators to implementing advance care planning. Participants noted several key components related to the name, structure, and content of advance care planning programs. Insights about who should initiate the conversation, when to continue the conversation, and how to deliver education about advance care planning were obtained. Findings contribute to identifying best practices for infusing advance care planning into prisons. Best practices will inform the development of a toolkit of contextually relevant, person-centered approaches to advance care planning that are tailored to meet the unique needs of people who are incarcerated.

Corrigendum: Safe and effective delivery of supplemental iron to healthy adults: a two-phase, randomized, double-blind trial - the safe iron study.

[This corrects the article DOI: 10.3389/fnut.2023.1230061.].

Revisiting the Definition of 'Healthy' Participants in Substantiation of Structure/Function Claims for Dietary Supplements.

Concepts and definitions of 'healthy' have been evolving within clinical treatment algorithms as well as reference standards such as Body Mass Index and Dietary Reference Intakes. Consumers' perception of the word 'healthy' is also changing to reflect longer life span, need to stay active and in a good state of mental well-being while managing multiple diseases. Guidelines from the US Food and Drug Administration indicate that substantiating evidence for support of Structure/Function (S/F) claims for dietary supplements is best derived from clinical research conducted in a 'healthy' population. S/F claims cannot be represented to diagnose, treat, cure or prevent any disease. However, in this context, the term 'healthy' is non-descriptive and largely interpreted as an absence of disease. Guidelines for treatment of disease have been broadened to include biomarkers of disease risk such that the pool of 'healthy' volunteers eligible to be enrolled in clinical trials for S/F claim substantiation is greatly diminished. This perspective presents the challenges faced by the food and dietary supplement industry and by researcher efforts designed to substantiate S/F claims and suggest the phrase 'physiologically stable' or 'apparently healthy' as descriptions better suited to replace the term 'healthy.'

Sex-specific effects of immune challenges on green anole lizard metabolism.

Immune responses can increase survival, but they can also incur a variety of costs that may lead to phenotypic trade-offs. The nature of trade-offs between immune activity and other components of the phenotype can vary and depend on the type and magnitude of immune challenge, as well as the energetic costs of simultaneously expressing other traits. There may also be sex-specific differences in both immune activity and trade-offs, particularly with regard to energy expenditure that might differ between males and females during the breeding season. Females are generally expected to invest less in nonspecific immune responses compared to males due to differences in the allocation of resources to reproduction, which may lead to sex differences in the metabolic costs of immunity. We tested for sex-specific differences in metabolic costs of different types of immune challenges in Anolis carolinensis lizards, including lipopolysaccharide (LPS) injection and wounding. We also tested for differences in immune prioritization by measuring bacterial killing ability (BKA). We predicted males would show a greater increase in metabolism after immune challenges, with combined immune challenges eliciting the greatest response. Furthermore, we predicted that metabolic costs would result in decreased BKA. LPS injection increased the resting metabolic rate (RMR) of males but not females. Wounding did not affect RMR of either sex. However, there was an inverse relationship between BKA and wound healing in LPS-injected lizards, suggesting dynamic tradeoffs among metabolism and components of the immune system.

Durable Learning Strategies in Nursing Education: State-of-the-Evidence Review.

BACKGROUND: Health professions (HP) students must achieve durable learning (DL) to transfer and apply knowledge from the classroom to the clinical setting. This review examines the state of the science of classroom-based DL in HP. METHOD: The Joanna Briggs Systematic Review Methodology was used. MEDLINE, CINAHL, PsycINFO, and ERIC databases were searched for articles published from 2006 to 2022. A total of 2,000 titles were identified for review, with 51 studies being selected for inclusion. RESULTS: Multiple classroom-based learning strategies generally reported as being effective were identified, including flipped classroom, educational technology, spaced learning, team-based learning, concept mapping and schema, testing, and case study and problem-based learning. CONCLUSION: Although DL has been proven to be effective in the classroom setting for HP, no one type has been shown to be more effective than others. Additional research is needed within the context of transferring knowledge to clinical settings and in nursing education. [J Nurs Educ. 2024;63(1):24-31.].

End-of-Life Care Planning: Perspectives of Returning Citizens.

Demographic shifts toward an older and sicker prison population present challenges for corrections leaders and incarcerated people. The priority of custody and control over care in prisons can deprive people of a modicum of autonomy even about expressing their end-of-life wishes. This study was undertaken to inform best practices and identify essential components of end-of-life care planning (EOLCP) for people who will likely die incarcerated. Individual interviews with formerly incarcerated people (n = 16) provided insights on EOLCP knowledge, perceptions, and future plans as each reflected on experiences while incarcerated. Zoom Video Communications were used for the interviews, and audio recordings were transcribed verbatim, verified, and deidentified prior to thematic analysis. Themes were defined and discussed until consensus was reached between the 2 researchers. End-of-life care planning themes included the following: understanding of and experience with advanced directives/care planning (AD/ACP), defining AD/ACP, timing of AD/ACP accessibility to health care resources, how to approach EOLCP in prison, advantages of EOLCP, and barriers to EOLCP. Formerly incarcerated peoples' knowledge, perceptions, and future plans revealed important considerations when developing a contextually relevant toolkit for EOLCP for people living in prison.

We are all in this together: Rurality, Social cohesion, and COVID-19 prevention behaviors.

BACKGROUND: Social cohesion refers to an individual's sense of belonging to their community and correlates with health outcomes. Rural communities tend to have higher social cohesion than urban communities. Social cohesion is relatively understudied as a factor impacting COVID-19 prevention behaviors. This study explores the associations between social cohesion, rurality, and COVID-19 prevention behaviors. METHODS: Participants completed a questionnaire assessing rurality; social cohesion (subscales of (1) attraction to neighborhood, (2) acts of neighboring, and (3) sense of community); COVID-19 behaviors; and demographics. Chi-square tests were used to characterize participant demographics and COVID-19 behaviors. Bivariate and multivariable logistic regression models were used to analyze the relationship between COVID-19 outcomes and rurality, social cohesion, and demographics. RESULTS: Most participants (n = 2,926) were non-Hispanic White (78.2%) and married (60.4%); 36.9% were rural. Rural participants were less likely than urban participants to practice social distancing (78.7% vs 90.6%, P<.001) or stay home when sick (87.7% vs 93.5%, P<.001). Social distancing was more common among participants with higher "attraction to neighborhood" scores (adjusted odds ratio [aOR] = 2.09; 95% confidence interval [CI] = 1.26-3.47) but was less common among participants with higher "acts of neighboring" scores (aOR = 0.59; 95% CI = 0.40-0.88). Staying home when sick was also more common among participants with higher scores on "attraction to neighborhood" (aOR = 2.12; 95% CI = 1.15-3.91), and less common among participants with higher scores on "acts of neighboring" (aOR = 0.53; 95% CI = 0.33-0.86). CONCLUSIONS: Efforts to maximize COVID-19 behavioral prevention, particularly among rural communities, should emphasize the importance of protecting the health of one's neighbors and how to support one's neighbors without face-to-face interactions.

Invading nonnative frogs use different microhabitats and change physiology along an elevation gradient.

The coqui frog (Eleutherodactylus coqui) was introduced to the island of Hawai'i in the 1980s, and has spread across much of the island. There is concern they will invade higher elevation areas where negative impacts on native species are expected. It is not known if coqui change behavior and baseline physiology in ways that allow them to invade higher elevations. We investigated where coqui are found across the island and whether that includes recent invasion into higher elevations. We also investigated whether elevation is related to coqui's microhabitat use, including substrate use and height off the forest floor, and physiological metrics, including plasma osmolality, oxidative status, glucose, free glycerol, and triglycerides, that might be associated with invading higher elevations. We found coqui have increased the area they occupy along roads from 31% to 50% and have moved into more high-elevation locations (16% vs. 1%) compared to where they were found 14 years ago. We also found frogs at high elevation on different substrates and closer to the forest floor than frogs at lower elevations-perhaps in response to air temperatures which tended to be warmer close to the forest floor. We observed that blood glucose and triglycerides increase in frogs with elevation. An increase in glucose is likely an acclimation response to cold temperatures while triglycerides may also help frogs cope with the energetic demands of suboptimal temperatures. Finally, we found that female coqui have higher plasma osmolality, reactive oxygen metabolites (dROMs), free glycerol, and triglycerides than males. Our study suggests coqui behavior and physiology in Hawai'i may be influenced by elevation in ways that allow them to cope with lower temperatures and invade higher elevations.

Safe and effective delivery of supplemental iron to healthy adults: a two-phase, randomized, double-blind trial - the safe iron study.

Introduction: The safety of novel forms of iron in healthy, iron-replete adults as might occur if used in population-based iron supplementation programs was examined. We tested the hypotheses that supplementation with nanoparticulate iron hydroxide adipate tartrate (IHAT), an iron-enriched Aspergillus oryzae product (ASP), or ferrous sulphate heptahydrate (FS) are safe as indicated by erythrocyte susceptibility to malarial infection, bacterial proliferation, and gut inflammation. Responses to FS administered daily or weekly, and with or without other micronutrients were compared. Methods: Two phases of randomized, double-blinded trials were conducted in Boston, MA. Phase I randomized 160 volunteers to six treatments: placebo, IHAT, ASP, FS, and FS plus a micronutrient powder (MNP) administrated daily at 60 mg Fe/day; and FS administered as a single weekly dose of 420 mg Fe. Phase II randomized 86 volunteers to IHAT, ASP, or FS administered at 120 mg Fe/day. Completing these phases were 151 and 77 participants, respectively. The study was powered to detect effects on primary endpoints: susceptibility of participant erythrocytes to infection by Plasmodium falciparum, the proliferation potential of selected pathogenic bacteria in sera, and markers of gut inflammation. Secondary endpoints for which the study was not powered included indicators of iron status and gastrointestinal symptoms. Results: Supplementation with any form of iron did not affect any primary endpoint. In Phase I, the frequency of gastrointestinal symptoms associated with FS was unaffected by dosing with MNP or weekly administration; but participants taking IHAT more frequently reported abdominal pain (27%, p < 0.008) and nausea (4%, p = 0.009) than those taking FS, while those taking ASP more frequently reported nausea (8%, p = 0.009). Surprisingly, only 9% of participants taking IHAT at 120 mg Fe/day (Phase II) reported abdominal pain and no other group reported that symptom. Discussion: With respect to the primary endpoints, few differences were found when comparing these forms of iron, indicating that 28 days of 60 or 120 mg/day of IHAT, ASP, or FS may be safe for healthy, iron-replete adults. With respect to other endpoints, subjects receiving IHAT more frequently reported abdominal pain and nausea, suggesting the need for further study. Clinical Trial Registration: ClinicalTrials.gov, NCT03212677; registered: 11 July 2017.

The role of social cohesion in explaining rural/urban differences in healthcare access and health status among older adults in the mid-Atlantic United States.

Social cohesion can influence health. It is higher among rural versus urban residents, but the burden of chronic disease is higher in rural communities. We examined the role of social cohesion in explaining rural/urban differences in healthcare access and health status. Rural (n = 1080) and urban (n = 1846) adults (ages 50+) from seven mid-Atlantic U.S. states completed an online, cross-sectional survey on social cohesion and health. We conducted bivariate and multivariable analyses to evaluate the relationships of rurality and social cohesion with healthcare access and health status. Rural participants had higher social cohesion scores than did urban participants (rural: mean = 61.7, standard error[SE] = 0.40; urban: mean = 60.6, SE = 0.35; adjusted beta = 1.45, SE = 0.54, p < .01). Higher social cohesion was associated with greater healthcare access: last-year check-up: adjusted odds ratio[aOR] = 1.25, 95% confidence interval[CI] = 1.17-1.33; having a personal provider: aOR = 1.11, 95% CI = 1.03-1.18; and being up-to-date with CRC screening: aOR = 1.17, 95% CI = 1.10-1.25. In addition, higher social cohesion was associated with improved health status: higher mental health scores (adjusted beta = 1.03, SE = 0.15, p < .001) and lower body mass index (BMI; beta = -0.26, SE = 0.10, p = .01). Compared to urban participants, rural participants were less likely to have a personal provider, had lower physical and mental health scores, and had higher BMI. Paradoxically, rural residents had higher social cohesion but generally poorer health outcomes than did urban residents, even though higher social cohesion is associated with better health. These findings have implications for research and policy to promote social cohesion and health, particularly for health promotion interventions to reduce disparities experienced by rural residents.

Invasive frogs show persistent physiological differences to elevation and acclimate to colder temperatures.

The coqui frog (Eleutherodactylus coqui) was introduced to the island of Hawai'i in the 1980s and has spread across much of the island. Concern remains that this frog will continue to expand its range and invade higher elevation habitats where much of the island's endemic species are found. We determined whether coqui thermal tolerance and physiology change along Hawai'i's elevational gradients. We measured physiological responses using a short-term experiment to determine baseline tolerance and physiology by elevation, and a long-term experiment to determine the coqui's ability to acclimate to different temperatures. We collected frogs from low, medium, and high elevations. After both the short and long-term experiments, we measured critical thermal minimum (CTmin), blood glucose, oxidative stress, and corticosterone levels. CTmin was lower in high elevation frogs than low elevation frogs after the short acclimation experiment, signifying that they acclimate to local conditions. After the extended acclimation, CTmin was lower in frogs acclimated to cold temperatures compared to warm-acclimated frogs and no longer varied by elevation. Blood glucose levels were positively correlated with elevation even after the extended acclimation, suggesting glucose may also be related to lower temperatures. Oxidative stress was higher in females than males, and corticosterone was not significantly related to any predictor variables. The extended acclimation experiment showed that coquis can adjust their thermal tolerance to different temperatures over a 3-week period, suggesting the expansion of coqui into higher elevation habitats may still be possible, and they may not be as restricted by cold temperatures as previously thought.