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UNH\u27s Vashisth Receives $2.1 Million from NIH Aimed at Advancing Therapeutic Discovery
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New England Municipal Sustainability Network: A Decade of Impactful Partnership Between UNH and Local Governments
No full textDeveloping a Rural Family Health Curriculum to Promote Retention of New Graduate Nurse Practitioners
No full textBackground: There is a critical shortage of primary care providers (PCPs) in rural areas of the United States. Nurse Practitioners (NPs) are essential for addressing the primary care shortage especially in rural communities. However, significant barriers exist to the retention of NPs in rural communities, especially new graduate NPs in the first year of practice. Evidence in the literature suggests bolstering the focus on transition-to-practice for new graduate NPs to improve retention and turnover rates.
Purpose: The aim of this quality improvement project was to develop a structured, postgraduate, on-boarding curriculum at a rural outpatient family medicine clinic with the purpose of improving retention rates of new graduate nurse practitioners as primary care providers. The goal and expected outcomes of this project reflect the findings in literature including decreased turnover rates/intention to leave current positions, increased provider preparedness, increased job satisfaction, greater provider autonomy, and improved interprofessional collaboration.
Methods: The project was designed using the Plan Do Study Act (PDSA) model for quality improvement. The intervention was a formal, peer-mentored curriculum that was developed based on best practices from the literature. The curriculum was tailored to the needs of the participant based on a needs-assessment. Additional curriculum content was developed based on ideas obtained from DNP team members and resources like the Southern New Hampshire Area Health Education Center and a clinical nurse educator certificate course. The curriculum was evaluated using validated tools obtained from the National Organization of Nurse Practitioner Faculties (NONPF). Pre and Post curriculum data regarding clinical confidence, job satisfaction, interprofessional collaboration and intent to leave current position were collected to evaluate the effectiveness of the program.
Results: Quantitative data revealed significantly improved rates of clinical confidence in every specialty covered in the curriculum. Confidence levels were unchanged in specialty areas that were not covered in the curriculum which supported the association between improved confidence and completing the curriculum experience. The new grad NPs confidence in outpatient procedures was unchanged and independent clinical competence was unchanged. Scores for job satisfaction, confidence in clinical decision making, interprofessional collaboration, burnout and likelihood to remain in current position all improved for the new graduate NP after completion of the curriculum experience.
Conclusion: The goal of the curriculum was to reduce turnover rates by improving clinical confidence, interprofessional collaboration, job satisfaction and reducing burnout. The results of this quality improvement project were promising for achieving the intended aim, however, significant limitations in scope and design of the project were present. There were significant limitations to the scope of this quality improvement project that limit generalizability and will need to be addressed in future PDSA cycles for sustainability. Specifically, it would be vital to show data of improved “ramp up” times for new graduate providers to see a full schedule of patients in the family medicine clinic to validate the cost effectiveness of investing in the curriculum project. Analysis of retention rates over longer periods of time will also be essential for future PDSA cycles
EVALUATING THE EFFECTS OF AGRICULTURAL MANAGEMENT PRACTICES ON BENEFICIAL ARTHROPOD COMMUNITIES
No full textArthropods provide essential ecosystem services to our agricultural landscapes. These ecosystem services include biological control of pest organisms, including weed seeds, and plant pollination. Concerningly, however, there has been a global decline in insect populations over the last decade, a major cause of which is agricultural intensification. Previous research has demonstrated that agricultural management practices can strongly influence the species composition and abundance of arthropod communities, and therefore presumably the ecosystem services or disservices these organisms provide; however, our understanding of these interactions remains limited. I conducted three studies to investigate whether agricultural practices common in annual row crop (tillage and the use of pesticide-treated crop seeds) and perennial forage (legume species selection and forage harvest intensity) agroecosystems impact beneficial arthropod communities. In the first study (Chapter 1), I quantified the independent and interactive effects of tillage (full tillage, strip-tillage, and no-tillage) and pesticide seed treatments (seed coatings containing fungicides and neonicotinoid insecticides) on epigeal arthropod communities and weed seed predation in a corn-soybean rotation. I found that both pesticide seed treatments and tillage can influence the communities of epigeal arthropods that inhabit annual row crop agroecosystems, even relatively late in the growing season when most pesticide residues have likely dissipated. Further, I documented that the weed seed predation services provided by members of the epigeal arthropod community can be strongly negatively impacted by intensive tillage. In the second study (Chapter 2), I quantified how floral resources and associated pollinator communities vary among four perennial forage legume species (white clover, red clover, alfalfa, and birdsfoot trefoil), each grown in biculture with orchardgrass, and determined how harvest intensity (harvest treatments varying in cutting frequency and cutting height) affects these relationships. In each of the two years I found differences in floral production between the four legume bicultures, and these were most pronounced in the “early” and “mid-early” periods of the growing season. Floral production in both the alfalfa and the red clover bicultures was higher under the less frequent (3 cuts per season) compared to the more frequent (5 cuts per season) cutting regimes, while the opposite was true in the birdsfoot trefoil and white clover bicultures. Patterns of pollinator abundance and diversity roughly followed patterns of floral production and were strongly influenced by legume species and date of sampling, and to a lesser extent harvest intensity. In the third study (Chapter 3), I quantified and characterized floral resource production and pollinator abundance and diversity over two years in two perennial legume mixtures containing all four legume species (in addition to orchardgrass) and compared these to simple legume-grass bicultures of the constituent species managed under four contrasting levels of harvest intensity. I found extensive evidence of overyielding in mixture floral production, including transgressive overyielding, but not in pollinator abundance. Harvest intensity often played an important role in mediating the apparent legume mixture effects that were observed. Finally, in a one-year companion study (Appendix) I investigated whether the patterns in floral resources and pollinators observed in our previous field studies, where forages were intensively harvested, were broadly representative of an on-farm situation where perennial forages were actively grazed by dairy cows. I found that leguminous forages (primarily white clover) were present in the pasture and these provided floral resources to pollinators, even though the pasture was intensively grazed. Taken together, the results of these studies indicate that agricultural management practices play an important role in mediating the populations of beneficial arthropods and the ecosystem services they provide. These results can be used to help guide agricultural management decisions and practices that promote rather than suppress populations of these essential organisms
Analyzing Regions for the Study of Localized Fluctuations in the Ground Magnetic Field for the Development of a Global Risk-Assessment Forecast
No full textThe dynamic relationship between the solar wind and the Earth\u27s magnetic field can produce rapid changes in the geomagnetic field measured on the ground (). The fluctuations can be highly localized, with differences of up to 100s of nT/min in a small geographic area. The field of space weather is entering a more data-driven era, with enormous amounts of publicly available datasets from satellites and ground measurements. In this work modern machine learning techniques were employed to make forecasting risk-assessment predictions of large and localized , and model explainability methods were employed to understand the non-linear connections being made. These results were analyzed as a function of spatial and temporal components.
This dissertation details an effort to understand the drivers of large and localized spikes in the ground magnetic field. Twenty-four viable regions were identified for study. Additionally, modern machine learning techniques were used to forecast extreme events, and model explainability methods were utilized to enhance our understanding of the magnetospheric system and its connection to the solar wind. Using these regions and methods, the correlation between a measure of localization (RSD) and , , and were confirmed. Through the use of model explainability techniques it was shown that the inertia of the internal geomagnetic system plays a crucial role in large and localized spikes during the recovery phase of geomagnetic storms. This method uncovered spatial and temporal asymmetries in how solar wind parameters not as often associated with geomagnetic phenomena are treated by the models, indicating a larger role as drivers than previously thought