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Background A shortage of behavioral health clinicians impedes access to mental health services nationwide in the U.S., with shortages most acute in federally designated Mental Health Professional Shortage Areas (mHPSAs). Retaining behavioral health clinicians currently working in mHPSAs is thus critical. This study sought to identify behavioral health clinicians’ assessments of various aspects of their work and jobs that are associated with their anticipated retention within mHPSA practices. Methods Data for this cross-sectional study were drawn from an annual feedback survey of clinicians when they complete federal education loan repayment support contracts for their work within mHPSAs, from 2016 to 2023. Clinicians’ assessments of various aspects of their work and jobs were measured with validated survey items with Likert-scaled response options, with most combined into scales for analyses. Bivariate and then adjusted associations with 5-year anticipated retention were assessed for clinicians’ assessments of various aspects of their work and jobs controlling for demographic, professional, and community characteristics. Results The 2,587 respondent behavioral health clinicians (67.5% response rate) included 42% licensed clinical social workers, 39% licensed professional counselors, 12% psychologists, and 7% licensed marriage and family therapists. Two-thirds of these clinicians worked in either community mental health centers or federally qualified health centers. 42% anticipated they would remain in their practices at least another five years. Five-year anticipated retention rates were nearly three times higher for clinicians who indicated satisfaction on global work and practice assessment measures than for clinicians neutral or dissatisfied on these measures. Five-year anticipated retention rates were also higher for clinicians who reported they had an effective and supportive administration, felt well and fairly compensated, had jobs that permitted a good work-life balance, and had jobs that allowed them to practice the full range of services they desired. Conclusions How behavioral health clinicians view their jobs within U.S. mHPSAs is important to their anticipated retention. Based on study findings, to promote their retention practice administrators should provide fair and adequate compensation, foster work-life balance, permit them to deliver the services they wish to provide, and value them and their input and maintain good relationships with them.

ObjectiveTo explore the causes and levels of moral distress experienced by clinicians caring for the low-income patients of safety net practices in the USA during the COVID-19 pandemic.DesignCross-sectional survey in late 2020, employing quantitative and qualitative analyses.SettingSafety net practices in 20 US states.Participants2073 survey respondents (45.8% response rate) in primary care, dental and behavioural health disciplines working in safety net practices and participating in state and national education loan repayment programmes.MeasuresOrdinally scaled degree of moral distress experienced during the pandemic, and open-ended response descriptions of issues that caused most moral distress.ResultsWeighted to reflect all surveyed clinicians, 28.4% reported no moral distress related to work during the pandemic, 44.8% reported ‘mild’ or ‘uncomfortable’ levels and 26.8% characterised their moral distress as ‘distressing’, ‘intense’ or ‘worst possible’. The most frequently described types of morally distressing issues encountered were patients not being able to receive the best or needed care, and patients and staff risking infection in the office. Abuse of clinic staff, suffering of patients, suffering of staff and inequities for patients were also morally distressing, as were politics, inequities and injustices within the community. Clinicians who reported instances of inequities for patients and communities and the abuse of staff were more likely to report higher levels of moral distress.ConclusionsDuring the pandemic’s first 9 months, moral distress was common among these clinicians working in US safety net practices. But for only one-quarter was this significantly distressing. As reported for hospital-based clinicians during the pandemic, this study’s clinicians in safety net practices were often morally distressed by being unable to provide optimal care to patients. New to the literature is clinicians’ moral distress from witnessing inequities and other injustices for their patients and communities.

Objectives: The impact of the COVID-19 pandemic has been particularly harsh for low-income and racial and ethnic minority communities. It is not known how the pandemic has affected clinicians who provide care to these communities through safety-net practices, including clinicians participating in the National Health Service Corps (NHSC). Methods: In late 2020, we surveyed clinicians who were serving in the NHSC as of July 1, 2020, in 20 states. Clinicians reported on work and job changes and their current well-being, among other measures. Analyses adjusted for differences in subgroup response rates and clustering of clinicians within practices. Results: Of 4263 surveyed clinicians, 1890 (44.3%) responded. Work for most NHSC clinicians was affected by the pandemic, including 64.5% whose office visit numbers fell by half and 62.5% for whom most visits occurred virtually. Fewer experienced changes in their jobs; for example, only 14.9% had been furloughed. Three-quarters (76.6%) of these NHSC clinicians scored in at-risk levels for their well-being. Compared with primary care and behavioral health clinicians, dental clinicians much more often had been furloughed and had their practices close temporarily. Conclusions: The pandemic has disrupted the work, jobs, and mental health of NHSC clinicians in ways similar to its reported effects on outpatient clinicians generally. Because clinicians’ mental health worsens after a pandemic, which leads to patient disengagement and job turnover, national programs and policies should help safety-net practices build cultures that support and give greater priority to clinicians’ work, job, and mental health needs now and before the next pandemic.

ABSTRACT While increases in nonstructural carbohydrate (NSC) content of forages are generally considered advantageous, there are times during the growing season when grasses with increased NSC levels may not be the desired forage, particularly for horses (Equus caballus). Hence, there is a need to better understand carbohydrate trends across the growing season. This study evaluated 15 grass species from May to August (growth phase‐1) and from September to November (growth phase‐2) in northern Utah during 2004 and 2005 for sugars, fructans, water‐soluble carbohydrates (WSC), starch, and total nonstructural carbohydrates (TNC). Sampling date and species had a significant effect on carbohydrate concentrations in cool‐season grasses, with a lesser effect on warm‐season grasses. Warm‐season grasses had uniformly lesser sugar, fructan, WSC, and TNC concentrations than cool‐season grasses; however, they had dry‐matter yields (DMY) greater than cool‐season grasses in August. If high TNC forage is desired, then, of the grasses examined, perennial ryegrass and timothy would be the species of choice for irrigated pastures. However, if forage lower in TNC is desired, then meadow bromegrass, which had the least overall sugar, fructan, WSC, starch, and TNC concentrations, would be best. On dryland pastures, Sandberg bluegrass (Poa secunda J. Presl.) and tall wheatgrass (Thinopyrum ponticum (Podp.) Z.‐W. Liu and R.‐C. Wang) had the least overall forage carbohydrates, while crested wheatgrass (Agropyron cristatum (L.) Gaertn.) maintained its carbohydrate concentrations better on 3 August. Fructan concentrations contributed 54, 47, and 42% of the total WSC concentrations in perennial ryegrass, crested wheatgrass, and Kentucky bluegrass, respectively, compared to 26 and 29% in tall wheatgrass and creeping meadow foxtail, respectively. Water‐soluble carbohydrates accounted for between 86 and 91% of the total TNC concentration in the cool‐season grasses compared to 75 to 80% in the warm‐season grasses.

The aim of this study was to identify quantitative trait locus (QTL) associated with grain yield (GY) in a recombinant inbred line (RIL) population from a cross between two elite soft red winter wheat (SRWW) cultivars (‘Pioneer 26R61’ and ‘AGS2000’). The RIL population was grown from 2011 to 2014 in 12 site-year combinations throughout the southeastern US. Overall, AGS2000 was the higher yielding parental line, out-performing 26R61 in seven of the 12 environments. Mean GY for the RILs ranged from 3.39 to 7.16 t ha −1 with significant genotype, environment and genotype by environmental interaction effects. Nine stable QTL were detected for yield, explaining up to 53 % of the phenotypic variation when fit into a multiple-QTL model. The QTL with the largest effect was detected at the Vrn - B1 locus with the short vernalization winter allele from AGS2000 favorable for yield. In addition, vrn - B1 acted additively with a region on chromosome 2B near the Ppd - B1 locus, indicating that a shorter vernalization requirement combined with the Ppd - B1b allele for photoperiod sensitivity may play a key role in adaptation of SRWW to the southern US. Single nucleotide polymorphism markers linked to additional QTL on chromosomes 3A and 3B were in agreement with a previous genome-wide association study in spring wheat, confirming the importance of these regions for yield across environments and germplasm pools. Overall the stable QTL were more predictive of GY compared to individual site-year QTL, indicating that a targeted QTL approach can be utilized by breeding programs to enrich for favorable loci.

To the Editor: In their report on the Cytoreductive Therapy in Polycythemia Vera (CYTO-PV) study, Marchioli et al. (Jan. 3 issue) 1 provide prospective evidence confirming the appropriate hematocrit target in patients with this disease. Since the study did not mandate phlebotomy as the only method to achieve the target hematocrit and more than 50% of patients received hydroxyurea, which also lowers the leukocyte count, it is impossible to discern the relative merits of more stringent hematocrit control from the merits of a lower leukocyte count, since both variables were significantly different in the two study groups. In the editorial accompanying . . .

  While population-based injury surveillance systems are obviously the best source for such information, it is also widely recognized that such infrastructure is unlikely to be established in most of the world for several decades. [...]there is an urgent need for the global injury community to collaborate to build the methods and tools that can be used to derive reasonable estimates from a wide range of existing sources, including hospital records, police reports, health surveys, and death registers, among many others. Challenges in Estimating the Global Burden of Injuries A basic guiding principle for this project is that best estimates of the burden of deaths and nonfatal injuries should be generated by inclusion of all existing knowledge and sources of information. [...]arguably, the most important inputs for this project are existing local, regional, and national administrative data sources that routinely collect information about victims as well as research studies that have collected relevant information as part of their investigation. [...]analytical tools are needed to maximize the utility of all known data sources for estimating the burden of injuries (see, for instance, [3,4]).

Fructans are thought to have a role in physiological responses and growth under low temperatures in cool-season grasses. Two cultivars of timothy ( Phleum pratense), Vega, a Scandinavian cultivar, and Climax, introduced from England and currently grown in the U.S., were compared in relation to their response to different growth temperatures. Leaf blades of neither of the two cultivars accumulated any fructan of high degree of polymerisation (DP) in leaves when grown at constant day/night temperature of 20 °C. At temperatures lower than 20 °C, content of total carbohydrate increased, especially in Vega. At 10/5 °C (day/night), a pronounced accumulation of total carbohydrate and high DP fructans occurred. A pronounced accumulation occurred also when plants grown at 20 °C were transferred to 10 °C for several days before sampling. A decrease in temperature is thought to induce a temporary imbalance in source and sink activities. Accumulated fructan was in the 12-80 DP range. Only very small amounts of low DP oligosaccharides (DP 4-12) were detected. The two timothy cultivars showed no apparent qualitative difference in fructan accumulation. Generally, Vega had significantly higher total carbohydrate and fructan content than Climax, suggesting possible differences in genetic adaptation to cool growth temperatures.