From Pandemic to Panacea: Solutions that Sustained: COVID Inspired Continuum of Care Initiatives.

In early 2020, the Covid-19 virus swept through the world, causing a global pandemic. The onset of this unprecedented situation forced the health care system in this country to pivot and implement creative strategies to manage patient care and healthcare operations in the safest, most effective way possible to provide high-quality care. Care across the continuum had to be rendered in ways that were developed and implemented in a very short span of time. This article highlights several initiatives implemented which are currently being used in practice, with outcomes, as they demonstrated effectiveness in care coordination and health care operations.

Commercial arbuscular mycorrhizal fungal inoculant failed to establish in a vineyard despite priority advantage.

BACKGROUND: Arbuscular mycorrhizal (AM) fungi associate with most plants and can increase nutrient uptake. As a result, commercial inoculants called "biofertilizers" containing AM fungi have been developed and marketed to increase plant performance. However, successful establishment of these inoculants remains a challenge, and may be negatively impacted by competition with fungi already present (priority effects). Perennial agriculture may be more amenable if inoculants can be successfully established on crops prior to field planting. METHODS: Here, we inoculate grapevine (Vitis vinifera) with a commercial inoculant in three treatments designed to manipulate the strength and direction of priority effects and quantified the abundance of the fungal strain before and after introduction using droplet digital PCR (ddPCR). RESULTS: We found that the introduced strain did not establish in any treatment, even with priority advantage, and inoculated vines did not differ in performance from non-inoculated vines. Fungal abundance was not greater than in pre-inoculation soil samples during any of the five years sampled and may have been impaired by high available phosphorus levels in the soil. This study highlights the need to understand and evaluate how the management of the agricultural system will affect establishment before introduction of "biofertilizers", which is often unpredictable.

Using subcutaneous fluids in end-of-life care.

There are currently no universally accepted medical or nursing guidelines for the administration of subcutaneous fluids at the end of life. Each case must be considered individually as it is unclear whether giving parenteral fluids to people who are dying causes, rather than alleviates, symptoms. This article discusses how to give fluids safely and suggests that relatives, who often feel very strongly about giving parenteral fluids, should be supported and involved in the decision making and care of their family member at the end of life.

Use of selective serotonin reuptake inhibitors in the treatment of depression in older adults: identifying and managing potential risk for hyponatremia.

A significant percentage of older adults experience a gradual decline in health, which influences their overall function, sense of well-being, and ability to perceive and participate in enjoyable life experiences. Personal and family history of depression further increases the likelihood of despair and mental decline related to aging. Consideration of selective serotonin reuptake inhibitors (SSRIs) as one form of treatment for depression is a clinically sound option; however, awareness of a potential side effect rarely reported in the general population yet prevalent among the elderly is essential: SSRI-induced hyponatremia with associated mental status impairment. Through knowledge, early recognition, and prompt intervention strategies, the clinician will be prepared to manage hyponatremia and reverse its serious consequences.

A study on the interplay between energy and matter transformation: the effect of elevated temperatures on the leaf morphology of Vitis vinifera var. Merlot.

This investigation explores the relationship between increased energy levels and leaf morphology. It tests the idea that the causal agent of development is the dissipation of energy into transformed matter. The energy under which leaves developed was modified by increasing temperatures in grape cordons through wrapping them in clear plastic sleeves in the early spring. At the higher temperatures, and energy levels, there was a small but statistically significant decrease in leaf size and a change in organization the leaves. The decrease in leaf size may be due to a reallocation of resources, either to greater shoot growth as a previous study demonstrated or to the appearance of more vectors of development in the leaves, i.e. the appearance of more developmental subsystems. The leaves that grew under the higher temperature regime were more complex, perhaps indicating that the grapes on those same vines may produce more complex juice, another expression of more developmental subsystems. The change in organization in these leaves that developed at higher temperature argues that the causal agent in plant development is energy dissipation and the concomitant transformation of matter, the latter expressed in the appearance of more growth vectors.