Exercise, diet, and sleep habits of nurses working full-time during the COVID-19 pandemic: An observational study

BACKGROUND

Healthy diet, exercise, and sleep practices may mitigate stress and prevent illness. However, lifestyle behaviors of acute care nurses working during stressful COVID-19 surges are unclear.

PURPOSE

To quantify sleep, diet, and exercise practices of 12-hour acute care nurses working day or night shift during COVID-19-related surges.

METHODS

Nurses across 10 hospitals in the United States wore wrist actigraphs and pedometers to quantify sleep and steps and completed electronic diaries documenting diet over 7-days.

FINDINGS

Participant average sleep quantity did not meet national recommendations; night shift nurses (n = 23) slept significantly less before on-duty days when compared to day shift nurses (n = 34). Proportionally more night shift nurses did not meet daily step recommendations. Diet quality was low on average among participants.

DISCUSSION

Nurses, especially those on night shift, may require resources to support healthy sleep hygiene, physical activity practices, and diet quality to mitigate stressful work environments.

Late Holocene volcanic and anthropogenic mercury deposition in the western Central Andes (Lake Chungará, Chile)

Volcanism is one of the major natural processes emitting mercury (Hg) to the atmosphere, representing a significant component of the global Hg budget. The importance of volcanic eruptions for local-scale Hg deposition was investigated using analyses of Hg, inorganic elemental tracers, and organic biomarkers in a sediment sequence from Lake Chungará (4520 m a.s.l.). Environmental change and Hg deposition in the immediate vicinity of the Parinacota volcano were reconstructed over the last 2700 years, encompassing the pre-anthropogenic and anthropogenic periods. Twenty eruptions delivering large amounts of Hg (1 to 457 μg Hg m^-2 yr^-1 deposited at the timescale of the event) were locally recorded. Peaks of Hg concentration recorded after most of the eruptions were attributed to a decrease in sedimentation rate together with the rapid re-oxidation of gaseous elemental Hg and deposition with fine particles and incorporation into lake primary producers. Over the study period, the contribution of volcanic emissions has been estimated as 32% of the total Hg input to the lake. Sharp depletions in primary production occurred at each eruption, likely resulting from massive volcaniclastic inputs and changes in the lake-water physico-chemistry. Excluding the volcanic deposition periods, Hg accumulation rates rose from natural background values (1.9 ± 0.5 μg m^-2 yr^-1) by a factor of 2.3 during the pre-colonial mining period (1400-900 yr cal. BP), and by a factor of 6 and 7.6, respectively, during the Hispanic colonial epoch (400-150 yr cal. BP) and the industrial era (~140 yr cal. BP to present). Altogether, the dataset indicates that lake primary production has been the main, but not limiting, carrier for Hg to the sediment. Volcanic activity and climate change are only secondary drivers of local Hg deposition relative to the magnitude of regional and global anthropogenic emissions.

Biodiversity of freshwater diatom communities during 1000 years of metal mining, land use, and climate change in central Sweden

We subjected a unique set of high-quality paleoecological data to statistical modeling to examine if the biological richness and evenness of freshwater diatom communities in the Falun area, a historical copper (Cu) mining region in central Sweden, was negatively influenced by 1000 years of metal exposure. Contrary to ecotoxicological predictions, we found no negative relation between biodiversity and the sedimentary concentrations of eight metals. Strikingly, our analysis listed metals (Co, Fe, Cu, Zn, Cd, Pb) or the fractional land cover of cultivated crops, meadow, and herbs indicating land disturbance as potentially promoting biodiversity. However, correlation between metal- and land-cover trends prevented concluding which of these two covariate types positively affected biodiversity. Because historical aqueous metal concentrations--inferred from solid-water partitioning--approached experimental toxicity thresholds for freshwater algae, positive effects of metal mining on biodiversity are unlikely. Instead, the positive relationship between biodiversity and historical land-cover change can be explained by the increasing proportion of opportunistic species when anthropogenic disturbance intensifies. Our analysis illustrates that focusing on the direct toxic effects of metals alone may yield inaccurate environmental assessments on time scales relevant for biodiversity conservation.

Development of an ombrotrophic peat bog (low ash) reference material for the determination of elemental concentrations

Given the increasing interest in using peat bogs as archives of atmospheric metal deposition, the lack of validated sample preparation methods and suitable certified reference materials has hindered not only the quality assurance of the generated analytical data but also the interpretation and comparison of peat core metal profiles from different laboratories in the international community. Reference materials play an important role in the evaluation of the accuracy of analytical results and are essential parts of good laboratory practice. An ombrotrophic peat bog reference material has been developed by 14 laboratories from nine countries in an inter-laboratory comparison between February and October 2002. The material has been characterised for both acid-extractable and total concentrations of a range of elements, including Al, As, Ca, Cd, Cr, Cu, Fe, Hg, Mg, Mn, Na, Ni, P, Pb, Ti, V and Zn. The steps involved in the production of the reference material (i.e. collection and preparation, homogeneity and stability studies, and certification) are described in detail.

Estimating the natural background atmospheric deposition rate of mercury utilizing ombrotrophic bogs in southern Sweden

A critical gap in the understanding of the global cycling of mercury is the limited data describing the natural background atmospheric deposition rate of mercury before the advent of pollution. Existing estimates of the natural deposition rate are typically about 2-5 microg of Hg m(-2) year(-1) (see, for example, Swain et al. Science 1992, 257, 784-787), based on studies that generally rely on short, 210Pb-dated lake sediment and peat cores that span the past 150 years. Analyses of mercury in long peat cores in southcentral Sweden indicate that natural mercury deposition rates in the period 4000-500 BP were lower, about 0.5-1 microg of Hg m(-2) year(-1). This suggests that recent mercury accumulation rates in the peat (15-25 microg of Hg m(-2) year(-1)) and measured atmospheric deposition rates of mercury in Sweden over the past 3 decades (5-30 microg of Hg m(-2) year(-1)) (Munthe et al. Water, Air, Soil Pollut.: Focus 2001, 1, 299-310) are at least an order of magnitude greater than the prepollution deposition rate, rather than representing only a 3-5-fold increase, as has generally been estimated.

Stable lead isotopes and lake sediments--a useful combination for the study of atmospheric lead pollution history

Analysis of stable lead isotopes and lead concentrations in lake-sediment deposits, not least in varved (annually-laminated) sediments, is a useful method to study lead pollution history. This paper presents details from a study of 31 lakes in Sweden. Using a strong acid digestion of sediment samples and ICP-MS analyses, we have found that Swedish lake sediments have a high natural (pre-pollution) 206[Pb]207[Pb] ratio (mean 1.52+/-0.18, range 1.28-2.01, n=31 lakes). In contrast, atmospheric lead pollution derived from metal smelting processes, coal burning and from alkyl-lead added to petrol has a lower ratio (< 1.2). Consequently, when pollution lead deposition began approximately 3500 years ago, the lead isotope ratio of the sediments started to decline, and in modern sediments it is typically < 1.2. Using the isotope and concentration values and a mixing model, the relative contribution of pollution and natural lead in sediment samples can be calculated. The pollution lead records of the Swedish lake sediments show a consistent picture of the atmospheric lead pollution history. Some noticeable features are the Roman peak (approx. 0 AD), the large and permanent Medieval increase (approx. 1000 AD), peaks at approximately 1200 and 1530 AD, the rapid increase after World War II, the peak in the 1970s, and the large modern decline.

Sediment evidence of early eutrophication and heavy metal pollution of Lake Mälaren, central Sweden

Lake Mälaren is the water supply and recreation area for more than 1 million people in central Sweden and subject to considerable environmental concern. To establish background data for assessments of contemporary levels of trophy and heavy metal pollution, sediment cores from the lake were analyzed. Diatom-inferred lake-water phosphorus concentrations suggest that pre-20th century nutrient levels in Södra Björkfjärden, a basin in the eastern part of Mälaren, were higher (c. 10-20 micrograms TP L-1) than previously assumed (c. 6 micrograms TP L-1). Stable lead isotope and lead concentration analyses from 3 basins (S. Björkfjärden, Gisselfjärden and Asköfjärden) show that the lake was polluted in the 19th century and earlier from extensive metal production and processing in the catchment, particularly in the Bergslagen region. The lake has experienced a substantial improvement of the lead pollution situation in the 20th century following closure of the mining and metal industry. The lead pollution from the old mining industry was large compared to late-20th century pollution from car emissions, burning of fossil fuels and modern industries.

Mercury accumulation rates and spatial patterns in lake sediments from west Greenland: a coast to ice margin transect

The Arctic is recognized as an important focus for long-range transport of contaminants, such as mercury (Hg), from industrial regions at lower latitudes. In addition to large geographic gaps, there are few long-term retrospective time trends in arctic research, besides the Greenland ice record, to assess the onset of atmospheric pollution as well as to establish the rates of change in the terrestrial environment. In a study of sediments from 21 lakes along a 150 km transect from the coast to the ice sheet margin in the Søndre Strømfjord (Kangerlussuaq) region, we present stratigraphic evidence for elevated Hg inputs to this ice-free region on Greenland's west coast. Nineteen study lakes showed Hg concentration enrichments (HgEFconc) in surface compared to deeper sediments, with a mean HgEFconc of 3. Higher HgEFconc are found in lakes closest to the ice margin. The existence of this Hg gradient is supported by pollution Hg inventories in three 210Pb-dated cores. While 210Pb inventories and Pb pollution are higher at the coast, pollution Hg inventories are nearly 3-fold higher at the ice margin (570 micrograms m-2) than at the coast (210 micrograms m-2). These dated cores also indicate an onset of Hg pollution in the region beginning at least by the late 19th century but possibly as early as the 17th century.

Effectiveness of medication calculation enhancement methods with nurses

Medication calculation errors occur in all settings and can cause serious disruption in treatment protocols. This experimental study used a pretest-posttest, control group design. Sixty-seven RNs from three healthcare agencies completed all phases of the study. All nurses completed a 20-item medication calculation test, used both as the pretest and the posttest, and completed a short questionnaire that contained demographic and attitudinal items. After taking the pretest, nurses were assigned randomly to one of three experimental groups or a control group. Intervention times for the experimental groups totaled 3 hours, followed by a posttest 4 to 5 months after the pretest. Scores on the pretest ranged from 25% to 100% (mean = 75.5%, standard deviation = 15.13) and from 30% to 100% on the posttest (mean = 80%, standard deviation = 14.72). Scores improved for all groups except the self-study workbook group. No significant difference was found between the experimental groups or the control group for posttest medication calculation test scores. The classroom intervention was most costly, and the workbook intervention was least costly. The nurses identified the workbook intervention as the most satisfying method and computer-assisted instruction (CAI) as least satisfying. A strong positive correlation existed between the nurses' self-assessment of comfort and skill levels with medication calculation test scores. Questions necessitating multiple calculations and those necessitating a conversion not provided were the most difficult to answer correctly. Staff development educators need to address their role in improving the effectiveness of medication calculation.

Medication calculation ability of registered nurses

A convenience sample of 110 registered nurses in four western states completed a demographic questionnaire and a 20-item medication calculation test to investigate errors in medication calculation that contribute to medication error rates. Intravenous questions were most difficult, then oral, then intramuscular/subcutaneous items. Nurses erred more when more than one calculation was required and when milligram to grain conversion was needed. Nurses who rated their skill and comfort with medication calculation above average scored higher. Yet 81 percent of the nurses were unable to correctly calculate medications 90 percent of the time and 43.6 percent of the test scores were below 70 percent accuracy. Strategies are suggested which may be used in staff development in identify registered nurse medication calculation abilities and to enhance these skills in practicing nurses.

Do Baccalaureate Students Possess Basic Mathematics Proficiency?

Since 1979, over 700 junior level baccalaureate nursing students at the Intercollegiate Center for Nursing Education (ICNE) in Spokane, Washington, have had their basic mathematical skills tested, using a teacher constructed examination. The "Mathematics Proficiency Exam" utilized evaluates the nursing student's ability to add, subtract, multiply, and divide whole numbers, fractions, decimals, and percentages. Ratios, proportions, and problems are also included in the exam. The results of the testing have been surprising. From 9% to 38% of each student group tested have been unable to pass all parts of the examination at the 70% level. These findings have led the ICNE to require basic mathematical proficiency via the "Mathematics Proficiency Exam," developed by the authors, as a criterion for admission to the upper division nursing major. Subsequently, competence in medication calculation skills has been required within the first clinical course at the ICNE via a second teacher-constructed examination.