Social Network Analysis of an Agricultural Center: Stakeholders and the Transfer of Information.

We conducted a social network analysis (SNA) of Central States Center for Agricultural Safety and Health (CS-CASH) to describe stakeholder networks for agricultural Research and Education/Outreach. This was a two-phase study. First, the Leader Survey went to N = 9 CS-CASH leaders to identify their key stakeholders. Next, the Stakeholder Survey was sent to these stakeholders to learn about their stakeholder collaborations, interactions, and communications. The Pajek Network Analysis measured SNA metrics for density, centrality, betweenness, k-core, and created the sociograms. The Leader Survey had a 100% response rate and generated N = 337 unique stakeholders. Most were researchers (44%) and educators (20%), with a primary sphere of influence in Nebraska-only (40%). The Stakeholder Survey had 46% response rate, and generated N = 199 names in the extended Education/Outreach network and N = 140 in the extended Research network. Stakeholders in both networks were employed mostly in universities/schools (61%) or non-profits (15%). Both networks had a single main component and 7/9 CS-CASH leaders had central roles in these components. CS-CASH is well positioned in the extended stakeholder networks based on SNA metrics. Stakeholders utilize CS-CASH resources, and they seek and exchange information with its leaders. To strengthen knowledge transfer, it will be useful to build on connections with stakeholders outside academia.

Dairy Caretaker Perspectives on Performing Euthanasia as an Essential Component of Their Job.

The objectives of this study were to identify caretakers' perceptions and stressors related to performing on-farm euthanasia as well as potential ideas for intervention strategies to alleviate negative effects of performing euthanasia on caretaker well-being. Additionally, we aimed to determine how euthanasia methods, procedures, and training correlate with dairy caretakers' attitudes toward performing on-farm euthanasia and their job satisfaction and sense of well-being. Thirty-eight dairy caretakers (19 workers, 15 supervisors, 3 owners, 1 veterinarian) participated in focus groups or interviews conducted and recorded on five Northern Colorado dairies. Thematic analysis of focus group and interview transcripts revealed seven recurring themes. Variation in available training and euthanasia protocols among dairy farms was evident. There was a lack of awareness regarding available mental health resources and little communication between farm personnel about euthanasia-related stress. Training was correlated with caretaker knowledge about euthanasia procedures and the language used to refer to euthanasia. Human-animal bonds and empathy toward animals were evident in participants regardless of training, job position, or dairy experience. Interventions such as training programs, mental health resources, and other support systems should be tested for effectiveness in addressing euthanasia-related stressors, improving euthanasia decision-making and practice, and increasing animal wellbeing on dairy farms.

Preliminary Study Exploring Caretaker Perspectives of Euthanasia on Swine Operations.

The purpose of this study was to gain a better understanding of euthanasia training, caretaker perceptions of euthanasia, and available resources for individuals who perform euthanasia as part of their job on swine operations in the United States. An online survey was distributed via an e-newsletter and in-person recruitment at swine industry events. Survey questions were related to training, attitudes towards performing euthanasia, work environment, and communication. Forty-five responses (17 workers, 21 managers, 7 owners) were recorded and summarized. The majority of workers (n = 14, 82%) agreed that they had "received enough training to euthanize pigs correctly" and that training had made them "confident about performing euthanasia", yet 35% (6) also indicated they would like more euthanasia training. Less than one-third of workers indicated that strategies for dealing with "personal stress" (4, 24%) and "emotional wellness" 29% (5) were included in training programs but the majority (14, 82%) agreed that "trainings included human safety while performing euthanasia". Most caretakers (37, 82%) agreed that they felt they could "communicate with my supervisors" if they felt uncomfortable performing euthanasia. Opportunities for the future include enhancing euthanasia training opportunities and content to include more awareness of strategies to deal with stress related to euthanasia.

Preliminary Exploration of Swine Veterinarian Perspectives of On-Farm Euthanasia.

Euthanasia is a critical component in swine production and veterinarians play an important role in euthanasia protocol development and training. This study aimed to understand veterinarian involvement in and perspectives on euthanasia on pig farms. An online survey was disseminated both at a pig welfare conference and online via a veterinarian e-newsletter. Twenty-five veterinarians participated in the survey. The majority of respondents indicated that caretakers are the individuals making euthanasia decisions and performing the task (n = 17, 68% and 22, 88%, respectively). The majority (22, 88%) of respondents indicated that most of the facilities with which they work have a written euthanasia protocol, and 72% (18) indicated that they assisted in protocol development. Only half of respondents (13, 52%) agreed that "all employees performing euthanasia have been trained adequately", and 80% (20) identified an interest in delivering more training. Less than half the respondents indicated that strategies for coping with "personal stress" and "emotional wellness" (12, 48%) were included in euthanasia training. While the moral stress of performing euthanasia is recognized, there is opportunity for addressing mental well-being in euthanasia resources. Although preliminary, this study supports the need for further euthanasia training on-farm, involving veterinarians in the process.

Determination of Dairy Cattle Euthanasia Criteria and Analysis of Barriers to Humane Euthanasia in the United States: The Veterinarian Perspective.

When dairy cattle become ill or injured to the extent that recovery is unlikely or impossible, on-farm euthanasia should be used as a tool to eliminate pain and suffering. Our study aimed to identify decision-making criteria and the most common factors considered by veterinarians when making and carrying out euthanasia decisions. Dairy cattle veterinarians were recruited to participate in an online survey (Part I, 61 surveys collected) or in one of three focus groups (Part II, 4-10 veterinarians/group, n = 22). Part I (survey): Surveyed veterinarians varied regarding health condition management and demonstrated a strong proclivity to treat compromised cattle, mirroring trends amongst dairy producers identified in previous research. Sixty percent of respondents indicated that most facilities for which they serve as the primary veterinarian have a written euthanasia protocol in place. Part II (focus groups): Three main themes about euthanasia decision-making (logistical, animal, and human) were identified from focus group discussions. Discussions focused primarily on logistical factors such as financial considerations and client/public perceptions. Development of specific standards for euthanasia, alongside interactive training programs for dairy veterinarians and producers are vital next steps to improving cattle welfare and consistency in euthanasia decision-making across the United States dairy industry.

Determination of Dairy Cattle Euthanasia Criteria and Analysis of Barriers to Humane Euthanasia in the United States: Dairy Producer Surveys and Focus Groups.

There are currently no clear guidelines in the US and some other countries regarding euthanasia decision making timelines for dairy cattle that become injured or ill to the extent that recovery is unlikely or impossible. Our study aimed to identify decision making criteria and the most common factors considered when making and carrying out euthanasia decisions. Dairy producers were recruited to participate in a mailed survey (Part I, 307 completed surveys were returned) or in one of three focus groups (Part II, 8-10 producers/group, n = 24). Part I (survey): Farm owners were most commonly responsible for on-farm euthanasia and most respondents would treat and monitor compromised cattle for a majority of 15 health conditions. Responses were highly variable; for example, 6.3% and 11.7% of respondents would never euthanize a non-ambulatory cow or calf, respectively. Part II (focus groups): Three main themes (animal, human, and farm operation) were identified from discussion which focused primarily on animal welfare (16% of the discussion) and human psychology (16%). Participants expressed a desire to eliminate animal suffering by euthanizing, alongside a wide range of emotional states. Development of specific standards for euthanasia is a critical next step and more research is needed to understand the human emotions surrounding euthanasia decision making.

Participatory needs assessment and action planning for a clinical and translational research network.

The goal of this study was to assess the utility of participatory needs assessment processes for continuous improvement of developing clinical and translational research (CTR) networks. Our approach expanded on evaluation strategies for CTR networks, centers, and institutes, which often survey stakeholders to identify infrastructure or resource needs, using the case example of the Great Plains IDeA-CTR Network. Our 4-stage approach (i.e., pre-assessment, data collection, implementation of needs assessment derived actions, monitoring of action plan) included a member survey (n = 357) and five subsequent small group sessions (n = 75 participants) to better characterize needs identified in the survey and to provide actionable recommendations. This participatory, mixed-methods needs assessment and strategic action planning process yielded 11 inter-related recommendations. These recommendations were presented to the CTR steering committee as inputs to develop detailed, prioritized action plans. Preliminary evaluation shows progress towards improved program capacity and effectiveness of the network to respond to member needs. The participatory, mixed-methods needs assessment and strategic planning process allowed a wide range of stakeholders to contribute to the development of actionable recommendations for network improvement, in line with the principles of team science.

Examining the Impact of Board-Certified Registered Nurses in Skilled Nursing Facilities Using National and State Quality and Clinical Indicators.

A convenience sample of skilled nursing facilities was selected from a sample of graduates of an online training program for RNs who subsequently achieved board certification in gerontological nursing (RN-BC). Facilities that employed one or more RN-BC were pair-matched using 11 organizational characteristics with facilities that did not employ a RN-BC. Facility data were collected at two time points, and differences between time points and between facility type (RN-BC versus non-RN-BC) were analyzed. Findings showed that there were no statistically significant differences between RN-BC and non-RN-BC facilities with respect to quality ratings and nurse sensitive clinical indicators (e.g., restraint use, urinary tract infections, falls, antipsychotic medication use) between the two time periods; however, in the second time period, RN-BC facilities showed greater improvement versus non-RN-BC facilities in seven of nine outcomes, achieving significance in Overall (4.10 vs. 3.55, p < 0.01) and Survey (3.48 vs. 2.86, p < 0.01) 5-Star ratings. [Journal of Gerontological Nursing, 45(11), 39-45.].

Pharmacokinetics of transdermal flunixin in sows.

The objective of this study was to describe the pharmacokinetics (PK) of flunixin in 12 nonlactating sows following transdermal (TD) flunixin (3.33 mg/kg) and intravenous (IV; 2.20 mg/kg) flunixin meglumine (FM) administration using a crossover design with a 10-day washout period. Blood samples were collected postadministration from sows receiving IV FM (3, 6, 10, 20, 40 min and 1, 3, 6, 12, 16, 24, 36, and 48 hr) and from sows receiving TD flunixin (10, 20, 40 min and 1, 2, 3, 4, 6, 8, 12, 16, 24, 36, 48, 60, and 72 hr). Liquid chromatography and mass spectrometry were used to determine plasma flunixin concentrations, and noncompartmental methods were used for PK analysis. The geometric mean ± SD area under the plasma concentration-time curve (AUC) following IV injection was 26,820.59 ± 9,033.88 and 511.83 ± 213.98 hr ng/ml for TD route. Mean initial plasma concentration (C0 ) was 26,279.70 ± 3,610.00 ng/ml, and peak concentration (Cmax ) was 14.61 ± 7.85 ng/ml for IV and TD administration, respectively. The percent mean bioavailability of TD flunixin was 1.55 ± 1.00. Our results demonstrate that topical administration is not an efficient route for delivering flunixin in mature sows.

Policy analysis of access to and reimbursement for nonpharmacologic therapies for cancer-related fatigue.

Cancer-related fatigue (CRF) is an important public health issue that involves millions of community-dwelling cancer survivors. CRF is the most debilitating patient reported symptom related to cancer therapies and exacts a significant economic and social toll. It adversely impacts patients' work, social relationships, and overall quality of life. CRF prevalence ranges from 30% to 90% during therapy and often persists months and years afterwards. This policy analysis examines the problem of lack of patient access to evidence-based nonpharmacologic CRF therapies. The authors use a five-step process described by Teitelbaum & Wilenski (2017) to address the problem statement, identify key stakeholders, explore problem landscape, describe two viable policy options, and make a recommendation. The two policy options considered were: (a) insurer reimbursements modeled after existing cardiac rehabilitation programs and (b) health care provider incentives that incorporate the oncology care model (OCM) quality measure. Advantages and disadvantages of both options are presented. Public health nurses are uniquely positioned in their communities to advocate for these changes to improve population health.

Innovation diffusion in an agricultural health center: moving information to practice.

This article presents a case study logic model-approach of the Central States Center for Agricultural Safety and Health (CS-CASH) - one of eleven federally funded Agricultural Health and Safety Centers in the United States. We used social network analysis (SNA) to examine how information generated from CS-CASH regarding respiratory personal protective equipment (PPE) use is disseminated across their network of key stakeholders and ultimately to end-users (i.e., agricultural workers). We developed a 22-item instrument based on SNA principles, and administered it to N = 49 CS CASH members and N = 158 external stakeholders. Questions focused on demographics, work setting, roles, and SNA concepts for betweenness, centrality, reciprocity, and density. Findings showed that CS-CASH has an extensive information sharing network for respiratory PPE, and there is high reciprocity with vigorous bi-directional communication; however, the network is fragmented and lacks diversity in key stakeholder roles needed to broadly diffuse information into practice. Implications are to (1) create new connections with a more diverse group of external stakeholders beyond academic and non-profit organizations, and (2) leverage primary network gatekeepers to build connections within the respiratory PPE group and with gatekeepers in the unconnected networks, thereby maximizing diffusion of information across the overall CS-CASH network. The case study has implications for evaluators and project directors looking to improve outcomes for enhanced use of respiratory PPE among end-users by working through external stakeholders who can enhance the information flow for dissemination and diffusion to practice.

The feasibility and promise of mobile technology with community health worker reinforcement to reduce rural preterm birth.

OBJECTIVES: (1) Assess feasibility of a smartphone platform intervention combined with Community Health Worker (CHW) reinforcement in rural pregnant women; (2) Obtain data on the promise of the intervention on birth outcomes, patient activation, and medical care adherence; and (3) Explore financial implications of the intervention using return on investment (ROI). SAMPLE: A total of 98 rural pregnant women were enrolled and assigned to intervention or control groups in this two-group experimental design. INTERVENTION: The intervention group received usual prenatal care plus a smartphone preloaded with a tailored prenatal platform with automated texting, chat function, and hyperlinks and weekly contact from the CHW. The control group received usual prenatal care and printed educational materials. MEASUREMENTS: Demographics, health risk data, interaction with platform, medical records, hospital billing charges, Client Satisfaction Questionnaire-8, satisfaction comments, and the Patient Activation Measure. RESULTS: A total of 77 women completed the study. The intervention was well-received, showed promise for improving birth outcomes, patient activation, and medical care adherence. Financial analysis showed a positive ROI under two scenarios. CONCLUSIONS: Despite several practical issues, the study appears feasible. The intervention shows promise for extending prenatal care and improving birth outcomes in rural communities. Further research is needed with a larger and more at-risk population to appreciate the impact of the intervention.

Identification of populations at risk: Stillbirth toolkit for health care providers.

BACKGROUND: Maternity care and women's health are measured, in part, by the stillbirth rate of a country. The purposes of this pilot project were to: a) establish a baseline of health care provider knowledge regarding stillbirth risk factors based on geographic distribution (urban/rural) and provider licensure (MD, APRN, PA, CNM) and b) evaluate the utility of a Stillbirth Risk Factor Toolkit and its effects on provider knowledge. METHODS: Evaluative research using a retrospective pre-posttest survey design was completed. The study setting included primary care clinics (urban [n=25] and rural [n=25]) in Nebraska. Health care providers from N=50 clinics were surveyed about their knowledge of stillbirth risk factors (modifiable and non-modifiable) before and after reading the Toolkit. RESULTS: Providers were least knowledgeable regarding the definition of stillbirth and the number of weeks' gestation that constitute a stillbirth. Overall, there was no significant difference in baseline knowledge between rural and urban providers. Nearly half (43.8%) found the Toolkit to be very helpful and applicable to their patient population, and 34.8% said they would be very likely to utilize it with their patients. There was a statistically significant increase in knowledge of stillbirth risk factors among all health care providers after reviewing the Toolkit (p<0.001). CONCLUSIONS: Health providers had varied baseline knowledge about stillbirth. The Toolkit improved provider knowledge, but further research is needed to assess its impact on clinical practice.

Community Advisory Board Members' Perspectives Regarding Opportunities and Challenges of Research Collaboration.

This case study examines the perspectives of rural community advisory board (CAB) members regarding the opportunities and challenges of partnering with academic investigators on funded research. We used a sequential exploratory design to evaluate the phenomena. Qualitative and quantitative data from CAB members were integrated to gain better understanding. Results showed that CAB members valued professional networking and gaining new evidence-based knowledge to enhance their professional practices. They identified rurality, the academic research process, and fulfilling research roles as the most significant challenges. CAB members also believed that strong community-based leaders had been essential in promoting and sustaining a shared vision for evidence-based research solutions to their community problem. Self-evaluation is essential for effective CAB research partnerships, and nurse researchers can strengthen these collaborations by (a) providing continuing education on research and evidence-based practices, (b) assuring that perceived benefits of CAB participation outweigh perceived challenges, and (c) supporting community-based leadership.

Evaluating Effective Leadership and Governance in a Midwestern Agricultural Safety and Health Coalition.

Agricultural Centers are a coalition of organizations and individual members with a common purpose: to improve the health and safety of the agricultural community. Successful leadership and governance are essential in accomplishing these goals. This article examined the effectiveness of a midwestern Agricultural Health and Safety Center (Ag Center) leadership and governance structure. The Internal Coalition Outcomes Hierarchy (ICOH) framework and the Internal Coalition Effectiveness (ICE©) instrument were used, with field visit interviews conducted to gain further insight. Combined comparative findings from both research methods showed that scores in each of the categories increased. Adjustments led to stronger collaborative leadership, vital to successful population health improvement programs. This study showcases coalition qualities in a broader environment, capturing a clearer depiction of leadership and member interaction. Field visit interviews confirmed that this midwestern Ag Center continued to have strong levels of effectiveness in each of the conceptual constructs of a coalition.

Social Networking in an Agricultural Research Center: Using Data to Enhance Outcomes.

The purpose of this article is to present a case study of one midwestern Agricultural Center (Ag Center) that used social network analysis (SNA) to (1) evaluate its collaborations with extramural stakeholders and (2) strategically plan for extending outreach for goal achievement. An evaluation team developed a data collection instrument based on SNA principles. It was administered to the Ag Center's intramural stakeholders (N = 9), who were asked to identify the key extramural stakeholders with whom they had collaborated within the previous 12 months. Additional questions about each extramural stakeholder helped to categorize them according to SNA network measures for degree of centrality, betweenness centrality, and closeness centrality. Findings showed the Ag Center had N = 305 extramural stakeholders. Most of these were other researchers and did not represent the diverse group of stakeholders that the Ag Center had targeted for engagement. Only a few of the intramural stakeholders had national or international connections. Findings were used to improve and diversify connections in order to leverage the Ag Center's expertise and ability to translate research into new best practices and policies. The SNA case study has implications for other evaluators and project directors looking for methodologies that can monitor networks in large science consortia and help leaders plan for translating research into practice and policies by networking with those who can influence such change.

Knowledge, Attitudes, and Practices for Respiratory and Hearing Health among Midwestern Farmers.

OBJECTIVE: The purpose of this study was to assess knowledge, attitudes, and practices for hearing and respiratory health/safety among farmers in seven Midwestern states served by a federally funded Agricultural Center. Findings provided a baseline to longitudinally track the Agricultural Center's program outcomes and to design community education to improve safety and health among farmers. DESIGN AND SAMPLE: This was a cross-sectional study using a 30 item mailed survey to describe farmers' operations, demographics, health conditions, related information sources, and knowledge/attitude/practices for personal protective equipment (PPE) (i.e., ear plugs/muffs and dust masks/respirators). MEASURES: Frequencies and percentages were calculated for each item and according to responses from younger versus older farmers. The unit of study was farm operators (N = 280) randomly selected from a publicly available database of corn/soybean and hog farmers in seven Midwestern states. RESULTS: Findings revealed important knowledge gaps among respondents regarding (1) hazardous exposure sources; (2) long-term health consequences of noise/dust exposure; (3) proper selection/fitting of PPE. CONCLUSIONS: Public health nurses and primary care providers in rural communities should address specific knowledge gaps in order to enhance farmers' perceived understanding of their susceptibility to hazardous exposures. Increasing farmers' knowledge through preferred venues may help to improve PPE effectiveness.

Informing Health Policy Decision Makers: A Nebraska Scope of Practice Case Study.

Medicare patients seeking care from nurse practitioners (NPs) increased 15-fold from 1998 to 2010, and a 2.5-fold patient increase was recorded in states that have eased the regulatory environment for NPs. It is increasingly important that state regulatory and licensing boards-charged with protecting the public through the assurance of a qualified health-care workforce-examine whether their state regulatory environment restricts or promotes public access to quality health care. This article presents a case study of a statutory scope of practice credentialing review process for NPs in Nebraska. It examines in depth what individuals involved in policy change processes found most useful for informed decision making. The methodology included observation of the process, review of submitted documents, and a survey to individuals involved in the decision-making process (n = 22/48). The study findings have application for those seeking scope of practice policy changes, with specific suggestions for how to better prepare themselves and present information in formats that are helpful to decision makers. Our results also shed new light on what specific evidence submitted during a scope of practice review process is most valued for promoting the understanding of decision makers to effect change.