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The objective was for nurses who are covering unfamiliar oncology clinics to increase the accuracy of advice and decrease time to respond to patients calling about timing of specific medications with their complex oral chemotherapy regimens. Oral chemotherapy regimens are becoming increasingly complex, and along with that comes questions about how and when to take the pills. At Moores Cancer Center (MCC), there are 9 specialty cancer groups. It is not uncommon for a covering nurse to be unfamiliar with the particular chemo regime the patient is undergoing. With the goal of increasing accuracy and decreasing delays in time to respond to patients questions about timing of complicated chemo, a calendar smart phrase tool has been developed. This performance improvement project utilized the PDSA approach. .Txcal was created in conjunction with input from PharmDs, MCC nurses, physicians, and Epic staff. This creates the ability to place a calendar into an after visit summary, or mychart message to patients which then has the specific chemotherapy names placed on the appropriate dates. A 10 question survey was sent to MCC nurses prior to the implementation of the .Txcal smartphrase to establish a baseline. Over the course of 3 months, educational sessions and one on one meetings were held introducing the smartphrase. A 10 question survey was immediately sent out after the educational session, as well as sent out 3 months after the education to evaluate effectiveness. As a result of the .txcal smartphrase, nurses were able to respond to questions much more quickly. Response times went from \"hours and days\" to \"seconds and minutes\". There was a significant decrease in time taken to answer the questions of which medications should be taken on any given day; from 81 and 220 seconds pre-intervention to 15 and 21 seconds post intervention. Accuracy in advice was also increased. Prior to implementing the .txcal smartphrase, only 79% of the time the covering nurse was able to correctly advise on which date an oral chemotherapy should be stopped. After the implementation, 100% identified correctly which date an oral chemotherapy should be stopped. The .txcal smartphrase increased accuracy of nurses covering for other teams when advising oral chemotherapy timing with patients/family members, as well as decreased the time it took to respond.

Objectives were to determine the influence of a vitamin and mineral supplement (VTM), an energy supplement (NRG), and day post-artificial insemination (DPAI) on concentrations of glucose and non-esterified fatty acids (NEFA) in beef heifers. Cross-bred heifers (n = 72; initial weight = 351.2 kg) were assigned to 4 treatments arranged as a 2 × 2 factorial with main factors of VTM and NRG supplement. Treatments were: 1) control (no VTM or NRG), 2) VTM (initiated 71 to 106 before breeding) only, 3) NRG (initiated at breeding) only, and 4) VTM and NRG. Heifers were synchronized then bred via artificial insemination on d 0. Blood was drawn on d -9, 14, 28, and 42 from all heifers and on d 56, 70, and 84 from pregnant heifers (n = 31). Plasma samples were analyzed for concentrations of glucose and NEFA. Data were analyzed using the MIXED procedure in SAS. There were no interactions between VTM, NRG, or DPAI (P > 0.05). In addition, pregnancy status did not influence concentrations of glucose or NEFA (P > 0.05). There were no effects (P > 0.35) of VTM on glucose or NEFA concentrations. Energy supplementation increased (P = 0.012) glucose and decreased (P = 0.013) NEFA concentrations. Glucose concentrations were greatest at d -9, decreased through d 42, and then, on d 70 and 84 increased to levels similar to d -9 (81.9, 76.1, 73.6, 73.7, 74.3, 76.2, and 78.4 ± 2.97 for d -9, 14, 28, 42, 56, 70, and 84, respectively). Concentrations of NEFA were greater (P < 0.01) at d -9 compared with 14, 28, 42, 56, and 70, and concentrations on d 84 were greater (P < 0.01) than all other days. In conclusion, glucose and NEFA were affected by NRG and DPAI, but not VTM.

Sauer et al discuss the effects of a vitamin and mineral supplement and an energy supplement on concentrations of glucose and non-esterified fatty acids in artificially inseminated beef heifers up to d 84 post-insemination. They aim to determine the influence of a vitamin and mineral supplement (VTM), an energy supplement (NRG), and day post-artificial insemination (DPAI) on concentrations of glucose and non-esterified fatty acids (NEFA) in beef heifers. They conclude that glucose and NEFA were affected by NRG and DPAI, but not VTM.

The primary purpose of this investigation was to research the dental hygiene baccalaureate degree completion program directors' level of agreement with and efforts to educate toward the six enhanced roles advocated by the American Dental Hygienists' Association. These roles, which are thought to educate a dental hygiene generalist, include clinician, consumer advocate, educator/health promoter, change agent, researcher, and administrator/management. In conjunction, the study sought to obtain demographics and determine the level of interest in professional accreditation of degree completion programs. The methodology consisted of a specifically designed questionnaire which was mailed to the directors of the forty-six dental hygiene baccalaureate degree completion programs identified by the American Dental Hygienists' Association. The response rate was 81%. The results of the demographics section indicated few changes from previous such investigations. Concerning education toward each of the roles there was strong agreement with each of the role definitions and descriptors or goals as well as harmony with institutional mission statements. Student assessment both before and after enrollment disclosed that most were seen as either well or partially prepared to assume the roles. All disciplines-dental hygiene, liberal arts and specialty courses-were seen as enhancing or contributing toward development of each of the roles. There was variable interest in a professional accreditation of degree completion programs. There was a 91% agreement with the statement regarding the degree completion programs preparing students for new entry level positions beyond those of the certificate level. However, there was less overall agreement with the statements regarding the need for specific accreditation of the programs (46%) or with utilizing professional role development as the basis for a curricular standard in such a process (37%). The conclusions which may be drawn from the study include the high overall agreement with the concept of the enhanced roles for dental hygienists; that these roles are compatible with the mission statements of the programs and that the majority of responding programs have begun to direct educational efforts toward development of the roles in their curricula.

In this population-based cohort study that included data on all live births in Brazil from 2015 to 2018, infants with congenital Zika syndrome had substantially higher mortality over the first 3 years of life than those without the syndrome.

Species extinctions have defined the global biodiversity crisis, but extinction begins with loss in abundance of individuals that can result in compositional and functional changes of ecosystems. Using multiple and independent monitoring networks, we report population losses across much of the North American avifauna over 48 years, including once-common species and from most biomes. Integration of range-wide population trajectories and size estimates indicates a net loss approaching 3 billion birds, or 29% of 1970 abundance. A continent-wide weather radar network also reveals a similarly steep decline in biomass passage of migrating birds over a recent 10-year period. This loss of bird abundance signals an urgent need to address threats to avert future avifaunal collapse and associated loss of ecosystem integrity, function, and services.

Chinese investments into fossil fuel-based electricity generation capacity under its belt and road initiative will create lock-in for decades. Despite China’s recent rise as major public finance provider for the electricity sector of the developing world and the related environmental impacts, there is limited knowledge of the extent and characteristics of non-Chinese participation in Chinese-funded projects. We apply complexity theory approaches and network modeling on a new dataset that links funding activities of developmental institutions (Chinese developmental institutions (CDIs), Western-backed multilateral development banks (MDBs)) and the involvement of companies in different roles (i.e., as direct investors, contractors, equipment suppliers, and other service providers) to power plants around the world at the unit-level (1999–2020). Previous literature suggests that CDI funded projects show preference to Chinese commercial partners, but we find more than 70% include non-Chinese participants. This also applies for fossil-fuel based technologies where we observe increasing shares of international actors that together account for nearly every third commercial linkage. However, involvement levels and interaction patterns not only differ by technologies (fossils, hydro, non-hydro renewable, nuclear) but also by the time period and types of commercial partners and we observe overall convergence between the CDI- and MDB-supported power plant networks over time. The decreasing involvement of Chinese companies in CDI-funded projects, across technologies, in favor of increasing Western involvement, has important implications for development and climate policy on which we elaborate. However, the failure of both MDB and CDI funding to promote domestic company involvement in the recipient countries may be the largest failing of both sets of agencies in the pursuit of development outcomes.