Examining the Impact of the COVID-19 Pandemic on Burnout and Stress Among U.S. Nurses.

Background: The COVID-19 pandemic has amplified long-standing issues of burnout and stress among the U.S. nursing workforce, renewing concerns of projected staffing shortages. Understanding how these issues affect nurses' intent to leave the profession is critical to accurate workforce modeling. Purpose: To identify the personal and professional characteristics of nurses experiencing heightened workplace burnout and stress. Methods: We used a subset of data from the 2022 National Nursing Workforce Survey for analysis. Binary logistic regression models and natural language processing were used to determine the significance of observed trends. Results: Data from a total of 29,472 registered nurses (including advanced practice registered nurses) and 24,061 licensed practical nurses/licensed vocational nurses across 45 states were included in this analysis. More than half of the sample (62%) reported an increase in their workload during the COVID-19 pandemic. Similarly high proportions reported feeling emotionally drained (50.8%), used up (56.4%), fatigued (49.7%), burned out (45.1%), or at the end of their rope (29.4%) "a few times a week" or "every day." These issues were most pronounced among nurses with 10 or fewer years of experience, driving an overall 3.3% decline in the U.S. nursing workforce during the past 2 years. Conclusion: High workloads and unprecedented levels of burnout during the COVID-19 pandemic have stressed the U.S. nursing workforce, particularly younger, less experienced RNs. These factors have already resulted in high levels of turnover with the potential for further declines. Coupled with disruptions to prelicensure nursing education and comparable declines among nursing support staff, this report calls for significant policy interventions to foster a more resilient and safe U.S. nursing workforce moving forward.

Assessing the Impact of the COVID-19 Pandemic on Nursing Education: A National Study of Prelicensure RN Programs.

Background: The COVID-19 pandemic has had a profound impact on prelicensure nursing education, leading to widespread disruptions that may have implications for nursing students' learning and engagement outcomes. Understanding how the rapid shift to online and simulation-based teaching methods has affected new graduates' clinical preparedness is critical to ensure patient safety moving forward. Purpose: To assess the impact of institutional, academic, and demographic characteristics on prelicensure nursing students' academic, initial postgraduation, and early career outcomes during the COVID-19 pandemic. Methods: We conducted a mixed-methods longitudinal study focused on prelicensure registered nurse (RN) students entering the core of their didactic and clinical nursing coursework during the pandemic. This study uses a combination of real-time student and faculty self-report data, including externally validated instruments, within and end-of-program standardized test scores, and focus group findings. Various statistical methods, ranging from simpler descriptive and non-parametric methods to Generalized Estimating Equation (GEE) models and detailed textual analysis, are applied to assess student, faculty, and institution-level data. Results: The final sample includes more than 1,100 student and faculty participants affiliated with 51 prelicensure RN programs located across 27 states. Leveraging more than 4,000 course observations collected from fall 2020 to spring 2022 and supplemented by the rich personal narratives of over 60 focus group participants, this study illuminates the breadth, scale, and ever-evolving nature of prelicensure RN programs' efforts to maintain the continuity of nursing students' education during the public health crisis. In doing so, it captures the many ways in which nursing administrators, faculty, and students sought to address the unparalleled challenges they confronted on a day-to-day basis. In particular, the findings provide critical insights into the efficacy of the changes nursing programs made to their course delivery formats to adjust to the confluence of rapidly evolving federal, state, and private restrictions to stem the spread of COVID-19. Conclusion: This study stands as the most comprehensive assessment of prelicensure nursing education in the United States since the onset of COVID-19. It extends knowledge by linking potential deficiencies in students' didactic and clinical education during the pandemic and their early career preparedness, clinical competence, and the patient safety implications therein.

Defining Predictors of Weight Loss Response to Lorcaserin.

CONTEXT: Individual responses to weight loss (WL) medications vary widely and prediction of response remains elusive. OBJECTIVE: We investigated biomarkers associated with use of lorcaserin (LOR), a 5HT2cR agonist that targets proopiomelanocortin (POMC) neurons that regulate energy and glucose homeostasis, to identify predictors of clinical efficacy. METHODS: Thirty individuals with obesity were treated with 7 days of placebo and LOR in a randomized crossover study. Nineteen participants continued on LOR for 6 months. Cerebrospinal fluid (CSF) POMC peptide measurements were used to identify potential biomarkers that predict WL. Insulin, leptin, and food intake during a meal were also studied. RESULTS: LOR induced a significant decrease in CSF levels of the POMC prohormone and an increase in its processed peptide ß-endorphin after 7 days; ß-endorphin/POMC increased by 30% (P < .001). This was accompanied by a substantial decrease in insulin, glucose, and homeostasis model assessment of insulin resistance before WL. Changes in CSF POMC peptides persisted after WL (6.9%) at 6 months that were distinct from prior reports after diet alone. Changes in POMC, food intake, or other hormones did not predict WL. However, baseline CSF POMC correlated negatively with WL (P = .07) and a cutoff level of CSF POMC was identified that predicted more than 10% WL. CONCLUSION: Our results provide evidence that LOR affects the brain melanocortin system in humans and that effectiveness is increased in individuals with lower melanocortin activity. Furthermore, early changes in CSF POMC parallel WL-independent improvements in glycemic indexes. Thus, assessment of melanocortin activity could provide a way to personalize pharmacotherapy of obesity with 5HT2cR agonists.

Resistance and Tolerance Screening of Spring Wheat Cultivars to Cereal Cyst Nematode (Heterodera avenae) in Southeastern Idaho.

Increased populations of Heterodera avenae in southeastern Idaho are associated with increased planting of susceptible cereal cultivars and lack of crop rotation. Identifying high-yield, resistant spring wheat cultivars with tolerance requires testing new genotypes and susceptibility assessments of marketed cultivars. We conducted two experiments to determine whether cultivars with putative resistance could maintain acceptable yield in the presence of H. avenae. We also evaluated the tolerance response in relation to previously tested cultivars. Seven spring wheat cultivars were planted in two irrigated commercial fields that were naturally infested with high populations of H. avenae. Measures of resistance, tolerance, and grain yield were assessed in aldicarb-treated versus nontreated plots. In aldicarb-treated plots in both years, grain yield of the susceptible cultivars Snow Crest, WestBred 936, WB9411, Patwin-515, and WB9668 was significantly increased. The expected yield increase with aldicarb was limited for the moderately susceptible Expresso due to water stress. 'WB-Rockland', carrying the Cre5 resistance gene, maintained its standard yield, while none of the other cultivars in the experiment showed resistance or tolerance. Our results indicated that aldicarb improves wheat grain yield in irrigated crop production systems, and although removed from the market, it is effective and has utility for research. The results also support the hypothesis that high yield susceptible cultivars can mask the effect of H. avenae on grain yield when managed appropriately.

Origin and Phylogeography of Chinese Cereal Cyst Nematode Heterodera avenae Revealed by Mitochondrial COI Sequences.

Heterodera avenae, a globally distributed plant-parasitic nematode, is one of the most significant pests on cereal crops. In China, it is widely distributed in cereal-growing areas of 16 provinces and causes serious yield losses. In the present study, a total of 98 populations of H. avenae were collected from major wheat-growing regions in China and six other countries. The mitochondrial COI genes were amplified and analyzed. Forty-one mitochondrial COI haplotypes were identified, suggesting a high genetic diversity and endemism level of H. avenae in China. Phylogenetic analysis showed that H. avenae populations in China were divided into four clades. Significant evolutionary and genetic differences were found between Chinese (except Hubei) and foreign populations. Hap1, the most widely distributed haplotype, was considered to be a separate evolutionary origin in China. The gene flow of H. avenae from the northwestern region to the north China region and Huang-Huai-Hai region was significant, so as the direction between north China and Huang-Huai-Hai region. We speculate that water flowing from the Yellow River and mechanical harvesters promoted gene exchange among these groups. A distance-based redundancy analysis showed that genetic distances observed among H. avenae populations were explained foremost not only by geographic distance but also by temperature and precipitation. This study provides theoretical support for the origin and spread of H. avenae populations in China and elsewhere in the world.

Prophylactic endovascular internal iliac balloon placement during cesarean hysterectomy for placenta accreta spectrum.

BACKGROUND: The utility of prophylactic endovascular internal iliac balloon placement in the surgical management of placenta accreta spectrum is debated. OBJECTIVE: In this study, we review outcomes of surgical management of placenta accreta spectrum with and without prophylactic endovascular internal iliac balloon catheter use at a single institution. STUDY DESIGN: This is a retrospective cohort study of consecutive viable singleton pregnancies with a confirmed pathologic diagnosis of placenta accreta spectrum undergoing scheduled delivery from October 2018 through November 2020. In the T1 period (October 2018-August 2019), prophylactic endovascular internal iliac balloon catheters were placed in the operating room before the start of surgery. Balloons were inflated after neonatal delivery and deflated after hysterectomy completion. In the T2 period (September 2019-November 2020), endovascular catheters were not used. In both time periods, all surgeries were performed by a dedicated multidisciplinary team using a standardized surgical approach. The outcomes compared included the estimated blood loss, anesthesia duration, operating room time, surgical duration, and a composite of surgical complications. Comparisons were made using the Wilcoxon rank-sum test and the Fisher exact test. RESULTS: A total of 30 patients were included in the study (T1=10; T2=20). The proportion of patients with placenta increta or percreta was 80% in both groups, as defined by surgical pathology. The median estimated blood loss was 875 mL in T1 and 1000 mL in T2 (P=.84). The proportion of patients requiring any packed red blood cell transfusion was 60% in T1 and 40% in T2 (P=.44). The proportion of patients requiring >4 units of packed red blood cells was 20% in T1 and 5% in T2 (P=.25). Surgical complications were observed in 1 patient in each group. Median operative anesthesia duration was 497 minutes in T1 and 296 minutes in T2 (P<.001). Median duration of operating room time was 498 minutes in T1 and 205 minutes in T2 (P<.001). Median surgical duration was 227 minutes in T1 and 182 minutes in T2 (P<.05). The median duration of time for prophylactic balloon catheter placement was 74 minutes (range, 46-109 minutes). The median postoperative length of stay was similar in both groups (6 days in T1 and 5.5 days in T2; P=.36). CONCLUSION: The use of prophylactic endovascular internal iliac balloon catheters was not associated with decreased blood loss, packed red blood cell transfusion, or surgical complications. Catheter use was associated with increased duration of anesthesia, operating room time, and surgical time.

Intrathecal 2-Chloroprocaine 3% Versus Hyperbaric Bupivacaine 0.75% for Cervical Cerclage: A Double-Blind Randomized Controlled Trial.

BACKGROUND: Cervical cerclage is a short ambulatory procedure. For spinal anesthesia, local anesthetic agents with rapid postoperative resolution are desired. We hypothesized that in combination with fentanyl, intrathecal 2-chloroprocaine would produce earlier resolution of motor block, resulting in shorter time to meet recovery room discharge criteria than hyperbaric bupivacaine. METHODS: Women undergoing cervical cerclage with spinal anesthesia were randomized to receive intrathecal 2-chloroprocaine 3% 50 mg or hyperbaric bupivacaine 0.75% 9 mg, both with fentanyl 15 µg. Doses were empirically selected. The onset and resolution of sensory and motor blockade and time to achieve recovery room discharge criteria were monitored. On postoperative day 1, patients rated their satisfaction with the anesthetic and reported on transient neurologic symptoms (TNS), back pain, or headache. The primary outcome was time from spinal injection to motor block resolution. The main secondary outcomes included times from spinal injection to (i) T12 dermatomal level, (ii) sensory block resolution, and (iii) ability to ambulate and void. RESULTS: Forty-three women were enrolled and randomized to either the chloroprocaine (N = 23) or bupivacaine group (N = 20). The mean (standard deviation [SD]) duration of surgery was 35.3 (11.4) minutes. There was no difference between groups for time to motor block resolution-the median [interquartile range] time for the bupivacaine group (N = 17) was 112 [97-143] minutes versus 109 [88-148] minutes in the chloroprocaine group (N = 22), P = .66, but there was a significant difference in median time to sensory block resolution: 143 [116-162] minutes in the chloroprocaine group versus 198 [152-263] minutes in the bupivacaine group, P = .002. The recovery room discharge criteria, which at our institution include the ability to ambulate unassisted and void urine, were met 76 (95% CI, 33-145) minutes earlier in the chloroprocaine group, P < .0005. One complete block failure occurred with hyperbaric bupivacaine and 2 subjects in each group received treatment for intraoperative discomfort. No patients reported TNS. CONCLUSIONS: Intrathecal 2-chloropocaine 3% provided similarly effective surgical anesthesia for cerclage placement. Although no difference in time to motor block resolution between groups was observed, the time to sensory block resolution and time to meet recovery room discharge criteria were both significantly shorter among patients who received chloroprocaine than patients who received bupivacaine. Future studies are needed to identify and compare equipotent doses of chloroprocaine and bupivacaine to confirm the superiority of chloroprocaine for this ambulatory obstetric procedure.

Randomized trial of transversus abdominis plane block with liposomal bupivacaine after cesarean delivery with or without intrathecal morphine.

STUDY OBJECTIVE: To investigate efficacy and safety of liposomal bupivacaine (LB) transversus abdominis plane (TAP) block with or without intrathecal morphine (ITM) compared with ITM alone for postsurgical analgesia after cesarean delivery (CD). DESIGN: Multicenter, open-label, randomized trial (NCT03853694). SETTING: Operating room. PATIENTS: Women with term pregnancy of 37 to 42 weeks scheduled for elective CD under spinal anesthesia. INTERVENTION: Patients were randomized 1:1:1 to LB 266 mg TAP block alone (LB group), ITM 50 µg followed by LB 266 mg TAP block (LB + ITM group), or ITM 150 µg alone (ITM group). All groups received the same postsurgical multimodal analgesic regimen. MEASUREMENTS: The LB and LB + ITM groups were compared with the ITM group for all efficacy outcomes. Postsurgical opioid consumption in morphine milligram equivalents (MMEs) through 72 h was compared by assessing noninferiority before testing superiority. Postsurgical pruritus severity was assessed on an 11-point numerical rating scale. MAIN RESULTS: Between March 4, 2019, and January 10, 2020, 153 patients (LB, n = 52; LB + ITM, n = 48; ITM, n = 53) were enrolled. Baseline characteristics were comparable across groups. The LB group had statistically noninferior postsurgical opioid consumption through 72 h compared with the ITM group (least squares mean [LSM], 19.2 vs 16.4 MMEs; LSM treatment ratio, 1.17 [95% confidence interval (CI), 0.74-1.86]; noninferiority P < 0.0034) as did the LB + ITM group (LSM, 14.6 vs 16.4 MMEs; LSM treatment ratio, 0.89 [95% CI, 0.55-1.44]; noninferiority P < 0.0001). The LB and LB + ITM groups had significantly reduced pruritus severity scores through 12, 24, 48, and 72 h compared with the ITM group (P ≤ 0.0121). Adverse events occurred in 58%, 85%, and 81% of the LB, LB + ITM, and ITM groups, respectively. CONCLUSIONS: LB TAP block with or without ITM resulted in statistically noninferior postsurgical opioid consumption through 72 h, reduced pruritus, and favorable safety compared with ITM in women undergoing CD.

Root-Lesion Nematodes Affecting Dryland Cereals in the Semiarid Pacific Northwest U.S.A.

Root-lesion nematodes (Pratylenchus spp.) are parasites that invade and deteriorate roots, thereby reducing the efficiency of water and nutrient uptake. Pratylenchus neglectus and P. thornei are the two species that are most prevalent and cause reduced yields of rainfed wheat and barley in semiarid regions of the Pacific Northwest. They are particularly damaging where wheat and barley are produced without irrigation in areas receiving less than 450 mm (18 in.) of precipitation annually. This review is focused on the biology and management of P. neglectus and P. thornei in semiarid rainfed agriculture. Characteristics of climates, soils, and crop production systems are described as a preface to constraints placed upon management options. Discussions include the economic importance, host ranges, and protocols for sampling and species identification. Discussion of disease management options include crop rotation, genetic resistance and tolerance, planting date, trap and biofumigant crops, crop nutrition, chemical and biological nematicides, and tillage. Predictions for rainfed agriculture in a period of changing climate are presented, as are suggestions for important areas of research including crop genetics, nematode testing, and communication of results, Pratylenchus biology, mechanisms of resistance, the phytobiome, and closing the "yield gap" between actual and attainable yields.

Pregnancy-specific Adaptations in Leptin and Melanocortin Neuropeptides in Early Human Gestation.

INTRODUCTION: Pregnancy is characterized by increased appetitive drive beginning early in gestation, yet the central mechanisms underlying this adaptation are poorly understood in humans. To elucidate central mechanisms underlying appetite regulation in early pregnancy, we examine plasma and cerebrospinal fluid (CSF) leptin and Agouti-related peptide (AgRP) as well as CSF proopiomelanocortin (POMC) as surrogates for brain melanocortin activity. METHODS: Plasma leptin, soluble leptin receptor, AgRP, and CSF leptin, POMC, and AgRP were collected from pregnant women before cerclage placement (16.6 ±â€…1.1 weeks; N = 24), scheduled cesarean section (39.2 ±â€…0.2 weeks; N = 24), and from nonpregnant controls (N = 24), matched for age and body mass index. RESULTS: Plasma leptin was 1.5 times higher in pregnancy vs controls (P = 0.01), but CSF leptin did not differ. CSF/plasma leptin percentage was lower in early pregnancy vs controls (0.8 ±â€…0.1 vs 1.7 ±â€…0.2; P < 0.0001) and remained unchanged at term (0.9 ±â€…0.1), supporting a decrease in leptin transport into CSF in pregnancy. Plasma AgRP, a peripheral biomarker of the orexigenic hypothalamic neuropeptide, was higher in early pregnancy vs controls (95.0 ±â€…7.8 vs 67.5 ±â€…5.3; P = 0.005). In early gestation, CSF AgRP did not differ from controls, but CSF POMC was 25% lower (P = 0.006). In contrast, at term, CSF AgRP was 42% higher vs controls (P = 0.0001), but CSF POMC no longer differed. Overall, the CSF AgRP/POMC ratio was 1.5-fold higher in early pregnancy vs controls, reflecting a decrease in melanocortin tone favoring appetitive drive. CONCLUSIONS: Pregnancy-specific adaptions in the central regulation of energy balance occur early in human gestation and are consistent with decreased leptin transport into brain and resistance to the effects of leptin on target melanocortin neuropeptides.

Economic Loss from Rhizoctonia Bare Patch in Rainfed Winter Wheat and Spring Barley in Oregon.

Economic loss from Rhizoctonia bare patch, caused by Rhizoctonia solani AG-8, was estimated in two 50-ha fields on a single farm. A winter wheat crop was managed as a conventionally cultivated 2-year wheat/fallow rotation and a spring barley crop was managed as a no-till annual crop. Aerial photographs revealed that the patch-affected area was nearly double in barley (17%) compared with wheat (9%). Yield inside patches was reduced by 73 and 68% for wheat and barley, respectively. Grain produced on each field was reduced more for winter wheat (21.6 metric tons [t], valued at US$5,080) than for spring barley (16.8 t, valued at US$2,784). More precise estimates of economic damage and more robust management practices for Rhizoctonia bare patch must be developed.

Check the Blood Pressure!: An Educational Tool for Anesthesiology Trainees Converting Epidural Labor Analgesia to Cesarean Delivery Anesthesia.

Recognition and treatment of maternal hypotension during epidural anesthesia administration for intrapartum cesarean delivery preserves maternal-fetal perfusion. A case that required quality assurance review uncovered lapses in maternal hemodynamic monitoring during the transition to intrapartum cesarean delivery anesthesia. To address this, a practice outline was designed for trainee's education describing intrapartum epidural dosing for cesarean delivery and adequate blood pressure monitoring. The time-lapse between epidural dosing and subsequent blood pressure was evaluated before and after the introduction of our educational tool. The time-lapse between blood pressure measures decreased to <10 minutes (10.78-13.92 vs 8.8-9.76 minutes).

Fusarium Crown Rot of Winter Wheat Influenced by Resource Competition Near a Tree Windbreak.

Fusarium crown rot becomes most severe when wheat is stressed for water near the time of anthesis. This research examined the potential to study crown rot in the gradient of resource competition near a tree windbreak. Winter wheat was planted for 2 years into a field infested by Fusarium pseudograminearum and bordered by 17-m-high Austrian pines. Crown rot, plant growth and yield, and soil water content were evaluated at six distances (5 to 46 m) perpendicular to the tree line in strip plots inoculated or not inoculated with the pathogen. Crown rot was minor (<5% whiteheads) in noninoculated strips and greater in inoculated strips (26 to 35%) in a 21-m zone from 9 to 30 m from the tree line (0.5-1.8 times the tree height; 0.5-1.8H). At 46 m (2.7H), crown rot was similar in noninoculated and inoculated strips (2 to 5% whiteheads). Whiteheads and culm browning were roughly the reverse of soil water depletion by tree roots. Grain yield at 23 m compared with 46 m was reduced by 33 to 35% in noninoculated plots and by 43 to 49% in inoculated plots. It is possible to study associations between water stress and Fusarium crown rot in the zone of resource competition near windbreaks.

Mechanized Method to Inoculate Field Soil to Evaluate Fusarium Crown Rot of Wheat.

Assessments of Fusarium crown rot are often made in field trials inoculated with Fusarium pseudograminearum or F. culmorum. Factors affecting the efficiency of two inoculation procedures were evaluated. Pulverized Fusarium-colonized wheat plus oat grain inoculum mixed with the wheat seed caused more seedling damping-off compared with equal rates of colonized whole millet seeds placed 2 cm above the wheat seed. Both inoculation systems increased the incidence and severity of crown rot. The efficiency of F. pseudograminearum-colonized millet seed inoculum was not reduced when wheat seed was treated with difenoconazole. Crown rot in inoculated plots became greater when starter fertilizer was applied with or below the wheat seed and when soil below the wheat seed was disrupted by a seed drill with an opener that creates a groove or trench directly below the seed. No biologically important associations were detected between whiteheads and other measures of crown rot, grain yield, or grain test weight. The millet seed inoculation system was the most efficient for wheat production systems in the semiarid U.S. Pacific Northwest.

Fusarium Crown Rot Whitehead Symptom as Influenced by Wheat Crop Management and Sampling Date.

Symptoms of Fusarium crown rot of wheat include premature death of inflorescens (whiteheads), lesions on subcrown internodes, and rotting of crown tissue and lower stem internodes. Each symptom type is influenced by a different set of environmental conditions. Whiteheads are the easiest symptom to quantify and are frequently reported in the Pacific Northwest U.S.A. The objective of this research was to examine factors associated with whitehead expression and relationships with wheat yield and test weight. Incidence of whiteheads differed for inoculations with different isolates of F. pseudograminearum and F. culmorum, and over years due to weather factors. Whiteheads became less as planting dates for winter wheat were delayed until after September, and incidence was increased with increasing nitrogen application rate. Dates of initial and greatest expression of whiteheads differed among cultivars, which was associated in part with the cultivar heading date. Whiteheads were not correlated with subcrown internode lesions or browning of crown tissue. Whiteheads were also not correlated with grain test weight. Whiteheads were sometimes negatively associated with grain yield, but that relationship was variable and could not be considered a reliable, recurrent, or accurate measure of crown rot severity. These results indicate the need for caution in reporting whiteheads as a sole indicator of cultivar susceptibility to Fusarium crown rot.