Diverse perspectives on unit-level nurse staffing ratios in medical-surgical units: A Delphi policy analysis.

BACKGROUND: Appropriate staffing is essential to acute care delivery. Staffing ratio policy generates controversy. PURPOSE: This study examines perspectives on unit-level nurse-to-patient ratio policy in adult medical-surgical units. METHOD: Delphi methodology uses an invited diverse panel to analyze a policy's effects. Panelists completed iterative surveys about the impact they expect from unit-level ratio policy. FINDINGS: Panelists demonstrated moderate agreement that the proposed policy could increase staffing levels, decrease patient length of stay, and reduce nurse attrition. Other potential outcomes included reducing staffing in units above the minimum and increasing short-term costs. Panelists agreed that the policy could increase patient safety and nurse satisfaction and did not agree about the effect on long-term cost and innovation. Panelists also anticipated a mostly positive effect on patients and nurses. DISCUSSION: Policies that set unit-level nurse-to-patient ratios offer a potential strategy to improve medical-surgical staffing. Policy design should consider the range of expected outcomes.

Social Determinants of Health and Satisfaction With Sources of Information About COVID-19 Related to Vaccine Uptake in a Safety Net Healthcare System.

BACKGROUND: Vaccination is a critical tool to combat the COVID-19 pandemic. Yet, vaccine uptake varies across communities and is often affected by sociodemographic factors and accessibility. OBJECTIVES: This article outlines a pilot study aimed to examine factors associated with COVID-19 patients within one of the nation's largest safety net healthcare systems. METHODS: A cross-sectional survey design was conducted with adults over 18 years of age eligible to receive the COVID-19 vaccine. Descriptive analysis of survey data collected in 2021-2022 was employed. Unconditional and multivariate logistic regression analyses were conducted to examine associations between sociodemographics, social factors, and COVID-19 vaccine uptake. RESULTS: Study participants ( N = 280) were a diverse patient population, primarily low-income and majority Hispanic/Latinx, with low education levels, but with a high level of COVID-19 vaccine uptake and a high rate of intent to vaccinate again. Approximately 22% report having unstable housing, and 46% experiencing food insecurity. Most trusted sources for COVID-19 data included mainstream media, including TV, radio, and newspapers, and friends, family, or other informal networks. We found that respondents who were satisfied or very satisfied with COVID-19 information received from healthcare providers or the government had higher odds of vaccine uptake rates. DISCUSSION: These findings highlight the critical role of access to the COVID-19 vaccine and sources of information as an independent factor in COVID-19 vaccine uptake among patients within a safety net healthcare system. This study expands the literature on COVID-19 vaccine uptake, particularly in an underresourced region of the South Los Angeles community. Future research is needed to better understand the mechanisms between social determinants of health, perceived discrimination, and vaccine uptake.

Caring for COVID's emotional long haulers.

14 strategies to safeguard nurses' mental health.

Prevalence, Proportionality, and Cause of Ventilator Alarms in a Pediatric Intensive Care Setting.

BACKGROUND: Clinical alarms play an important role in monitoring physiological parameters, vital signs and medical device function in the hospital intensive care environment. Delays in staff response to alarms are well documented as health care providers become desensitized to increased rates of nuisance alarms. Patients can be at increased risk of harm due to alarm fatigue. Current literature suggests alarms from ventilators contribute significantly to nonactionable alarms. A greater understanding of which specific ventilator alarms are most common and the rates at which they occur is fundamental to improving alarm management. METHODS: A retrospective review was performed on alarms that occurred on the Avea and Servo-i ventilators used in the pediatric ICU and pediatric cardiothoracic ICU at a major metropolitan children's hospital. High- and medium-priority alarms, as classified by the manufacturer, were studied between June 1, 2017, and November 31, 2017. Descriptive data analysis and a 2-proportion z-test were performed to identify proportionality, cause, and prevalence rates in the pediatric ICU and the cardiothoracic ICU. RESULTS: Eleven distinct ventilator alarms were identified during 2,091 d of mechanical ventilation. The Inspiratory Flow Overrange alarm (42.4%) on the Servo-i, Low VTE (20.4%; expiratory tidal volume) and Circuit Integrity alarm (20.0%) on the Avea were the most prevalent causes according to ventilator type. Medium-priority alarms comprised 68.7% of all Servo-i alarms, and high-priority alarms comprised 84% of all Avea alarms. The 2-sample test of proportions was significant for differences between both areas (P < .001). The overall alarm prevalence rate was 22.5 ventilator alarms per ventilator-day per patient. CONCLUSIONS: The cause and proportion of alarms varied by ventilator and care unit. High-priority alarms were most common with the Avea and medium-priority alarms for the Servo-i. The overall combined ventilator alarm prevalence rate was 22.5 alarms per ventilator-day per patient.

Allelic response of yield component traits to resource availability in spring wheat.

KEY MESSAGE: Investigation of resource availability on allele effects for four yield component quantitative trait loci provides guidance for the improvement of grain yield in high and low yielding environments. A greater understanding of grain yield (GY) and yield component traits in spring wheat may increase selection efficiency for improved GY in high and low yielding environments. The objective of this study was to determine allelic response of four yield component quantitative trait loci (QTL) to variable resource levels which were manipulated by varying intraspecific plant competition and seeding density. The four QTL investigated in this study had been previously identified as impacting specific yield components. They included QTn.mst-6B for productive tiller number (PTN), WAPO-A1 for spikelet number per spike (SNS), and QGw.mst-3B and TaGW2-A1 for kernel weight (KWT). Near-isogenic lines for each of the four QTL were grown in multiple locations with three competition (border, no-border and space-planted) and two seeding densities (normal 216 seeds m-2 and low 76 seeds m-2). Allele response at QTn.mst-6B was driven by changes in resource availability, whereas allele response at WAPO-A1 and TaGW2-A1 was relatively unaffected by resource availability. The QTn.mst-6B.1 allele at QTn.mst-6B conferred PTN plasticity resulting in significant GY increases in high resource environments. The gw2-A1 allele at TaGW2-A1 significantly increased KWT, SNS and GPC offering a source of GY improvement without negatively impacting end-use quality. QGw.mst-3B allelic variation did not significantly impact KWT but did significantly impact SPS. Treatment effects in both experiments often resulted in significant positive impacts on GY and yield component traits when resource availability was increased. Results provide guidance for leveraging yield component QTL to improve GY performance in high- and low-yield environments.

Analysis of recombinant inbred line populations derived from wheat landraces to identify new genes for wheat stem sawfly resistance.

Wheat landrace accessions were chosen from areas of the world with historical European wheat stem sawfly (Cephus pygmaeus L.) selection pressure to develop six recombinant inbred line (RIL) populations. Molecular maps were constructed, and resistance due to antibiosis and antixenosis was assessed at sites in Montana naturally infested by Cephus cinctus Norton, the wheat stem sawfly (WSS). Novel QTLs were identified along with QTL previously identified in elite germplasm. A newly identified QTL on chromosome 1B provided a new source for pith-filled solid stems. An allele for resistance on chromosome 4A unrelated to solid stems was identified in four of the six RIL populations. A landrace from Turkey, PI 166471, contained alleles at three QTLs causing high levels of larval mortality. None of the QTLs were related to stem solidness, but their combined effect provided resistance similar to that observed in a solid-stemmed check cultivar. These results show the utility of genetic populations derived from geographically targeted landrace accessions to identify new alleles for insect resistance. New PCR-based molecular markers were developed for introgression of novel alleles for WSS resistance into elite lines. Comparison of results with previous analysis of elite cultivars addresses changes in allele frequencies during the wheat breeding process.

A Novel QTL in Durum Wheat for Resistance to the Wheat Stem Sawfly Associated with Early Expression of Stem Solidness.

The wheat stem sawfly (WSS) (Cephus cinctus Norton) is a major yield-reducing pest of wheat (Triticum aestivum L.). Varieties with pith-filled, or solid, stems provide a measure of resistance by inhibiting larval survival inside the stem. Durum wheat (Triticum turgidum L.) has resistance to the wheat stem sawfly even in the absence of known genes for stem solidness. To determine the genetic basis of resistance in durum wheat, a susceptible durum wheat, PI 41353, was identified from among 1,211 landrace accessions from around the world screened in WSS-infested sites. A recombinant inbred line (RIL) population of 105 individuals was developed from a cross of PI 41353 with a typically resistant variety, Pierce. The RIL were screened in a total of three WSS-infested locations in Montana over a two year period. A genetic map was constructed with 2,867 SNP-based markers. A quantitative trait locus (QTL) analysis identified six QTL associated with resistance. An allele from resistant cultivar Pierce at a QTL on chromosome 3A, Qss.msub-3AL, caused a 25% reduction in stem cutting. Assessment of near-isogenic lines that varied for alleles at Qss.msub-3AL showed that the Pierce allele was also associated with higher stem solidness as measured early in stem development, which is a critical stage for WSS oviposition and larval development. Stem solidness of Pierce and other resistant durum wheat lines largely disappeared later in plant development. Results suggest a genetic mechanism for WSS resistance observed in durum wheat, and provide an additional source of WSS resistance for hexaploid bread wheat.