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To investigate different social support dimensions and their association with mortality among older adults in Finland. This study is part of the longitudinal population-based Cardiovascular Risk Factors, Aging and Dementia (CAIDE) study (N = 1,295), with an age range of 65 to 80 years and a follow-up of 21 years. Cox proportional hazard models were used. In the unadjusted analyses, older adults without general social support and health-related social support from nonrelatives had higher mortality risk than those with social support in the overall population, respectively (hazard ratio [HR], 1.23; 95% confidence interval [CI] [1.02, 1.48]), (HR 1.23; [1.04, 1.44]). After stratifying into age groups and adjusting for covariates, heterogeneous trajectories emerged for associations between social support dimensions and mortality. Lack of social support predicts mortality even after 21 years of follow-up. The findings highlight the diversity of social support patterns and the importance of preventive measures when aiming to support health and well-being in later life. Future research should harness age variations to understand the different needs and explore nonrelatives’ roles in social support.

ObjectivesExacerbations of asthma and viral induced wheeze are leading causes of morbidity and hospital admission in children and young people. Salbutamol is a mainstay of treatment for these conditions, however there is limited evidence to inform the optimal salbutamol dosing regimen at discharge.1 2 We aimed to investigate the effect of updated salbutamol discharge dosing guidance (1000 microgram 4 hourly) versus the previously followed guidance of 500 microgram 4 hourly in a specialist children’s hospital.MethodsData from the hospital’s electronic patient record was used to identify inpatients with diagnoses of asthma or viral wheeze treated in the year before and two years after the dosing guidance was updated in November 2020. Data from 491 patient records (227 pre-update, 264 post-update) was analysed for salbutamol discharge doses, readmission rates and length of stay.ResultsFollowing the change in guidance, the proportion of patients discharged on 10 puffs of salbutamol 4 hourly, increased significantly from 6.2% to 49.2% (Mann Whitney U value 17057, p <0.05).The seven-day readmission rate increased from 0.0% (n = 0/227) to 2.7% (n = 7/264) (Fisher’s exact test value 0.0168, p <0.05). However, the readmission rates were not significantly different between the cohort of children who were discharged on five puffs of salbutamol (n = 4/134, 3.0%) compared to the group discharged on ten puffs (n = 3/130, 2.3%) (Chi-square statistic = 0.1173, p = 0.739).There was a non-statistically significant reduction in median length of stay between the two periods (27 hours vs. 23 hours (Mann-Whitney U-value = 17177.5, p = 0.9676)).(See table 1)There were no reported clinical incidents associated with the use of salbutamol on discharge.ConclusionDischarging patients on ten puffs of salbutamol proved to be feasible, was associated with a trend towards a reduced length of stay and was not associated with any adverse events. Although there was an increased readmission rate in the period following the change in the dosing guidance, this did not seem to be related to the discharge dose of salbutamol.We conclude that the key factor in guiding patient discharge is the ability to remain clinically stable in the four-hour interval in between the doses of salbutamol rather than the dose of salbutamol itself. Further research, ideally using high-quality prospective study designs, is required to confirm these findings so that clinicians can make evidence-based decisions.Abstract 7771 Table 1[Image Omitted. See PDF.]ReferencesAndrzejowski P, Carroll W. Salbutamol in paediatrics: pharmacology, prescribing and controversies. Archives of Disease in Childhood-Education and Practice 2016 Aug 1;101(4):194–7.Babl FE, Sheriff N, Borland M, Acworth J, Neutze J, Krieser D, Ngo P, Schutz J, Thomson F, Cotterell E, Jamison S. Paediatric acute asthma management in Australia and New Zealand: practice patterns in the context of clinical practice guidelines. Archives of disease in childhood 2008 Apr 1;93(4):307–12.

The ability to document the frequency, extent, and severity of fires in wetlands, as well as the dynamics of post-fire wetland land cover, informs fire and wetland science, resource management, and ecosystem protection. Available information on Everglades burn history has been based on field data collection methods that evolved through time and differ by land management unit. Our objectives were to (1) design and test broadly applicable and repeatable metrics of not only fire scar delineation but also post-fire land cover dynamics through exhaustive use of the Landsat satellite data archives, and then (2) explore how those metrics relate to various hydrologic and anthropogenic factors that may influence post-fire land cover dynamics. Visual interpretation of every Landsat scene collected over the study region during the study time frame produced a new, detailed database of burn scars greater than 1.6 ha in size in the Water Conservation Areas and post-fire land cover dynamics for Everglades National Park fires greater than 1.6 ha in area. Median burn areas were compared across several landscape units of the Greater Everglades and found to differ as a function of administrative unit and fire history. Some burned areas transitioned to open water, exhibiting water depths and dynamics that support transition mechanisms proposed in the literature. Classification tree techniques showed that time to green-up and return to pre-burn character were largely explained by fire management practices and hydrology. Broadly applicable as they use data from the global, nearly 30-year-old Landsat archive, these methods for documenting wetland burn extent and post-fire land cover change enable cost-effective collection of new data on wetland fire ecology and independent assessment of fire management practice effectiveness.

ObjectiveManagement of wheezy children admitted with viral induced wheeze and asthma involves frequent clinician reviews to wean treatment with salbutamol inhalers. We proposed that a nurse led salbutamol weaning training package would enable the assessment of patients by experienced nurses and would facilitate more timely reviews of wheezy children. Our objective was to assess the feasibility and acceptability of implementing the training package and to explore the nurses’ perceptions of its effects on their confidence to review and wean salbutamol treatment.MethodAfter a literature review and multi-professional consultation, we created a teaching package for eligible nurses working on a general paediatric ward and defined eligibility criteria for patients (see table 1 for patient eligibility criteria). The training package included a pre-recorded educational video, face-to-face clinical examination training and supervised clinical patient reviews with a standardised competency sign off procedure.Nursing staff who participated in the training programme were asked to complete anonymous questionnaires designed to measure the impact of the training on their confidence levels and practice when managing wheezy children.ResultsThe training package was completed by 12 out of the 21 (57%) eligible nurses working on the general paediatric ward.All of the nurses who completed the training(100%) responded to the questionnaire.Before the training only 1/12 (8.3%)nurse felt either extremely or somewhat confident to assess a wheezy child’s salbutamol requirements. After training 12/12 (100%) nurses reported feeling either extremely or somewhat confident. (Graph 2 shows nurses’ confidence before and after training).There was a statistically significant increase in self-reported confidence levels following completion of the training.(Fisher exact test statistic < 0.01)All (100% )nurses surveyed reported a perception that the introduction of the training package would improve patient care and patient/parent/carer confidence in nursing staff’s ability to assess their need for salbutamol. 92% of nurses surveyed found the training beneficial and 67% felt the training had positively impacted on their other nursing practices. Time constraint was identified as potential barrier to implementation of practiceConclusionImplementing a ward-based training package to improve nurses’ confidence to assess and wean salbutamol treatment in wheezy children proved to be feasible and acceptable. Further evaluation objectives include monitoring the effects of the training intervention on key outcomes including length of stay and readmission rates.Abstract 287 Table 1[Image Omitted. See PDF.]

The purpose of this descriptive case study was to explore K–12 teachers’ perspectives on distance learning and teaching during the COVID-19 pandemic. The research questions that guided the study were: How do schoolteachers perceive online teaching during the pandemic? What advantages of online teaching did schoolteachers experience during the pandemic? What disadvantages of online teaching did school teachers experience during the pandemic? What impact did the pandemic have on online learning during the pandemic? What suggestions do schoolteachers have about online teaching? Twenty participants were chosen from school districts in Alabama to participate in interviews and focus group discussions. The findings showed 10 significant themes: 1) provided a quick resolution for institutions to continue educational service, 2) difficult for students to learn and teachers to teach, 3) a sudden, unanticipated adjustment, 4) both teachers and students learned technology, 5) fewer behavioral issues, 6) lack of support for teachers and students transitioning to virtual education, 7) no direct contact with students, 8) educators, parents, and students were not ready for the pandemic impact, 9) more training and support for educators teaching online, and 10) parents and students lack technology skills. Recommendations were provided based on the findings.

Cardiovascular disease (CVD) remains the major cause of morbidity, mortality, health care costs, and disability in the United States effecting thirty percent of adults under age 65 with higher incidence rates over fifty percent for commercial drivers (CD). An estimated forty percent of CD remain uninsured or without primary care and do not receive the nationally recommended baseline or annual/biannual screening for CVD risk factors (RF). CD must complete a federally mandated physical examination for interstate driving at least biannually. Therefore, certified Medical Examiners (ME) in occupational medicine can address this high-risk population's need and develop services to fill a gap in health care delivery that could negatively affect CD' medical certification and their overall health. This DNP project applied leadership and advanced practice nurse (APN) competencies to implement CVD risk assessment for CD examined in occupational medicine. Increased screening in this setting is logical and financially prudent. The principal investigator (PI) trained staff to apply the non-laboratory Framingham 10-year CVD risk score and utilize standardized CVD RF education to promote health behaviors to reduce the risk of CVD. Implementation involved application of advanced knowledge and physical assessment, population screening, policy review and development, informatics, communication, multidisciplinary collaboration, and financial review. Providing CVD risk assessment and CVD RF education of commercial drivers (CD) examined in occupational medicine will champion the health of workers, enhance health care delivery, expand APNs' roles, and ensure public safety for this high-risk population.

Damasus I (305-384) ascended to the office of the Bishop of Rome after a bitter and bloody battle with Ursinus in 366 CE. The violence was a culmination of doctrinal squabbles and power contests which erupted in the Roman church over the course of the fourth century. Damasus engaged in a substantial program of physical renovation and enlargement of martyr sites and personally penned numerous epigrams both extolling the virtue of the honored dead and the patronage of the bishopric. Scholarship related to Damasus and his works is typically narrowly focused, considering motive(s) for his actions, his use of specific architecture and/or materials, the content of his epigrams, etc. This dissertation expands the analysis to synthesize elements of space and architectural theory, sensory theory, and anthropological issues to fully explore the impact of his works related to martyr sites on the minds and bodies of pilgrims visiting such sites during martyr festival. Damasus I (305-384) ascended to the office of the Bishop of Rome after a bitter and bloody battle with Ursinus in 366 CE. The violence was a culmination of doctrinal squabbles and power contests which erupted in the Roman church over the course of the fourth century. Damasus engaged in a substantial program of physical renovation and enlargement of martyr sites and personally penned numerous epigrams both extolling the virtue of the honored dead and the patronage of the bishopric. Scholarship related to Damasus and his works is typically narrowly focused, considering motive(s) for his actions, his use of specific architecture and/or materials, the content of his epigrams, etc. This dissertation expands the analysis to synthesize elements of space and architectural theory, sensory theory, and anthropological issues to fully explore the impact of his works related to martyr sites on the minds and bodies of pilgrims visiting such sites during martyr festival. The bishop’s interventions at the catacomb of Callistus serve as a prime example of his use of architectural features, materials, decoration, and rhetoric to forge a distinct collective memory for visitors to the space – memory that was both manifestly Christian and manifestly Roman. Damasus’ use of materials and architectural features redefined the catacomb as monumental space. His proscription of physical movement and the stunning impact of the performance of his epigrams, combined with the sights, sounds, and smells within the space engaged the visitors’ senses to incite synesthesia and visceral seeing toward an encounter with the divine. These elements--catacomb-as-monument and synesthesia--provided visitors a shared visceral experience, which cemented a message of unity and a distinct collective identity for the fracturing Roman Christian community. The bishop’s interventions at the catacomb of Callistus serve as a prime example of his use of architectural features, materials, decoration, and rhetoric to forge a distinct collective memory for visitors to the space – memory that was both manifestly Christian and manifestly Roman. Damasus’ use of materials and architectural features redefined the catacomb as monumental space. His proscription of physical movement and the stunning impact of the performance of his epigrams, combined with the sights, sounds, and smells within the space engaged the visitors’ senses to incite synesthesia and visceral seeing toward an encounter with the divine. These elements--catacomb-as-monument and synesthesia--provided visitors a shared visceral experience, which cemented a message of unity and a distinct collective identity for the fracturing Roman Christian community.

I mapped three elevation classes in a Mid-Atlantic tidal freshwater marsh using QuickBird multi-spectral imagery and field measurements of elevation and channel networks. The elevation map reveals heterogeneous surfaces at a 2.4 m pixel scale. Field collected vegetation cover data differed among the three elevation classes. Species richness and the number of positive associations among species were higher in the mid- and high-marsh than the low marsh. The number of negative associations among species increased with rising elevation. Random forest classification of elevation class using species cover vectors selected only Impatiens capensis and Nuphar luteum and had an out of box predictive error of 26%. My research shows that the vegetation of freshwater tidal marshes is diverse with ill-defined boundaries between distinct communities. Yet vegetation shifts beyond the traditional low and high marsh communities could be detected, which should provide a useful tool for restoration and management.

This thesis is about the perceptual nature of aesthetic experience and the importance of nature as a paradigmatic object of aesthetic perception and aesthetic experience more broadly conceived. For this reason, it merits serious attention by philosophers working in aesthetics, as has been argued since Ronald Hepburn’s seminal essay “Contemporary Aesthetics and the Neglect of Natural Beauty”. If aesthetic experience is anything, it is at least perceptual. It is a mode of perceptual experience that is the result of having been attentive to and having discriminated between, the aesthetic and non-aesthetic, and invites room for reflection on, and connections to be made with, cognitive and emotive processes. Rooting the aesthetic in perception allows us to recognize and understand that it has an impact on our daily activities, rather than being restricted either to a particular kind of object, to the knowledge we might have about it, or to intense, rarefied aesthetic experience. If an object is to be an aesthetic object it need not be an artwork, indeed, one might even argue that nature is more interesting an aesthetic object from the perspective that it is indeterminate, not the result of human intentionality, and from an existential point of view, one that acknowledges our dependence on it. In the course of the argument, I thus resist the idea that the aesthetic experience of art is necessarily prior to the aesthetic experience of nature. The perceptual account put forward is based on a realist account of aesthetic properties that considers aesthetic properties to be perceptual properties and that considers aesthetic experience to be perceptually rich. I link it to the idea of ‘whole formalism’, a perceptual, aesthetic account that is nestled in the wider thought that aesthetic perception relates, although not causally, to other features of experience, such as emotion, and knowledge. Perceptual, aesthetic experience is thus not reduced to an austere account of aesthetic formalism. The thesis begins by analysing historical accounts of aesthetic perception, beginning with Plato, Aristotle and Aquinas. It builds on this analysis by reinterpreting crucial concepts to the discipline of aesthetics, such as disinterest and formalism that originated in the eighteenth century and are relevant to the idea of aesthetic perception. It then brings the idea of aesthetic perception up to date by addressing the current debate about cognitivism and non-cognitivism about aesthetic experience where nature is concerned. By tracing the idea of aesthetic perception historically, I will have also shown the role of nature as a paradigm of aesthetic experience through history and that nature is a repository for rich aesthetic experience and for rich experiential engagement with it.