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The surge in critically ill patients has pressured hospitals to expand their intensive care unit capacities and critical care staff. This was difficult given the country's shortage of intensivists. This paper describes the implementation of a multidisciplinary central line placement team and its impact in reducing the vascular access workload of ICU physicians during the height of the COVID-19 pandemic. Vascular surgeons, interventionalists, and anesthesiologists, were redeployed to the ICU Access team to place central and arterial lines. Nurses with expertise in vascular access were recruited to the team to streamline consultation and assist with line placement. While 51 central and arterial lines were placed per 100 ICU patients in 2019, there were 87 central and arterial lines placed per 100 COVID-19 ICU patients in the sole month of April, 2020. The ICU Access Team placed 107 of the 226 vascular access devices in April 2020, reducing the procedure-related workload of ICU treating teams by 46%. The ICU Access Team was able to complete a large proportion of vascular access insertions without reported complications. Given another mass casualty event, this ICU Access Team could be reassembled to rapidly meet the increased vascular access needs of patients.

Executive Summary * The purpose of this quality improvement project was to develop a catheter-associated urinary tract infection (CAUTI) reduction program focusing on developing best practices and transferring them across the healthcare organization. * Quantitative measures and formative evaluation processes used to determine success of the program were by measures of standardized infection ratio, incidence, and catheter days for both North Shore University Hospital and Northwell Health in both the intensive care unit (ICU) and non-ICU areas. * Processes such as CAUTI root cause analysis, CAUTI rounds, CAUTI ambassadors, and development of novel ideas contributed to the program's success. * Development and autonomy of frontline staff contributed to improvement in safe quality care to patients. Beginning 2015, the Centers for Medicare & Medicaid Services (CMS) altered the guidelines and reporting structures around hospital-acquired conditions (HACs) (CMS, 2016). [...]to move away from volume of care to value of care, CMS, under Section 3008 of the Affordable Care Act, mandated that hospitals reduce HACs not present on admission (CMS, 2016). The Centers for Disease Control and Prevention (CDC) and the National Healthcare Safety Network (NHSN) (2013) estimate there were more than 93,300 urinary tract infections (UTIs) in acute care hospitals in 2011, accounting for 12% of acute care infections. According to North Shore University Hospital (NSUH) performance and financial data, the average cost for a patient with a CAUTI is estimated at $1,642 per case. [...]in 2013, a CAUTI reduction program was launched which focused on developing best practices transferable across Northwell...

While the role of the Registered Nurse (RN) has evolved since Nightingale’s time, providing care to the dying continues to be an important skill provided by nurses of every specialty. Today’s medicine incorporates modern technology, thereby extending life for those with serious illnesses. Patients and families expect expert quality management of their care since consumers are increasingly educated about health care issues. Information today is available through a variety of sources, such as the internet, providing an increased wealth of information about disease processes and treatments. Family participation in treatment choices and decisions about impending death has greatly impacted care in the Intensive Care Unit (ICU) and transition to Palliative Care (PC). As technological changes in healthcare, the nurse’s role during End of Life (EOL) continues to evolve since ICU patients require higher levels of care and advanced technology, all of which are monitored by nurses.The purpose of this research was to determine the relationship of Compassion Satisfaction (CS), Compassion Fatigue (CF), and Death Anxiety (DA) on Role Ambiguity (RA) and Role Conflict (RC) in ICU nurses providing care at EOL. The study utilized a quantitative non-experimental correlation design. The population included critical care nurses currently working as staff in an ICU who were able to read Standard English. The sample participants were a convenience sample targeting nurses with 1 or more years of ICU experience. Instruments included The Professional Quality of Life Scale (ProQOL) (Stamm, 2010), Rizzo’s Role Conflict and Role Ambiguity Scales (RQ) (Rizzo et al. 1970), and Templer’s Death Anxiety Scale (DAS) (1970). Additionally, the researcher developed a Socio-demographic Data Form and Questionnaire. Lastly, participants answered nine questions relating to their experiences which were relevant to the study’s aim. These nine questions addressed participant practices as pertained to EOL care. The final portion of the analysis focused on two research questions that required a narrative response from study participants. The participant narratives were analyzed using content and thematic analysis.The major findings of this study were that: 1. Nurses’ role ambiguity and role conflict were negatively related to compassion satisfaction; 2. Nurses’ role ambiguity and conflict were positively related to compassion fatigue; 3. Nurses role ambiguity and role conflict were positively related to death anxiety; 4. There was no relationship between increased years of ICU experience and role ambiguity and role conflict; 5. Analyses were conducted to examine the relationship of role ambiguity and role conflict to the demographic variables. Within the demographic questionnaire the analysis revealed five demographic variables that were related to role ambiguity. There was a significant relationship with gender and role ambiguity demonstrating that men have more role ambiguity then women. There was a significant relationship based on the type of ICU in which participants were employed. There was a significant relationship based on the number of ICU beds in the participant’s hospital. For role conflict, there was a significant relationship for participants’ and their entry level into practice. There was a significant relationship with religion and role conflict. Based on these findings, Hypothesis 5 is partially supported.Additional analysis demonstrated role ambiguity had a negative beta value accounting for 26.7% of the variance. This suggested that as compassion satisfaction decreases, role ambiguity increases. Lastly for role conflict, only burnout (BO) proved to be significant, accounting for 24.2% of the variance. This suggests that as ICU nurses experience increased role conflict they experience higher levels of burnout. While the findings from this study are not generalizable to the population at large, these findings may have implications for nursing practice.Nurse administrators, educators, and policy makers should use the information from this study to guide practice, considering that stress, fatigue, and death anxiety may contribute to a nurse’s intent to leave their job or the field entirely. Understanding how these factors impact quality of care and safety for patients and families at EOL remains of great concern. Equally important is the fact that death anxiety is as important factor which can impact care at end of life. Nursing research should continue to investigate death anxiety along with its prevalence and impact on compassion satisfaction and compassion fatigue.

ObjectivesTo determine if a newer design of total knee replacement (TKR) (Journey II BCS) produces superior patient-reported outcomes scores and biomechanical outcomes than the older, more established design (Genesis II).SettingPatients were recruited from an NHS University Hospital between July 2018 and October 2019 with surgery at two sites. Biomechanical and functional capacity measurements were at a University Movement and Exercise Laboratory.Participants80 participants undergoing single-stage TKR.InterventionsPatients were randomised to receive either the Journey II BCS (JII-BCS) or Genesis II TKR.Primary and secondary outcome measuresPrimary outcome was the Oxford Knee Score (OKS), at 6 months. Secondary outcomes were: OKS Activity and Participation Questionnaire, EQ-5D-5L and UCLA Activity scores, Timed Up and Go Test, 6 min walk test, lower limb kinematics and lower limb muscle activity during walking and balance.ResultsThis study found no difference in the OKS between groups. The OKS scores for the JII-BCS and Genesis II groups were mean (SD) 42.97 (5.21) and 43.13 (5.20) respectively, adjusted effect size 0.35 (-2.01,2.71) p=0.771In secondary outcome measures, the Genesis II group demonstrated a significantly greater walking range-of-movement (50.62 (7.33) vs 46.07 (7.71) degrees, adjusted effect size, 3.14 (0.61,5.68) p=0.02) and higher peak knee flexion angular velocity during walking (mean (SD) 307.69 (38.96) vs 330.38 (41.40) degrees/second, adjusted effect size was 21.75 (4.54,38.96), p=0.01) and better postural control (smaller resultant centre of path length) during quiet standing than the JII-BCS group (mean (SD) 158.14 (65.40) vs 235.48 (176.94) mm, adjusted effect size, 59.91 (–105.98, –13.85) p=0.01.).ConclusionsIn this study population, the findings do not support the hypothesis that the Journey II BCS produces a better outcome than the Genesis II for the primary outcome of the OKS at 6 months after surgery.Trial registration numberISRCTN32315753.

Seedling root traits impact plant establishment under challenging environments. Pearl millet is one of the most heat and drought tolerant cereal crops that provides a vital food source across the sub-Saharan Sahel region. Pearl millet’s early root system features a single fast-growing primary root which we hypothesize is an adaptation to the Sahelian climate. Using crop modeling, we demonstrate that early drought stress is an important constraint in agrosystems in the Sahel where pearl millet was domesticated. Furthermore, we show that increased pearl millet primary root growth is correlated with increased early water stress tolerance in field conditions. Genetics including genome-wide association study and quantitative trait loci (QTL) approaches identify genomic regions controlling this key root trait. Combining gene expression data, re-sequencing and re-annotation of one of these genomic regions identified a glutaredoxin-encoding gene PgGRXC9 as the candidate stress resilience root growth regulator. Functional characterization of its closest Arabidopsis homolog AtROXY19 revealed a novel role for this glutaredoxin (GRX) gene clade in regulating cell elongation. In summary, our study suggests a conserved function for GRX genes in conferring root cell elongation and enhancing resilience of pearl millet to its Sahelian environment. Pearl millet is a staple food for over 90 million people living in regions of Africa and India that typically experience high temperatures and little rainfall. It was domesticated about 4,500 years ago in the Sahel region of West Africa and is one of the most heat and drought tolerant cereal crops worldwide. In most plants, organs known as roots absorb water and essential nutrients from the soil. Young pearl millet plants develop a fast-growing primary root, but it is unclear how this unique feature helps the crop to grow in hot and dry conditions. Using weather data collected from the Sahel over a 20-year period, Fuente, Grondin et al. predicted by modelling that early drought stress is the major factor limiting pearl millet growth and yield in this region. Field experiments found that plants with primary roots that grow faster within soil were better at tolerating early drought than those with slower growing roots. Further work using genetic approaches revealed that a gene known as PgGRXC9 promotes the growth of the primary root. To better understand how this gene works, the team examined a very similar gene in a well-studied model plant known as Arabidopsis. This suggested that PgGRXC9 helps the primary root to grow by stimulating cell elongation within the root. Since it is well adapted to dry conditions, pearl millet is expected to play an important role in helping agriculture adjust to climate change. The findings of Fuente, Grondin et al. may be used by plant breeders to create more resilient and productive varieties of pearl millet.

Interest in ultrasound education in medical schools has increased dramatically in recent years as reflected in a marked increase in publications on the topic and growing attendance at international meetings on ultrasound education. In 2006, the University of South Carolina School of Medicine introduced an integrated ultrasound curriculum (iUSC) across all years of medical school. That curriculum has evolved significantly over the 9 years. A review of the curriculum is presented, including curricular content, methods of delivery of the content, student assessment, and program assessment. Lessons learned in implementing and expanding an integrated ultrasound curriculum are also presented as are thoughts on future directions of undergraduate ultrasound education. Ultrasound has proven to be a valuable active learning tool that can serve as a platform for integrating the medical student curriculum across many disciplines and clinical settings. It is also well-suited for a competency-based model of medical education. Students learn ultrasound well and have embraced it as an important component of their education and future practice of medicine. An international consensus conference on ultrasound education is recommended to help define the essential elements of ultrasound education globally to ensure ultrasound is taught and ultimately practiced to its full potential. Ultrasound has the potential to fundamentally change how we teach and practice medicine to the benefit of learners and patients across the globe.

Seedling root traits impact plant establishment under challenging environments. Pearl millet is one of the most heat and drought tolerant cereal crops that provides a vital food source across the sub-Saharan Sahel region. Pearl millet’s early root system features a single fast-growing primary root which we hypothesize is an adaptation to the Sahelian climate. Using crop modeling, we demonstrate that early drought stress is an important constraint in agrosystems in the Sahel where pearl millet was domesticated. Furthermore, we show that increased pearl millet primary root growth is correlated with increased early water stress tolerance in field conditions. Genetics including genome-wide association study and quantitative trait loci (QTL) approaches identify genomic regions controlling this key root trait. Combining gene expression data, re-sequencing and re-annotation of one of these genomic regions identified a glutaredoxin-encoding gene PgGRXC9 as the candidate stress resilience root growth regulator. Functional characterization of its closest Arabidopsis homolog AtROXY19 revealed a novel role for this glutaredoxin (GRX) gene clade in regulating cell elongation. In summary, our study suggests a conserved function for GRX genes in conferring root cell elongation and enhancing resilience of pearl millet to its Sahelian environment. Pearl millet is a staple food for over 90 million people living in regions of Africa and India that typically experience high temperatures and little rainfall. It was domesticated about 4,500 years ago in the Sahel region of West Africa and is one of the most heat and drought tolerant cereal crops worldwide. In most plants, organs known as roots absorb water and essential nutrients from the soil. Young pearl millet plants develop a fast-growing primary root, but it is unclear how this unique feature helps the crop to grow in hot and dry conditions. Using weather data collected from the Sahel over a 20-year period, Fuente, Grondin et al. predicted by modelling that early drought stress is the major factor limiting pearl millet growth and yield in this region. Field experiments found that plants with primary roots that grow faster within soil were better at tolerating early drought than those with slower growing roots. Further work using genetic approaches revealed that a gene known as PgGRXC9 promotes the growth of the primary root. To better understand how this gene works, the team examined a very similar gene in a well-studied model plant known as Arabidopsis. This suggested that PgGRXC9 helps the primary root to grow by stimulating cell elongation within the root. Since it is well adapted to dry conditions, pearl millet is expected to play an important role in helping agriculture adjust to climate change. The findings of Fuente, Grondin et al. may be used by plant breeders to create more resilient and productive varieties of pearl millet.

Seedling root traits impact plant establishment under challenging environments. Pearl millet is one of the most heat and drought tolerant cereal crops that provides a vital food source across the sub-Saharan Sahel region. Pearl millet early root system features a single fast-growing primary root which we hypothesize is an adaptation to the Sahelian climate. Using crop modelling, we demonstrate that early drought stress is an important constraint in agrosystems in the Sahel where pearl millet was domesticated. Furthermore, we show that increased pearl millet primary root growth is correlated with increased early water stress tolerance in field conditions. Genetics including GWAS and QTL approaches identify genomic regions controlling this key root trait. Combining gene expression data, re-sequencing and re-annotation of one of these genomic regions identified a glutaredoxin-encoding gene PgGRXC9 as the candidate stress resilience root growth regulator. Functional characterization of its closest Arabidopsis homolog AtROXY19 revealed a novel role for this glutaredoxin (GRX) gene clade in regulating cell elongation. In summary, our study suggests a conserved function for GRX genes in conferring root cell elongation and enhancing resilience of pearl millet to its Sahelian environment.Competing Interest StatementThe authors have declared no competing interest.Footnotes* Added explanation on the population genetics and transcriptomics. Revised figure 4 to include a scalebar. Changed the conclusion to tone down some sentences.

This unique collection of case studies introduces readers to many of the common yet extraordinary social problems in contemporary American society. Employing a symbolic interaction approach to the case studies, the authors identify the origins of the problems, define the issues, and explore the outcomes and potential remedies. The case studies themselves introduce readers to the very personal side of the problems as the emotions, actions, and perceptions of the subjects are revealed and analyzed. The problems studied here are organized into three categories— health-related issues, family issues, and behavior beyond the boundaries—and include many problems that often receive too little attention in the existing literature, making this book an original and timely contribution. Each of the three sections is preceded by a general review of the chapters to follow and offers readers a prelude to the exploration of human thought, language, and behavior captured and illustrated in the case studies. In the first section of the book, problems covered include suicide, anorexia nervosa, alcohol and drug abuse, and AIDS/STDs. The second section covers teenage mothers, domestic violence, divorce and poverty, child support and deadbeat dads, and homelessness. The last section focuses on sexual harassment, equal protection and racial exclusion, prostitution, career criminals, mass murder, and serial killers. This book represents a fresh new approach and a welcome addition to the study of social problems in America today.

Editors' introduction to a special issue, containing essays which seek to inaugurate amongst British lawyers an informed debate about the implications of the genetic revolution. The essays focus primarily on human genetics, although other forms are touched upon in some contributions. (Quotes from original text)