Complete Shifts Research Articles

On-call simulation: Evaluating cost and impact.

On-call simulation has been shown to improve the confidence of prospective junior doctors in undertaking on-call shifts. Despite this, it is not mandated in UK medical school curricula, leading to variations in provision. Barriers to widespread implementation may include doubts surrounding effectiveness, feasibility of delivering on-call simulation across multiple sites and unknown costs. To address these gaps in the literature, we designed and implemented a multi-site on-call simulation programme. We aimed to evaluate it both educationally, using student preparedness to complete on-call shifts as our outcome, and economically, by performing a cost-outcome description. An on-call simulation programme, 'Bleep 101', was developed and implemented at eight hospitals. Students were 'bleeped' around a circuit of written scenarios including clinical emergencies, prescribing and distractor tasks. Students could escalate to their facilitator on the phone for advice at any time. Sessions concluded with a 30-minute debrief focusing on prioritisation and communication skills. Between 2018 and 2023, 217 students took part and completed feedback forms. Post-session feedback using Likert scales demonstrated a significant increase in preparedness to complete an on-call shift (pre-4/10, post-7/10, p < 0.01) with outcomes consistent across sites. A cohort of 20 students completed paired pre- and post-session feedback to evaluate the impact of the session on specific skills. This demonstrated increased confidence in using a bleep, prioritisation, gathering information and handing over. The costs of implementation at one site were reported, demonstrating a cost of £1.99/student/year or £99.48/student/year excluding costs saved by volunteers and room hire. This study indicates that on-call simulation can be delivered at a low cost using existing medical education infrastructure within hospitals. Results suggested an improvement in medical students' preparedness for on-call practice. We therefore recommend on-call simulation be available to all medical students as part of medical school curricula.

Larval transcriptomes reflect the evolutionary history of plant-insect associations.

In this study, we investigated whether patterns of gene expression in larvae feeding on different plants can explain important aspects of the evolution of insect-plant associations, such as phylogenetic conservatism of host use and re-colonization of ancestral hosts that have been lost from the host repertoire. To this end, we performed a phylogenetically informed study comparing the transcriptomes of 4 nymphalid butterfly species in Polygonia and the closely related genus Nymphalis. Larvae were reared on Urtica dioica, Salix spp., and Ribes spp. Plant-specific gene expression was found to be similar across butterfly species, even in the case of host plants that are no longer used by two of the butterfly species. These results suggest that plant-specific transcriptomes can be robust over evolutionary time. We propose that adaptations to particular larval food plants can profitably be understood as an evolved set of modules of co-expressed genes, promoting conservatism in host use and facilitating re-colonization. Moreover, we speculate that the degree of overlap between plant-specific transcriptomes may correlate with the strength of trade-offs between plants as resources and hence to the probability of colonizing hosts and complete host shifts.

World Stability and Monetary Legal Relations

In the article former currency (monetary) systems were reviewed; their characteristics were briefly outlined; their merits and demerits were pointed out. There were examples of countries making complete shifts from “paper” money circulation to “metal” and back to “paper”. The author points out some discrepancies between legislative and actual monetary relations of states-participants of treaties. The author defines reasons why prior currency systems were replaced and describes certain events that, according to the author, lead to those replacements. It was illustrated that treaties between economically developed countries have an impact on the world stability or instability. Major military conflicts were proven to be connected with the change of monetary system in the world. The currently effective system under Jamaica Accords is revealed as far too “elderly”. Given the events that took place 100–150 years ago, supposed ways out of the current situation become clear. The author defines the optimal “chronological window” and legislative “basis” necessary for taking measures.

A Pedagogical Perspective to Semantic Features of Nigerian English

The study examined the semantic manifestations of English words in the Nigerian contexts and the implications for teaching in Nigerian secondary and primary education. The data for this study were obtained from Roger Blench’s (2005) Dictionary of Nigerian English (DNE) and Corpus of Global Web-Based English. While lexical items were culled from the dictionary, the contextual usages of the words which were drawn from the dictionary were gathered through the Corpus of Global Web-Based English. Using a lexical semantic approach, the study compared Standard English and Nigerian English by accounting for semantic shifts, semantic extensions, and morphologically marked neologisms in Nigerian English. Nigerians rarely utilize NE words that represent complete semantic shifts from BrE meanings. Unlike the 'total shift' situation, there is a disparity in the general usage of words to manifest NE extended meaning. The conclusion from the study is that, as it is evident that the English spoken in Nigeria is not the same as British English or American English, examination bodies’ insistence on BrE and AmE is futile and unreasonable. Nigerian English should be recognised by examination agencies; it should be developed and adopted as the Language of pedagogy for primary and secondary education in Nigeria.

New hydroperoxycycloartane—complete chemical shifts assignment of 13C and 1H—and cytotoxicity evaluation of cycloartanes isolated from Trichilia casaretti

New cycloartane, 22-hydroxy-25-hydroperoxycycloart-23E-en-3-one (1), along with six known analogues (2–7) and three steroids (8–10), were isolated from the leaves of Trichilia casaretti. Structures were elucidated mainly on the basis of the analysis of 1D and 2D NMR (1H and 13C) and HRESIMS spectroscopic data, involving comparison with data of the literature. The cytotoxic activities of 1–7 and 10 isolated compounds were also evaluated against human leukemia cell line Molt-4 (acute lymphoblastic) and exhibited good cytotoxic activity with IC50 values ranging from 10.62 to 21.14 μM.

How do nurses spend their time? A time and motion analysis of nursing activities in an internal medicine unit.

AimTo describe the nature and duration of nursing activities and how much time registered nurses allocate to the different dimensions of their scope of practice in a Swiss university hospital internal medicine ward.DesignA single‐centre observational descriptive study.MethodUsing a time and motion study, two researchers shadowed healthcare workers (N = 21) during 46 complete work shifts in 2018. They recorded each activity observed in real time using a tablet computer with a pre‐registered list of 42 activities classified into 13 dimensions.ResultsA total of 507.5 work hours were observed. Less than one third of registered nurses’ work time was spent with patients. They allocated the most time to the dimensions of ‘communication and care coordination’ and ‘care planning’, whereas ‘optimizing the quality and safety of care’, ‘integrating and supervising staff’ and ‘client education’ were allocated the least time.ConclusionThis study provided a reliable description of nurses’ time use at work. It highlighted suboptimal use of the full scope of nursing practice.ImpactBoth work organization and culture should be reconsidered to promote better use of nursing skills. Practice optimization should focus on the following three main areas: (1) greater involvement of registered nurses in building relationships and directly caring for patients and their families; (2) better use of registered nurses’ skills in the activities required of their proper roles, including nursing clinical assessments and patient education and (3) more systematically updating registered nurses’ knowledge.

Visualization of user interactions with a pressure mapping mobile application for wheelchair users at risk for pressure injuries

ABSTRACT Pressure injuries for individuals with spinal cord injuries (SCI) are correlated with mortality and are a leading cause for rehospitalizations. The Assisted Weight Shift (AW-Shift©) is a mobile pressure mapping application designed to provide users with a live map view and reminders to perform weight shifts. Novel visualization techniques were used to understand daily distributions of user interaction with AW-Shift©. The date and time of system interactions were recorded for six participants with SCI over 7 days (five males/one female, five manual users/one power user, 55.3 ± 17.3 years old, 10.6 ± 6.5 years since injury). Circular frequency plots were created to visualize the time and frequency participants brought the app to the foreground of their phone and received alerts and reminders to complete weight shifts. While some participants used the system regularly throughout the day, others primarily used it before 8am; highlighting the system’s importance for regular spot checks and morning wheelchair setup. Participant adherence to weight shift reminders was low suggesting the live pressure map may be more useful. Circular frequency plots can be used by clinicians to more easily review large amounts of patient data. Future work will investigate raw pressure mat data and create a closed-loop weight shift detection algorithm.

Regional changes in Cladocera (Branchiopoda, Crustacea) assemblages in subarctic (Yellowknife, Northwest Territories, Canada) lakes impacted by historic gold mining activities

In Yellowknife (Northwest Territories, Canada), roaster stack emissions from historic gold mining activities, particularly Giant Mine (1948–2004), have left a legacy of arsenic contamination in lakes. We examined Cladocera (Branchiopoda, Crustacea) subfossil remains in the recent and pre-industrial sediments of 23 lakes (arsenic gradient of 1.5–750 µg/l) within a 40 km radius of Giant Mine to provide a snapshot of regional change in Cladocera since pre-1850. We found that littoral and benthic taxa dominated the recent assemblages in high-[As] lakes (surface water [As] > 100 µg/l), while pelagic Bosmina was dominant in lakes with lower [As]. Cladocera richness and diversity were positively correlated with [As] (P = 0.004, R2 = 0.39; and P = 0.002, R2 = 0.46, respectively), except for four lakes with [As] > 100 µg/l. The lakes that showed the most pronounced changes in Cladocera since pre-1850 were those affected by both metal(loid) pollution and urban development, where complete shifts in the dominant taxa occurred. Lakes that were most heavily impacted by arsenic emissions did not experience notable shifts in Cladocera assemblages. Our study suggests that changes in Cladocera assemblages in mining-impacted subarctic lakes are modulated by local, lake-specific limnological conditions and the interaction of multiple stressors.

Productivity and costs of harvester cutting of teak trees for thinning

ABSTRACT This work was carried out in a teak plantation in the state of Mato Grosso, Brazil. The objective was to evaluate technical and economic indicators of the cutting and processing of trees with a track harvester. Twenty complete work shifts were evaluated using direct thinning to determine operational cycle times. Other information was also recorded for the calculation of production costs. The second thinning was performed at 12 years, with a volume of 0.1648 m³/tree, and the third thinning at 18 years with 0.3408 m³/tree. The main finding was an increase in productivity and decrease in production costs with rising tree volumes. For each hour of effective work, 53 trees were cut (339 trees/day), and processed into 1,047 logs. The decrease in the cost of cutting and processing trees in proportion to the increase in the average volume of trees to be extracted was confirmed.

Lexico – Semantic Transfer in the Interlanguage of Serbophone Students Learning Italian as L2 and Spanish as L3

Lexical transfer, ie the influence of the student's knowledge of a word of one language on the knowledge or use of words in the target language is an important cognitive process in learning a new language students often use as a compensation strategy. This paper deals with errors in the interlanguage of L1 Serbian students learning two typologically similar languages: Italian and Spanish, which arose as a consequence of lexico - semantic transfer. The most frequent errors caused by lexico - semantic transfer were identified and classified by the method of error analysis. An extremely large number of cases of lexico-semantic transfer were found in the corpus. All errors are classified into five categories: loan translations, semantic extension, cognates or false friends, hybrids and complete language shifts. In all cases, the negative lexical transfer occurred with words that are similar in Italian and Spanish. The errors in the written production in Spanish did not originate from the typologically distant, although the most dominant language of the students - Serbian as L1, but from the typologically similar Italian as L2. This proves the hypothesis that in typologically similar languages, lexical transfer is the most common and also that the factors of language distance and psychotypology are the key linguistic factors that will cause the transfer. Moreover, this kind of transfer was mainly used as a compensation strategy that students relied on to fill lexical gaps in situations where they did not have sufficient knowledge of the target language. Among the lexical errors, the largest number concerns cognates or false friends and hybrids. On the other hand, examples of loan translations or calques and semantic extensions were not frequent, so we conclude that the transfer of form (lexical transfer) is more frequent than the transfer of meaning (semantic transfer).

Genetics and evolution of developmental plasticity in the nematode C. elegans: Environmental induction of the dauer stage

Adaptive developmental plasticity is a common phenomenon across diverse organisms and allows a single genotype to express multiple phenotypes in response to environmental signals. Developmental plasticity is thus thought to reflect a key adaptation to cope with heterogenous habitats. Adaptive plasticity often relies on highly regulated processes in which organisms sense environmental cues predictive of unfavourable environments. The integration of such cues may involve sophisticated neuro-endocrine signaling pathways to generate subtle or complete developmental shifts. A striking example of adaptive plasticity is found in the nematode C. elegans, which can undergo two different developmental trajectories depending on the environment. In favourable conditions, C. elegans develops through reproductive growth to become an adult in three days at 20 °C. In contrast, in unfavourable conditions (high population density, food scarcity, elevated temperature) larvae can adopt an alternative developmental stage, called dauer. dauer larvae are highly stress-resistant and exhibit specific anatomical, metabolic and behavioural features that allow them to survive and disperse. In C. elegans, the sensation of environmental cues is mediated by amphid ciliated sensory neurons by means of G-coupled protein receptors. In favourable environments, the perception of pro-reproductive cues, such as food and the absence of pro-dauer cues, upregulates insulin and TGF-β signaling in the nervous system. In unfavourable conditions, pro-dauer cues lead to the downregulation of insulin and TGF-β signaling. In favourable conditions, TGF-β and insulin act in parallel to promote synthesis of dafachronic acid (DA) in steroidogenic tissues. Synthetized DA binds to the DAF-12 nuclear receptor throughout the whole body. DA-bound DAF-12 positively regulates genes of reproductive development in all C. elegans tissues. In poor conditions, the inhibition of insulin and TGF-β signaling prevents DA synthesis, thus the unliganded DAF-12 and co-repressor DIN-1 repress genes of reproductive development and promote dauer formation. Wild C. elegans have often been isolated as dauer larvae suggesting that dauer formation is very common in nature. Natural populations of C. elegans have colonized a great variety of habitats across the planet, which may differ substantially in environmental conditions. Consistent with divergent adaptation to distinct ecological niches, wild isolates of C. elegans and other nematode species isolated from different locations show extensive variation in dauer induction. Quantitative genetic and population-genomic approaches have identified many quantitative trait loci (QTL) associated with differences in dauer induction as well as a few underlying causative molecular variants. In this review, we summarize how C. elegans dauer formation is genetically regulated and how this trait evolves- both within and between species.

NMR assignments of the WBSCR27 protein related to Williams-Beuren syndrome.

Williams-Beuren syndrome is a genetic disorder characterized by physiological and mental abnormalities, and is caused by hemizygous deletion of several genes in chromosome 7. One of the removed genes encodes the WBSCR27 protein. Bioinformatic analysis of the sequence of WBSCR27 indicates that it belongs to the family of SAM-dependent methyltransferases. However, exact cellular functions of this protein or phenotypic consequences of its deficiency are still unknown. Here we report nearly complete 1H, 15N, and 13C chemical shifts assignments of the 26kDa WBSCR27 protein from Mus musculus in complex with the cofactor S-adenosyl-L-methionine (SAM). Analysis of the assigned chemical shifts allowed us to characterize the protein's secondary structure and backbone dynamics. The topology of the protein's fold confirms the assumption that the WBSCR27 protein belongs to the family of class I methyltransferases.

Human DMBT1-Derived Cell-Penetrating Peptides for Intracellular siRNA Delivery.

Small interfering RNA (siRNA) is a promising molecule for gene therapy, but its therapeutic administration remains problematic. Among the recently proposed vectors, cell-penetrating peptides show great promise in in vivo trials for siRNA delivery. Human protein DMBT1 (deleted in malignant brain tumor 1) is a pattern recognition molecule that interacts with polyanions and recognizes and aggregates bacteria. Taking advantage of these properties, we investigated whether specific synthetic DMBT1-derived peptides could be used to formulate nanoparticles for siRNA administration. Using an electrophoretic mobility shift assay and UV spectra, we identified two DMBT1 peptides that could encapsulate the siRNA with a self- and co-assembly mechanism. The complexes were stable for at least 2 hr in the presence of either fetal bovine serum (FBS) or RNase A, with peptide-dependent time span protection. ζ-potential, circular dichroism, dynamic light scattering, and transmission electron microscopy revealed negatively charged nanoparticles with an average diameter of 10–800 nm, depending on the reaction conditions, and a spherical or rice-shaped morphology, depending on the peptide and β-helix conformation. We successfully transfected human MCF7 cells with fluorescein isothiocyanate (FITC)-DMBT1-peptide-Cy3-siRNA complexes. Finally, DMBT1 peptides encapsulating an siRNA targeting a fluorescent reporter gene showed efficient gene silencing in MCF7-recombinant cells. These results lay the foundation for a new research line to exploit DMBT1-peptide nanocomplexes for therapeutic siRNA delivery.

Deadly competition and life-saving predation: the potential for alternative stable states in a stage-structured predator-prey system.

Predators often undergo complete ontogenetic diet shifts, engaging in resource competition with species that become their prey during later developmental stages. Theory posits that this mix of stage-specific competition and predation, termed life-history intraguild predation (LHIGP), can lead to alternative stable states. In one state, prey exclude predators through competition (i.e. juvenile competitive bottleneck), while in the alternative, adult predators control prey density to limit competition and foster coexistence. Nevertheless, the interactions leading to these states have not been demonstrated in an empirical LHIGP system. To address this gap, we manipulated densities of cannibalistic adult cyclopoid copepods (Mesocyclops edax) and their cladoceran prey (Daphnia pulex) in a response-surface design and measured the maturation and survival of juvenile copepods (nauplii). We found that Daphnia reduced and even precluded both nauplii maturation and survival through depletion of a shared food resource. As predicted, adult copepods enhanced nauplii maturation and survival through Daphnia consumption, yet this positive effect was dependent on the relative abundance of Daphnia as well as the absolute density of adult copepods. Adult copepods reduced nauplii survival through cannibalism at low Daphnia densities and at the highest copepod density. This work demonstrates that predation can relax a strong juvenile competitive bottleneck in freshwater zooplankton, though cannibalism can reduce predator recruitment. Thus, our results highlight a key role for cannibalism in LHIGP dynamics and provide evidence for the interactions that drive alternative stable states in such systems.

Estudio Cuali-Cuantitativo sobre la atención de salud de niños menores de tres años en establecimientos de salud de nueve regiones pobres del Perú

To assess five elements of healthcare quality (physical space, equipment, personnel, waiting time, and counseling) in growth and development services (GDS) at 18 healthcare establishments in nine regions of Peru with high rates of poverty. A quali-quantitative study was carried out in the Amazonas, Apurímac, Ayacucho, Cajamarca, Cusco, Huánuco, Huancavelica, Puno, and Ucayali regions, that included direct observation (DO) during medical assistance in GDS, focus groups (FG, one user per healthcare establishment), and in-depth interviews (IDI) with healthcare workers (two per healthcare establishment). There were 18 DOs carried out to assess environment and equipment, 23 DOs of complete service shifts, 67 accompaniments to users during medical assistance in GDS, 18 FGs (118 participating mothers), and 36 IDIs. Both mothers and healthcare professionals agreed that there were limitations in infrastructure, equipment, materials, and personnel that impacted quality medical assistance in GDS. Delays in medical assistance, failure to comply with schedules, and lack of friendliness when providing medical care were the aspects that produced the greatest user dissatisfaction. Only 24.3% of the total amount of time spent at the healthcare establishment corresponded to beneficial activities for the user, although the Health Department was meeting the objective to promote improvement of childcare practices. The study was useful in identifying weaknesses and strengths that may help redirect GDS efforts within the framework of policies aimed at strengthening first-class medical assistance.

Proteome analysis of testis from infertile protein C inhibitor-deficient mice reveals novel changes in serpin processing and prostaglandin metabolism.

Serine protease inhibitors (serpin) have therapeutic potential in a variety of pathogenic processes, ranging from thrombosis and altered immune response to liver cirrhosis. To investigate the physiological effects of protein C inhibitor (PCI, serpinA5), its gene was inactivated in a mouse model, resulting in male infertility. In the present report, 2D differential gel electrophoresis was utilized to investigate the molecular mechanisms for PCI involvement in male reproduction. Comparing the testes proteomes of three PCI-knockout mice with three wild types demonstrated similar patterns with the exception of a massive upregulation of prostaglandin reductase 1 (tenfold; p < 0.002) and the complete shifts in the molecular weights of serpinA1C and serpinA3K. All these PCI-dependent proteome changes were immunologically verified. Unbiased proteome analysis indicated that inactivation of serpinA5 strongly influenced both the protein species pattern of other A-clade serpins as well as prostaglandin metabolism in the testes.

2-Substituted and 2,2-disubstituted adamantane derivatives as models for studying substituent chemical shifts and C–Hax⋯Yax cyclohexane contacts—results from experimental and theoretical NMR spectroscopic chemical shifts and DFT structures

The complete 1H and 13C NMR chemical shifts assignment for various 2-substituted and 2,2-disubstituted adamantane derivatives 1–38 in CDCl3 solution was realized on the basis of NMR experiments combined with chemical structure information and DFT-GIAO (B3LYP/6-31+G(d,p)-GIAO) calculations of chemical shifts in solution. Substituent-induced 13C NMR chemical shifts (SCS) are discussed. C–Hax⋯Yax contacts are a textbook prototype of steric hindrance in organic chemistry. The nature of these contacts will be further investigated in this work on basis of new adamantane derivatives, which are substituted at C-2 to provide models for 1,4-C–Hax⋯Yax and 1,5-C–Hax⋯Yax contacts. The B3LYP/6-31+G(d,p) calculations predicted the presence of NBO hyperconjugative attractive interactions between C–Hax and Yax groups along C–Hax⋯Yax contacts. The 1H NMR signal separation, Δδ(γ-CH2), reflects the strength of the H-bonded C–Hax⋯Yax contact.

Occipitoparietal alpha-band responses to the graded allocation of top-down spatial attention.

The voluntary, top-down allocation of visual spatial attention has been linked to changes in the alpha-band of the electroencephalogram (EEG) signal measured over occipital and parietal lobes. In the present study, we investigated how occipitoparietal alpha-band activity changes when people allocate their attentional resources in a graded fashion across the visual field. We asked participants to either completely shift their attention into one hemifield, to balance their attention equally across the entire visual field, or to attribute more attention to one-half of the visual field than to the other. As expected, we found that alpha-band amplitudes decreased stronger contralaterally than ipsilaterally to the attended side when attention was shifted completely. Alpha-band amplitudes decreased bilaterally when attention was balanced equally across the visual field. However, when participants allocated more attentional resources to one-half of the visual field, this was not reflected in the alpha-band amplitudes, which just decreased bilaterally. We found that the performance of the participants was more strongly reflected in the coherence between frontal and occipitoparietal brain regions. We conclude that low alpha-band amplitudes seem to be necessary for stimulus detection. Furthermore, complete shifts of attention are directly reflected in the lateralization of alpha-band amplitudes. In the present study, a gradual allocation of visual attention across the visual field was only indirectly reflected in the alpha-band activity over occipital and parietal cortexes.

Rapid chemical characterisation of stilbenes in the root bark of Norway spruce by off-line HPLC/DAD-NMR.

Stilbenes are plant secondary metabolites that have shown promising and varied biological activities. Stilbenes are presently actively studied for the exploitation of this primary raw material resource, involving the concept of biorefining. Methods for the rapid discovery of new and known stilbene structures from various plant sources are thus keenly sought. To establish a simple and rapid technique of off-line HPLC with a diode-array detector (DAD) and NMR for the unambiguous structural elucidation of stilbene structures in the root bark of Norway spruce [Picea abies (L.) Karst.]. The stilbene containing fraction was extracted from the plant bark with an ethanol:water mixture (95:5, v/v) preceded by defatting of hydrophobic compounds with n-hexane using the accelerated solvent extraction technique. A portion of the ethanol-water soluble extract was hydrolysed with β-glucosidase to prepare stilbene aglycones. The extracts were further purified and enriched using a polymeric adsorbent. Stilbene-enriched extracts were directly characterised by off-line HPLC/DAD-NMR in conjunction with HPLC/DAD and HPLC/DAD with electrospray ionisation MS(n). Trans-isorhapontin and trans-astringin were identified as the major, and trans-piceid as a minor, stilbene glucosides of the bark of roots of Picea abies. Not only stilbene glucosides but also the corresponding stilbene aglycones, such as trans-resveratrol, trans-piceatannol and trans-isorhapontigenin, were rapidly identified from the hydrolysed extract. The acquired heteronuclear single-quantum coherence and heteronuclear multiple bond correlation spectra were used to assign the complete carbon NMR chemical shifts of trans-isorhapontin and trans-astringin without the need of acquiring a (13)C-NMR spectrum. The off-line HPLC/DAD-NMR method is expedient for the unambiguous identication of structurally similar stilbenes in plant extracts.

Nurse Staffing and NICU Infection Rates

There are substantial shortfalls in nurse staffing in US neonatal intensive care units (NICUs) relative to national guidelines. These are associated with higher rates of nosocomial infections among infants with very low birth weights. To study the adequacy of NICU nurse staffing in the United States using national guidelines and analyze its association with infant outcomes. Retrospective cohort study. Data for 2008 were collected by web survey of staff nurses. Data for 2009 were collected for 4 shifts in 4 calendar quarters (3 in 2009 and 1 in 2010). Sixty-seven US NICUs from the Vermont Oxford Network, a national voluntary network of hospital NICUs. All inborn very low-birth-weight (VLBW) infants, with a NICU stay of at least 3 days, discharged from the NICUs in 2008 (n = 5771) and 2009 (n = 5630). All staff-registered nurses with infant assignments. We measured nurse understaffing relative to acuity-based guidelines using 2008 survey data (4046 nurses and 10 394 infant assignments) and data for 4 complete shifts (3645 nurses and 8804 infant assignments) in 2009-2010. An infection in blood or cerebrospinal fluid culture occurring more than 3 days after birth among VLBW inborn infants. The hypothesis was formulated prior to data collection. Hospitals understaffed 31% of their NICU infants and 68% of high-acuity infants relative to guidelines. To meet minimum staffing guidelines on average would require an additional 0.11 of a nurse per infant overall and 0.34 of a nurse per high-acuity infant. Very low-birth-weight infant infection rates were 16.4% in 2008 and 13.9% in 2009. A 1 standard deviation-higher understaffing level (SD, 0.11 in 2008 and 0.08 in 2009) was associated with adjusted odds ratios of 1.39 (95% CI, 1.19-1.62; P < .001) in 2008 and 1.40 (95% CI, 1.19-1.65; P < .001) in 2009. Substantial NICU nurse understaffing relative to national guidelines is widespread. Understaffing is associated with an increased risk for VLBW nosocomial infection. Hospital administrators and NICU managers should assess their staffing decisions to devote needed nursing care to critically ill infants.