A pediatric intensivist in the University of Iowa Hospitals and Clinic's (UIHC) Pediatric Intensive Care Unit (PICU) was concerned about antimicrobial use in the unit. However, no one had quantified antimicrobial use in the UIHC's PICU or described the patterns of antimicrobial use in this unit. To address the intensivist's concern, the principal investigator (PI) conducted a retrospective study to determine the percentage of patients who received antimicrobial treatments, to determine the indications for antimicrobial use, and to identify antimicrobial agents used most frequently in the unit. On basis of our data, we hypothesized that empiric antimicrobial use, particularly the duration of therapy, could be decreased. We implemented a six-month intervention during which we asked the pediatric intensivists to complete an antimicrobial assessment form (AA) to document their rationale for starting antimicrobial treatments. We postulated that this documentation process might remind physicians to review antimicrobial therapies, especially empiric therapies, when the microbiologic data became available. In addition, we utilized the AA form to identify factors pediatric intensivists considered when deciding to prescribe empiric antimicrobial treatments. Data from the AA forms suggested that pediatric intensivists in the UIHC's PICU often considered elevated C-reactive protein, elevated white blood cell counts, and elevated temperatures when deciding to start empiric antimicrobial therapy. Data from the three nested periods showed that the median duration of empiric and targeted treatments decreased during the intervention and remained stable during the post-intervention period. The PI estimated that 193 days of empiric antimicrobial therapy and 59 days of targeted antimicrobial therapy, respectively, may have been saved by the decreased durations of therapy. Time series analysis assessing the trend in use of piperacillin-tazobactam, cefepime, and ceftriaxone (measured in mg/wk) did not reveal a significant change over time. On the basis of our results, an intervention strategy using an AA form alone may not be an effective strategy for antimicrobial stewardship in PICUs. Additional measures such as automatic stop orders and computer decision support may be useful for reducing the duration of empiric therapy in PICUs.

Objective: To understand the association between dental insurance coverage and dental care utilization in Iowa children. Methods: The 2010 Iowa Child and Family Household Health Survey (IHHS) data was used to assess the association between dental insurance coverage and dental care utilization in Iowa children. Andersen’s model of health services utilization was used as a framework for determining the predictors of dental care utilization. Chi-square test was used for determining bivariate associations and Logistic regression analysis was used to determine factors associated with dental care utilization. Results: The results from the multivariable logistic regression model indicate that children with private dental insurance (p<0.001) and 4-9 years of age (p=0.005) were more likely to have a dental visit. Additionally, respondents who were always able to get dental appointments for their child (p<0.001), had a regular source of dental care for the child (p<0.001) and perceived dental need for their child (p<0.001), were more likely to report having a dental check-up for their child in the past 12 months. Conclusion: Dental insurance was significantly associated with having a dental visit in the past year in Iowa children 4-17 years of age. Some of the other predictors of dental care utilization were: having a regular source of dental care for the child, ease of getting dental appointment for the child, younger child’s age and having perceived dental need for the child.

Forages containing condensed tannins (CT) have potential to reduce the environmental impact of dairy farming. In 3 studies, I hypothesized that feeding CTcontaining birdsfoot trefoil (Lotus corniculatus, BFT) would result in improved nutrient utilization and lactational performance of dairy cows compared with control forages of the respective experiments. Improved milk components, reduction in waste N, and overall improved N efficiency were hypothesized for BFT-fed cows compared to those cows fed alfalfa hay (Study 1) or grass-based diets (Study 2). In addition, a decrease in in vitro methane production and improved rumen fermentation due to diets based on BFT pasture and concentrate supplementation compared with grass pasture-based diets was the hypothesis of the third study. Study 1 showed BFT-hay diets improved lactational performance through increased energy-corrected milk yield and increased milk protein yield, resulting in improved N utilization efficiency compared with the alfalfa hay diet. Total volatile fatty acids concentration tended to increase, and greater microbial protein yield was exhibited by cows fed BFT compared to other diets tested. Therefore, BFT can replace alfalfa hay in dairy diets and showed improved feed and N utilization efficiencies and lactational performance. Study 2 determined that pasture nutrient content increased for BFT pasture compared to the mixed grass control, contributing to increases in milk yield most weeks during the 2-year study. Energy-corrected milk yield increased most weeks by BFT-grazed cows due to increased milk yield, although milk protein concentration was similar between treatments. Cows grazing BFT pasture increased N efficiency coupled with decreased milk urea N secretion in the first, but not the second year, suggesting an environmental advantage over traditional grass-based pastures depending on the effect of growing conditions on pasture quality at time of grazing. Study 3 showed that offering BFT pasture to continuous cultures without or with barley grain or total mixed ration supplements reduced methane production and altered rumen microbial populations. The reduced methane production on the continuous cultures was likely due to direct and/or indirect effects of CT on rumen microbiota. Overall, diets including BFT showed improved nutritive, lactational, and environmental benefits by decreasing N waste and methane production over typical alfalfa hay-based dairy diets and grass pastures.

Three experiments were conducted to evaluate low quality forages treatment by anhydrous ammonia (NH3) and(or) hydrogen peroxide (H2O2). In experiment I, a control and three treatments of barley straw were compared: NH3, NH3 after rehydration of the straw with water (NH3+H2O), and NH3 after rehydration with a H2O2 solution (NH3+H2O2). Forages were fed, with a supplement, at two levels of intake (ad libitum and 75% of ad lib.). Treatments were administered in a split-plot in a Latin square design to 8 ewes. Total collections and rumen digesta measurements were made. Ammoniation, rehydration, and H2O2 increased primarily dry matter intake (DMI) but also digestibility of different nutrients. A similar trend was observed in rumen fermentation characteristics. Dry matter (DM) digestibility was slightly raised by limiting DMI. Digestible DMI (DDMI) was correlated with both the increase of forage CP content and the decrease of forage neutral detergent fiber. Water intake and output were highly correlated with fiber. Intake and digestibility better than acid detergent lignin insoluble ash (ADLIA). Both markers were adequate in determining hemicellulose digestibility. In experiment II, ten solutions were prepared to rehydrate wheat straw. Six solutions were adjusted (with NaOH) to a pH of 9, 11, or 13 and contained 2% H2O2. Four solutions had a pH of 7 or 11 and contained no H2O2. Half of the straws were treated with NH3. In situ DM disappearance (DMD) of the different straws was measured at different times in 10 Holstein cows and three periods (Incomplete block design). The evolution of DMD was slow and almost linear. The positive effect of ammoniation on DMD was consistently apparent at all pH levels though depressed at pH 11. The effect of H2O2 was minor, but was complementary with ammoniation. In experiment III, mature baltic rush (Juncus balticus Willd.) was either treated or not with NH3. Eight wethers had ad libitum access to the nonsupplemented forages in a cross-over design. total collections and rumen digesta measurements were made. DMI and DDMI were not affected by treatment, but DM digestibility was decreased by ammoniation.

Censuses of two 20-acre plots in upper Logan Canyon, Utah, were made by the spot-mapping method during 1970 and 1971 to determine the differences in composition and density of breeding-bird populations in aspen stands of significantly different density and stature. The less dense stand of greater average d.b.h., average height and per cent ground cover had 20 breeding species totalling 615 pairs per 100 acres (expressed as equivalent territories). The more dense stand of smaller trees and brushy undergrowth had 14 breeding species with 267.5 equivalent territories per 100 acres. Nine species were found on both areas. Observations of foraging height were made concurrently with recordings of time spent at various methods of feeding- ground, vi foliage, bark, hover, and hawking- for the birds of the more open stand. Comparison showed that more ground- and low bush-nesters were present on the dense, brushy stand whereas more cavity-nesters were found in the larger trees. Cavity excavation was limited to trees of greater d.b.h. and cavity-dependent birds were thus limited by nest-hole availability. The horizontal, heavy branch stubs preferred by pewees and tree swallows and the high perches and open areas of the olive-sided flycatcher were also limited to the less dense stand. Cassin's finches and pine siskins were not found in the dense stand which had fewer invading conifers and was farther from conifer stands. Attributes of the terrain, foraging sites, nest sites, and location of perches were analyzed as possible proximate factors of habitat selection within aspen.

Patterns of grazing on individual crested wheatgrass plants were studied using scale maps of plant basal outlines within randomly located plots. The occurrence and extent (part of plant grazed, stubble height) of grazing on each plant was recorded on the maps at two and three day intervals throughout a grazing treatment. Allometric equations for estimating phytomass from plant photosynthetic volume were generated using nonlinear regression analysis. Equations were specific to year. The percent weight remaining in the stubble of a grazed plant was estimated using a second-order polynomial equation relating cumulative percent plant height to cumulative percent plant weight. A modified bootstrap analysis was used due to the autocorrelated nature of these data. These equations were used to estimate the percent biomass grazed from individual plants. The presence of standing dead culms substantially reduced the severity of grazing on individual crested wheatgrass plants. This effect was most pronounced for large plants. The deterrence effect of xiii standing dead culms declined as plants matured, but remained an important factor affecting grazing severity. The pattern of grazing on crested wheatgrass plants was examined under three grazing systems: 1) continuous season-long grazing (CSLG), 2) high intensity grazing (approximately 60 percent utilization in eight days), and 3) short duration grazing. For all grazing treatments, a lower proportion of small plants was grazed than medium and large. Only under CSLG were small plants grazed more severely than large plants. Under all ocher grazing treatments, medium and large plants were grazed as severely as small plants. The proportion of plants regrazed was low when grazing began at the boot phenological stage and regrowth was minimal. It was higher when grazing began at later phenological stages , presumably due to the presence of regrowth. The proportion of small grazed plants that were regrazed was much lower than the proportion of large grazed plants that were regrazed. The re grazing event, however, involved, on average, more of the previously ungrazed portion of a plant than the part which had been grazed before. These results indicate that grazing of regrowth on crested wheatgrass pastures under CSLG may not be a serious problem.

In this study, biogeochemical regimes of Marguerite Bay and the adjacent part of the West Antarctic Peninsula (WAP) continental shelf were delineated through integration of nutrient, hydrographic, and biological measurements obtained during the LTER and SO GLOBEC studies during austral summer, autumn, and winter of 2001 and 2002. Marguerite Bay biogeochemical regime was found to differ from those of the adjacent WAP continental shelf. In terms of Treguer and Jacques (1992), Marguerite Bay is a combination of Coastal Continental Shelf Zone (CCSZ) and Seasonal Ice Zone (SIZ) distinguished by shallow mixing regime, high primary production and export production. At the end of the growing season (autumn) in both years, waters in Marguerite Bay were strongly depleted in nutrients (the deficits of total inorganic nitrogen (NO3-+NO2-+NH4+) and silica were >0.6 mol m-2 and >2.5 mol m-2, respectively). Observed ΔN/ΔP removal ratios of 10-12.5, lower than that of Redfield et al. (1963), and ΔSi/ΔN removal ratios as high as 4-5 indicated the dominance of diatoms. High autumnal ammonium stocks (>0.25 mol m-2) were observed in Marguerite Bay and were co-located with the areas of the highest nutrient deficits suggesting spatial coupling between primary and heterotrophic production during both years. Consistency of this feature was not disrupted by significant interannual variability of biological production in Marguerite Bay that resulted in ~30-50% reduction in nutrient deficits and ammonium stocks from the first year to the next.The other two biogeochemical regimes were at the central part of the continental shelf characterized by mixed phytoplankton community and at the outer shelf dominated by diatoms. Both regimes were characterized by considerably lower depletion of nutrients compare to those of the Marguerite Bay regime and were consistent between the two years. Interannual variability of biological production and possible sources of high ammonium stocks in Marguerite Bay were studied with a one-dimensional model, a modification of that of Walsh et al. (2001). The model attributed the decline in nutrient deficits to the difference in sea ice cover dynamics between two years. The greater sea ice presence led to the somewhat lower primary production during the second year compare to the fist one. Moreover, model's tight coupling between primary and bacterial production resulted in a decline of bacterial ammonification between the two years. Bacteria were found to be the primary source of ammonium in the Marguerite Bay model. Yet, 3-4-fold fluctuations in macro- and mesozooplankton biomass might have led to 15-25% variability in model's autumnal ammonium stocks.

Mental disorders among adolescents are on the rise and are among the most common chronic conditions, constituting a national epidemic. Prevalence rates indicate that 20–40% of the adolescent population in the U.S. suffers from emotional or behavioral difficulties significant enough to lead to functional impairment. Further, estimates suggest that more than 20% of the adolescent population has a diagnosable mental disorder, which significantly impacts their functioning substantially at school, at home and in their communities. Despite national agendas to address the mental health needs of adolescents, studies suggest that approximately 50 percent of adolescents with mental health needs do not seek mental health services. Framed within the Andersen Behavioral Health Model, the objective of this research was to identify and describe the factors that contribute to the under-utilization of mental health services among adolescents. A qualitative meta-synthesis of the literature was conducted to identify the contributing factors. The goal of a meta-synthesis is to provide a greater depth of knowledge and a more extensive understanding of both the theory and the phenomena being studied. A meta-synthesis of 12 qualitative studies was conducted. Focusing on qualitative studies provides a deeper understanding of the contextual issues involved in the utilization of mental health services for adolescents. Findings from this study suggest that need and enabling factors are important drivers of mental health service use and adolescents’ and parents’ perceptions of services, providers, and sigma are particularly important to determining use of services. The study also identified that opinions of families and peers can influence whether or not an adolescent will remain in treatment. It is critical to increase understanding of the role social networks as many adolescents suggest their network may provide some form of informal support. It may be beneficial to focus specifically on the provision of peer-delivered support services for adolescents as well as develop and implement strategies aimed at improving perceptions around mental health. Adolescence is a critical point in time when social and emotional development are encouraged; if mental health needs are not addressed during this developmental stage, many adolescents will potentially experience more severe disorders in adulthood.

Background: The nurses’ responsibility is to give good and safe health care based on nursing science and proved practice, and also keeping up to date with the latest nursing science. The most common use of research utilization is instrumental, which is nursing science directly applied when caring for patients. By acquiring and utilizing new nursing science, the nurse is able to develop safe care for patients.  Aim: The aim of this review was to describe nurses’ perceptions of implementing research science in clinical practice. Method: A literary review based on studies acquired from the database CINAHL Complete and Academic Search Complete  Result: The impact of nursing science describes that nurses believe nursing science as important for the evolvement and quality of the profession, but perceives it to be too complex to utilize. Nurses’ perceptions of barriers and facilitators towards research utilization in nursing science describe what organizational factors affect nurses´ perceptions of research utilization in nursing care. Nurses also describe that they want to utilize research, but they lack the skill to critically appraise scientific literature. Lack of time and low research availability are described as barriers towards research, and support and engagement from nursing administrators are considered a facilitator towards better research utilization. Discussion: Despite having a positive attitude towards nursing science, the result shows that the nurses today find it difficult to implement it in a clinical practice. The results indicate that there needs to be support from the management to facilitate research utilization in a clinical practice.

Perovskite-type oxides show irrefutable potential for feasible thermochemical solar-driven CO2 conversion. These materials exhibit the exact characteristics required by the low temperature reverse water-gas shift chemical looping process. These properties include structural endurance and high oxygen redox capacity, which results in the formation of numerous oxygen vacancies, or active sites for CO2 conversion. A major drawback is the decrease in oxygen self-diffusion with increasing perovskite particle size. In this study, the La0.75Sr0.25FeO3 (LSF) perovskite oxide was combined with various supports including popular redox materials CeO2 and ZrO2 along with more abundant alternatives such as Al2O3, SiO2, and TiO2, in view of its potential application at industrial scale. Supporting LSF on SiO2 by 25% mass resulted in the largest increase of 150% in CO yields after reduction at 600 °C. This result was a repercussion of significantly reduced perovskite particle size confirmed by SEM/TEM imaging and Scherrer analyses of XRD patterns. Minor secondary phases were observed during the solid-state reactions at the interface of SiO2 and TiO2. Density functional theory-based calculations, coupled with experiments, revealed oxygen vacancy formation only on the perovskite phase at these low temperatures of 600 °C. The role of each metal oxide support towards suppressing or enhancing the CO2 conversion has been elucidated. Through utilization of SiO2, the reverse water-gas shift chemical looping process using perovskite-based composites was significantly improved.