The Agile Clinical Nurse Specialist: Navigating the Challenges of the COVID-19 Pandemic.

PURPOSE/OBJECTIVES: This article describes the contributions of the clinical nurse specialist in navigating the challenges of the COVID-19 pandemic to ensure patient and staff safety while providing science-based quality of care. DESCRIPTION: The group of clinical nurse specialists using advanced practice knowledge and skills within the 3 spheres of impact (ie, patient, organization, and nurse) developed and implemented strategies that supported frontline clinicians and met emerging organizational needs during the COVID-19 pandemic. OUTCOMES: The clinical nurse specialist's agility was imperative in navigating the challenges of the pandemic to ensure the safety of patients and staff by providing strategies and standardization to workflow processes across the organization. CONCLUSION: The group's combined clinical expertise and support of frontline nurses positioned the clinical nurse specialist to rapidly escalate the bedside nurse's concerns and provide recommendations to improve workflow while maintaining patient and staff safety.

Long-term, process-based, continuous simulations for a small, nested rangeland watershed near Tombstone, AZ (USA): Extending model validity to include soil redistribution.

Soil or sediment redistribution prediction along hillslopes and within small watersheds is considered to be a great challenge for the application of watershed erosion models in predicting the impact of soil and water conservation measures as well as for the redistribution of pollution such as radioactive fallout. In this study, long-term soil loss and deposition were estimated for two nested semi-arid watersheds within the Walnut Gulch Experimental Watershed in Southeastern Arizona using the process-based Geo-spatial interface of WEPP (GeoWEPP). While soil parameters were previously parametrized and validated through watershed outlet runoff and sediment yields, the channel parameters were adjusted and validated based on reference values of soil redistribution generated from fallout radionuclide 137Cs samples within the watersheds. Two methods were applied for the soil redistribution analysis by comparing observed and simulated soil loss/deposition rates (a) at single pixels and reference values at the specific location of each 137Cs sample site; and (b) for average values of a 5 m radius around each 137Cs sample site to compensate for measurement and model uncertainties. Surprisingly, soil redistribution predictions improved as topographic data resolution increased from 5 m to 3 m and were best at 1 m without changing key model parameters that were originally derived at the watershed scale.

Enhancing Mindfulness and Well-Being in Higher Education.

This article outlines the steps taken to establish the University of Wisconsin-Superior's Pruitt Center for Mindfulness and Well-Being. Major historical components include: gaining momentum; securing funding; developing mission and vision statements; launching the Pruitt Center; and recounting the services, programs, and impacts achieved to date. Through outlining experiences and lessons learned, others in higher education looking to enhance the well-being of their campus communities could benefit, regardless of whether creating a center is their goal. The process and rationale for creating and adopting the PERMANENT Model of Well-Being is also provided. Comparisons are made regarding the similarities and differences between the PERMANENT Model and two existing models: the PERMA Model and the Universidad Tecmilenio Well-being in Happiness Ecosystem. Also depicted is the intention concerning: 1) describing each domain of the PERMANENT Model of Well-Being, including Present Moment Awareness, the model's foundation; 2) the meaning behind the PERMANENT acronym, inspiring the notion of long-lasting well-being; 3) including the greater community; and 4) the model's process of learn, experience, reflect, and repeat, a reminder that all learning takes effort and practice. This process is supported by current mindfulness and well-being research, specifically as it relates to higher education.

How Long Before a Second Defoliation of Actively Growing Grass Plants in the Desert Grassland?

In the Desert Grassland, second and subsequent defoliations on perennial grasses during the active growing season can have substantial impacts on grass recovery and reproduction following herbivory. Land managers implement tactics to avoid multiple defoliations on plants by way of rotational grazing, reduced stocking rates, and/or reduced time spent within a given pasture. We explored frequency and rate of defoliation by cattle on perennial bunchgrasses within an 11-day grazing period in three pastures including distance to water (300 and 600 m) and plant height to determine their influence on animal diet selection. Results indicate that 32% of all marked plants were defoliated by cattle and only 5% of defoliated plants were defoliated a second time by day 10 of the grazing period. Defoliation patterns in the studied pastures did not differ between two distances from water, or in relation to plant height. However, at the second defoliation cattle grazed plants that were shorter than at the first defoliation suggesting a selection for high quality re-growth over larger forage on offer. The results of this study show that a 10-day grazing period during the growing season of the Desert Grassland is an effective strategy to avoid second defoliations on individual perennial grass plants while maintaining sufficient forage for use during the dormant winter grazing season.

Native lagomorphs suppress grass establishment in a shrub-encroached, semiarid grassland.

Shrub encroachment into arid grasslands has been associated with reduced grass abundance, increased soil erosion, and local declines in biodiversity. Livestock overgrazing and the associated reduction of fine fuels has been a primary driver of shrub encroachment in the southwestern United States, but shrublands continue to persist despite livestock removal and grassland restoration efforts. We hypothesized that an herbivory feedback from native mammals may contribute to continued suppression of grasses after the removal of livestock. Our herbivore exclusion experiment in southeastern Arizona included five treatment levels and allowed access to native mammals based on their relative body size, separating the effects of rodents, lagomorphs, and mule deer. We included two control treatments and replicated each treatment 10 times (n = 50). We introduced uniform divisions of lawn sod (Cynodon dactylon) into each exclosure for 24-hr periods prior to (n = 2) and following (n = 2) the monsoon rains and used motion-activated cameras to document herbivore visitations. In the pre-monsoon trials, treatments that allowed lagomorph access had less sod biomass relative to other treatments (p < 0.001), averaging 44% (SD 36%) and 29% (SD 45%) remaining biomass after the 24-hr trial periods. Following the onset of monsoons, differences in remaining biomass among treatments disappeared. Desert cottontails (Sylvilagus audubonii) were detected more frequently than any of the other 11 herbivore species present at the site, accounting for 83% of detections during the pre-monsoon trials. Significantly more (p < 0.001) desert cottontails were detected during the pre-monsoon trials (2,077) compared to the post-monsoon trials (174), which coincided with biomass removal from lagomorph accessible treatments. We conclude that desert cottontails are significant consumers of herbaceous vegetation in shrub-encroached arid grasslands and they, along with other native herbivores, may act as a biotic feedback contributing to the competitive advantage and persistence of shrubs.

Considerations for Achieving Cross-Platform Point Cloud Data Fusion across Different Dryland Ecosystem Structural States.

Remotely sensing recent growth, herbivory, or disturbance of herbaceous and woody vegetation in dryland ecosystems requires high spatial resolution and multi-temporal depth. Three dimensional (3D) remote sensing technologies like lidar, and techniques like structure from motion (SfM) photogrammetry, each have strengths and weaknesses at detecting vegetation volume and extent, given the instrument's ground sample distance and ease of acquisition. Yet, a combination of platforms and techniques might provide solutions that overcome the weakness of a single platform. To explore the potential for combining platforms, we compared detection bias amongst two 3D remote sensing techniques (lidar and SfM) using three different platforms [ground-based, small unmanned aerial systems (sUAS), and manned aircraft]. We found aerial lidar to be more accurate for characterizing the bare earth (ground) in dense herbaceous vegetation than either terrestrial lidar or aerial SfM photogrammetry. Conversely, the manned aerial lidar did not detect grass and fine woody vegetation while the terrestrial lidar and high resolution near-distance (ground and sUAS) SfM photogrammetry detected these and were accurate. UAS SfM photogrammetry at lower spatial resolution under-estimated maximum heights in grass and shrubs. UAS and handheld SfM photogrammetry in near-distance high resolution collections had similar accuracy to terrestrial lidar for vegetation, but difficulty at measuring bare earth elevation beneath dense herbaceous cover. Combining point cloud data and derivatives (i.e., meshes and rasters) from two or more platforms allowed for more accurate measurement of herbaceous and woody vegetation (height and canopy cover) than any single technique alone. Availability and costs of manned aircraft lidar collection preclude high frequency repeatability but this is less limiting for terrestrial lidar, sUAS and handheld SfM. The post-processing of SfM photogrammetry data became the limiting factor at larger spatial scale and temporal repetition. Despite the utility of sUAS and handheld SfM for monitoring vegetation phenology and structure, their spatial extents are small relative to manned aircraft.

Maternal perspectives on postpartum return to the workplace.

OBJECTIVE: To describe maternal perceptions about postpartum return to the workplace. DESIGN AND SETTING: The research framework was McCubbin and McCubbin's Resiliency Model of Family Stress, Adjustment, and Adaptation. Employed, postpartum women, who resided in six different states, were recruited from day care and primary care settings to participate in this descriptive study. PARTICIPANTS: Seventy-four employed, married women, who returned to the workplace within one year after childbirth. MAIN OUTCOME MEASURE: As part of a larger study, perceptions about combining multiple roles after return to the workplace are the focus for this report. RESULTS: Participants responded to open-ended questions about their return to the workplace during the first months after giving birth. Content analysis of those responses resulted in two major categories, Resiliency Challenges: Negative Aspects (role conflict/overload, family stress, family/child issues, finances, psychosocial issues) and Resiliency Building: Positive Aspects (social support, maternal role satisfaction, positive adaptation, career role satisfaction). CONCLUSIONS: The data support the premise that employed women view returning to the workforce as having more challenges than they expected because the experience was viewed as being mostly negative. Preparing for return to the workplace is an important, but neglected, topic that needs to be addressed and defined more clearly in the literature. Therefore, future research is needed to identify resources and interventions that will help women experience fewer challenges associated with postpartum employment.

Preventing pediatric obesity: assessment and management in the primary care setting.

PURPOSE: To review the literature on and discuss the role of the primary care provider in assessing and managing overweight children before they become obese. DATA SOURCES: Selected research, national guidelines and recommendations, and the professional experience of the authors. CONCLUSIONS: The focus of primary care involves early detection and family interventions that are designed for lifestyle modifications, specifically for improved nutrition and an increase in regular physical activity, to achieve optimal child health. Early identification and management of children who exceed a healthy weight for height, gender, and age will prevent the increasing incidence of pediatric obesity. Early prevention and management of pediatric overweight and obesity will also decrease the potential for associated medical and psychosocial problems. IMPLICATIONS FOR PRACTICE: Pediatric obesity has risen dramatically in the United States during the last two decades; it is a significant child health problem that is preventable and largely under-diagnosed and under-treated. It is essential to discuss prevention of obesity with parents at every well-child visit; treatment should be initiated when patterns of weight gain exceed established percentiles for increasing height for age and gender.

Durability of vaccinia immunization based on reaction at the rechallenge site.

The authors reviewed the immunization records of 621 patients who received vaccinia vaccination in our Occupational Medicine Clinic between July 26, 1994 and October 11, 2001 to evaluate the durability of the vaccine over time, as judged by the patients' local skin reactions following revaccination. Results of the study document a waning immunity to vaccinia immunization in the majority of re-vaccinees. Over 63.4 percent of those previously immunized in the study population were found to lack adequate immunity against vaccinia rechallenge based on their response to it. Of the remaining third, only 6.4 percent elicited an immune response to rechallenge. Overall, 75.5 percent of those receiving vaccinia vaccination in the clinic lacked adequate immunity. Given that this study involved a young, healthy, HIV-negative, pre-screened workforce, the actual projected immunity to vaccinia of the general population should have been significantly lower. Although the study data suggests the persistence of adequate immunogenicity of the vaccinia vaccine stockpile, over the past year an increased frequency (3.7 percent) of vaccine-associated cellulitis was noted, coinciding with the Centers for Disease Control (CDC) decision to allow vaccinia vaccine stockpile to be used after its expiration date of April 2000.

Patient-centered group diabetes care: a practice innovation.

The purpose of this project was to evaluate the efficacy of group diabetes care for an underserved population using a patient-centered approach with the inclusion of interactive diabetes self-management education. In place of the traditional office visit, patients attended three group visits. Improvements in diabetes knowledge and patient-perceived self-efficacy resulted.

Very-high-resolution time-lapse photography for plant and ecosystems research.

PREMISE OF THE STUDY: Traditional photography is a compromise between image detail and area covered. We report a new method for creating time-lapse sequences of very-high-resolution photographs to produce zoomable images that facilitate observation across a range of spatial and temporal scales. • METHODS AND RESULTS: A robotic camera mount and software were used to capture images of the growth and movement in Brassica rapa every 15 s in the laboratory. The resultant time-lapse sequence (http://timemachine.gigapan.org/wiki/Plant_Growth) captures growth detail such as circumnutation. A modified, solar-powered system was deployed at a remote field site in southern Arizona. Images were collected every 2 h over a 3-mo period to capture the response of vegetation to monsoon season rainfall (http://timemachine.gigapan.org/wiki/Arizona_Grasslands). • CONCLUSIONS: A technique for observing time sequences of both individual plant and ecosystem response at a range of spatial scales is available for use in the laboratory and in the field.

Clinical nurse specialists shaping policies and procedures via an evidence-based clinical practice council.

In the practice of nursing, organizations with progressive evidence-based practice programs implement structures and processes whereby nurses are engaged in the review of existing research and in the development of clinical practice documents to better align nursing practices with the best available scientific knowledge. At our academic hospital system, clinical nurse specialists (CNSs) took the lead to help transform a traditional nursing policy and procedure committee into a hospital-wide, staff-represented Clinical Practice Council (CPC) that ensures evidence-based nursing practices are reflected in the organization's nursing practice documents for the provision of patient care. Clinical nurse specialists function as mentors and cochairs who are dedicated to ensuring that nursing practice is supported by the latest evidence and committed to guiding staff nurses to continually move their practice forward. The success of the CPC is due to the leadership and commitment of the CNSs. This article describes the structure, process, and outcomes of an effective CPC where CNSs successfully engage frontline clinicians in promoting nursing care that is evidence based. Clinical nurse specialist leadership is increasingly made visible as CNSs effectively involve staff nurses in practice reforms to improve patient outcomes.

Primigravid and multigravid women: prenatal perspectives.

A paucity of prenatal data is available concerning prenatal experiences of primigravid women compared with those of multigravid women. Therefore, the objectives of this study were twofold: to compare prenatal personal (demographic and other descriptive elements, including self-esteem) and psychosocial variables (maternal-fetal attachment, marital satisfaction) and to describe perceived pregnancy experiences for both primigravid and multigravid women. Both quantitative and qualitative data were collected using a descriptive mixed-methods design. The data were part of a larger, longitudinal study focused on adjustment to parenthood in military and civilian couples. Married pregnant women who resided on the east and west coasts of the United States were recruited from prenatal care facilities. Participants included 50 pregnant primigravid and 50 multigravid married women recruited during the last trimester of a healthy, uncomplicated pregnancy. The main outcome measures included personal and psychosocial variables (demographics, self-esteem, maternal-fetal attachment, marital satisfaction) and perceived pregnancy experiences. Multigravid women had significantly lower levels of maternal-fetal attachment (p < .00) and marital satisfaction (p < .00) than did primigravid women during their third trimester of pregnancy. The pregnant women's responses clearly reveal that unique and distinct differences exist between the needs of primigravid women and those of multigravid women. Innovative prenatal educational interventions tailored to meet the distinct needs of primigravid and multigravid women are suggested.