Health System Redesign of Cardiac Monitoring Oversight to Optimize Alarm Management, Safety, and Staff Engagement.

OBJECTIVE: The purpose of this quality improvement project was to improve health system patient safety by creating a cardiac monitoring structure aligned with national standards. BACKGROUND: Excessive alarms pose patient safety threats and are often false or clinically insignificant. The Joint Commission identified reduction of nonactionable alarms as a National Patient Safety Goal. METHODS: The conversion to structured monitoring occurred in 4 phases: 1) defining health system monitoring structure and processes; 2) co-create sessions; 3) implementation and impact analysis; and 4) ongoing evaluation and optimization. RESULTS: Twenty-two clinical units participated. At the conclusion of phase 4, total 30-day alarm rates decreased by 74% at the academic hospital and by 92% and 95% at the community hospitals and were sustained for 12 months. CONCLUSIONS: Decreasing alarm frequency can be safely achieved in academic and community hospitals by creating a system-wide monitoring infrastructure and standardized processes that engage interdisciplinary teams.

Release of Plastics to Australian Land from Biosolids End-Use.

Plastics are contaminants of emerging concern that can enter the environment from multiple sources, including via land application of treated sewage sludge (biosolids). Biosolids samples collected from 82 wastewater treatment plants (WWTPs) across Australia and covering 34% of the population during census week in 2016 were quantitatively analyzed to estimate the release of seven common plastics. Quantitative analysis was performed by pressurized liquid extraction followed by double-shot microfurnace pyrolysis coupled to gas chromatography mass spectrometry. Ninety nine percent of the samples contained plastics (Σ6plastics) at concentrations of between 0.4 and 23.5 mg/g dry weight (median; 10.4 mg/g dry weight), while polycarbonate was not detected in any sample. Per-capita mass loads of plastics (Σ6plastics) released were between 8 and 877 g/person/year across all investigated WWTPs. Polyethylene was the predominant plastic detected, contributing to 69% of Σ6plastics. Based on the concentrations measured, it was projected that around 4700 metric tons (Mt) of plastics are released into the Australian environment through biosolids end-use each year, equating to approximately 200 g/person/year, which represents 0.13% of total plastics use in Australia. Of this, 3700 Mt of plastics are released to agricultural lands and 140 Mt to landscape topsoil. Our results provide a first quantitative per-capita mass loads and emission estimate of plastic types through biosolids end-use.

Quantitative Analysis of Selected Plastics in High-Commercial-Value Australian Seafood by Pyrolysis Gas Chromatography Mass Spectrometry.

Microplastic contamination of the marine environment is widespread, but the extent to which the marine food web is contaminated is not yet known. The aims of this study were to go beyond visual identification techniques and develop and apply a simple seafood sample cleanup, extraction, and quantitative analysis method using pyrolysis gas chromatography mass spectrometry to improve the detection of plastic contamination. This method allows the identification and quantification of polystyrene, polyethylene, polyvinyl chloride, polypropylene, and poly(methyl methacrylate) in the edible portion of five different seafood organisms: oysters, prawns, squid, crabs, and sardines. Polyvinyl chloride was detected in all samples and polyethylene at the highest total concentration of between 0.04 and 2.4 mg g-1 of tissue. Sardines contained the highest total plastic mass concentration (0.3 mg g-1 tissue) and squid the lowest (0.04 mg g-1 tissue). Our findings show that the total concentration of plastics is highly variable among species and that microplastic concentration differs between organisms of the same species. The sources of microplastic exposure, such as packaging and handling with consequent transference and adherence to the tissues, are discussed. This method is a major development in the standardization of plastic quantification techniques used in seafood.

Comparison of ultra high performance supercritical fluid chromatography, ultra high performance liquid chromatography, and gas chromatography for the separation of synthetic cathinones.

A comparison of ultra high performance supercritical fluid chromatography, ultra high performance liquid chromatography, and gas chromatography for the separation of synthetic cathinones has been conducted. Nine different mixtures of bath salts were analyzed in this study. The three different chromatographic techniques were examined using a general set of controlled synthetic cathinones as well as a variety of other synthetic cathinones that exist as positional isomers. Overall 35 different synthetic cathinones were analyzed. A variety of column types and chromatographic modes were examined for developing each separation. For the ultra high performance supercritical fluid chromatography separations, analyses were performed using a series of Torus and Trefoil columns with either ammonium formate or ammonium hydroxide as additives, and methanol, ethanol or isopropanol organic solvents as modifiers. Ultra high performance liquid chromatographic separations were performed in both reversed phase and hydrophilic interaction chromatographic modes using SPP C18 and SPP HILIC columns. Gas chromatography separations were performed using an Elite-5MS capillary column. The orthogonality of ultra high performance supercritical fluid chromatography, ultra high performance liquid chromatography, and gas chromatography was examined using principal component analysis. For the best overall separation of synthetic cathinones, the use of ultra high performance supercritical fluid chromatography in combination with gas chromatography is recommended.

Improved adhesion of gold thin films evaporated on polymer resin: applications for sensing surfaces and MEMS.

We present and analyze a method to improve the morphology and mechanical properties of gold thin films for use in optical sensors or other settings where good adhesion of gold to a substrate is of importance and where controlled topography/roughness is key. To improve the adhesion of thermally evaporated gold thin films, we introduce a gold deposition step on SU-8 photoresist prior to UV exposure but after the pre-bake step of SU-8 processing. Shrinkage and distribution of residual stresses, which occur during cross-linking of the SU-8 polymer layer in the post-exposure baking step, are responsible for the higher adhesion of the top gold film to the post-deposition cured SU-8 sublayer. The SU-8 underlayer can also be used to tune the resulting gold film morphology. Our promoter-free protocol is easily integrated with existing sensor microfabrication processes.

Implementation of an Evidence-Based Onboarding Program to Optimize Efficiency and Care Delivery in an Intensive Care Unit.

Nationally, nurse turnover is 18.7%, and 24.1% of nurses leave their organization within a year of hire. Onboarding is a key component of a nurse's intent to stay and job satisfaction. This article describes the implementation and results of an onboarding program in a large intensive care unit.

There's something in the air: A review of sources, prevalence and behaviour of microplastics in the atmosphere.

Literature regarding microplastics in the atmosphere has advanced in recent years. However, studies have been undertaken in isolation with minimal collaboration and exploration of the relationships between air, deposition and dust. This review collates concentrations (particle count and mass-based), shape, size and polymetric characteristics for microplastics in ambient air (m3), deposition (m2/day), dust (microplastics/g) and snow (microplastics/L) from 124 peer-reviewed articles to provide a holistic overview and analysis of our current knowledge. In summary, ambient air featured concentrations between <1 to >1000 microplastics/m3 (outdoor) and <1 microplastic/m3 to 1583 ± 1181 (mean) microplastics/m3 (indoor), consisting of polyethylene terephthalate, polyethylene, polypropylene. No difference (p > 0.05) was observed between indoor and outdoor concentrations or the minimum size of microplastics (p > 0.5). Maximum microplastic sizes were larger indoors (p < 0.05). Deposition concentrations ranged between 0.5 and 1357 microplastics/m2/day (outdoor) and 475 to 19,600 microplastics/m2/day (indoor), including polyethylene, polystyrene, polypropylene, polyethylene terephthalate. Concentrations varied between indoor and outdoor deposition (p < 0.05), being more abundant indoors, potentially closer to sources/sinks. No difference was observed between the minimum or maximum reported microplastic sizes within indoor and outdoor deposition (p > 0.05). Road dust concentrations varied between 2 ± 2 and 477 microplastics/g (mean), consisting of polyvinyl chloride, polyethylene, polypropylene. Mean outdoor dust concentrations ranged from <1 microplastic/g (remote desert) to between 18 and 225 microplastics/g, comprised of polyethylene terephthalate, polyamide, polypropylene. Snow concentrations varied between 0.1 and 30,000 microplastics/L, containing polyethylene, polyamide, polypropylene. Concentrations within indoor dust varied between 10 and 67,000 microplastics/g, including polyethylene terephthalate, polyethylene, polypropylene. No difference was observed between indoor and outdoor concentrations (microplastics/g) or maximum size (p > 0.05). The minimum size of microplastics were smaller within outdoor dust (p > 0.05). Although comparability is hindered by differing sampling methods, analytical techniques, polymers investigated, spectral libraries and inconsistent terminology, this review provides a synopsis of knowledge to date regarding atmospheric microplastics.

Connection is key when there's no planet B: The need to innovate environmental science communication with transdisciplinary approaches.

As anthropogenic damage to the environment continues worldwide, effective science communication has never been more important. Despite this there are numerous barriers between traditional science communication (e.g. journal articles to news media) and the goal of encouraging more sustainable behaviours. Connections between public groups, science communicators and the environment, are all key to overcome barriers in intergroup communication. It is vital science communication adapts with transdisciplinary approaches to become more effective in its purpose. As such training of environmental science communicators must change. This endeavour will be supported by the enrichment of academic institutions through becoming more active in expediting cooperation between STEM (science, technology, engineering and maths) and HASS (humanities, arts and social science) disciplines. Modern dissemination of misinformation must be tackled with holistic approaches to bridge outgroups and enable the formation of trust.

Does size matter? Quantification of plastics associated with size fractionated biosolids.

This study investigated the occurrence and contribution of plastic particles associated with size fractionated biosolids to the total concentration in biosolids (treated sewage sludge) samples collected from 20 wastewater treatment plants (WWTP) across Australia. This was achieved through sequential size fractionation of biosolids samples to quantify the mass concentration of 7 common plastics across a range of biosolids size fractions, including below 25 µm which has not been assessed in many previous studies. Quantitative analysis was performed by pressurized liquid extraction followed by pyrolysis coupled to gas chromatography - mass spectrometry. Of the total quantified plastics (Σ7plastics), the greatest proportion (27%) of the total mass were identified in the nominal <25 µm sized biosolids fraction. Polyethylene dominated the polymer mass in every size fraction, even though profiles varied between WWTPs. When comparing the sum of all sites for each sized biosolids fraction, the plurality of the polyethylene, polyvinyl-chloride, polystyrene, polypropylene, polycarbonate, and polyethylene-terephthalate concentrations were associated with the smallest size fraction (<25 µm). We confirm for the first time the presence of plastic particles in biosolids below a size fraction that is not captured by many methods. This is important, because of the potential greater significance of plastics in the low sizes to environmental and human health.

Using Learning Style Assessments to Effectively Match Preceptors and Orientees.

Ineffective pairings between preceptors and orientees can lead to decreased job satisfaction and burnout. This article describes the results of a study using a learning style assessment tool to pair preceptors and orientees in an intensive care unit for newly hired registered nurses between February 2017 and December 2019 (n = 173).

Quantification of selected microplastics in Australian urban road dust.

Microplastics (1 - 5000 µm) are pervasive in every compartment of our environment. However, little is understood regarding the concentration and size distribution of microplastics in road dust, and how they change in relation to human activity. Within road dust, microplastics move through the environment via atmospheric transportation and stormwater run-off into waterways. Human exposure pathways to road dust include dermal contact, inhalation and ingestion. In this study, road dust along an urban to rural transect within South-East Queensland, Australia was analysed using Accelerated Solvent Extraction followed by pyrolysis Gas Chromatography-Mass Spectrometry (Pyr-GC/MS). Polypropylene, polystyrene, polyethylene terephthalate, polyvinyl chloride, poly (methyl methacrylate) and polyethylene were quantified. Microplastic concentrations ranged from ~0.5 mg/g (rural site) to 6 mg/g (Brisbane city), consisting primarily of polyvinyl chloride (29%) and polyethylene terephthalate (29%). Size fractionation (< 250 µm, 250-500 µm, 500-1000 µm, 1000-2000 µm and 2000-5000 µm) established that the < 250 µm size fraction contained the majority of microplastics by mass (mg/g). Microplastic concentrations in road dust demonstrated a significant relationship with the volume of vehicles (r2 = 0.63), suggesting traffic, as a proxy for human movement, is associated with increased microplastic concentrations in the built environment.

Plastic particles in soil: state of the knowledge on sources, occurrence and distribution, analytical methods and ecological impacts.

Increased production and use of plastics has resulted in growth in the amount of plastic debris accumulating in the environment, potentially fragmenting into smaller pieces. Fragments <5 mm are typically defined as microplastics, while fragments <0.1 µm are defined as nanoplastics. Over the past decade, an increasing number of studies have reported the occurrence and potential hazards of plastic particles in the aquatic environment. However, less is understood about plastic particles in the terrestrial environment and specifically how much plastic accumulates in soils, the possible sources, potential ecological impacts, interaction of plastic particles with the soil environment, and appropriate extraction and analytical techniques for assessing the above. In this review, a comprehensive overview and a critical perspective on the current state of knowledge on plastic pollution in the soil environment is provided: detailing known sources, occurrence and distribution, analytical techniques used for identification and quantification and the ecological impacts of particles on soil. In addition, knowledge gaps are identified along with suggestions for future research.

Influence of surface oxidation on the quantification of polypropylene microplastics by pyrolysis gas chromatography mass spectrometry.

The influence of photo-oxidation on the quantification of isotactic polypropylene by Pyrolysis Gas Chromatography/Mass Spectrometry (Pyr-GC/MS) was assessed. Beads (oval shape, ~5 mm) and fragments (irregular shaped, 250-50 µm and 500-1000 µm) were subjected to relatively harsh simulated accelerated weathering conditions (using a filtered xenon-arc reproducing sunlight's full spectrum) for up to 37 and 80 days, respectively. Samples collected (n = 10 replicates for each treatment) at increasing number of weathering days were analysed by Fourier-transform infrared spectroscopy with Attenuated Total Reflection (FTIR-ATR), scanning electron microscopy, and differential scanning calorimetry in order to assess the extent and the rate of degradation. The rate of surface oxidation occurred faster for fragments compared to beads, probably due to their higher surface area. Quantification of the polypropylene trimer (2,4-dimethyl-1-heptene) via double shot Pyr-GC/MS, showed that the signal of the trimer relative to the mass of polypropylene was reduced through weathering with a degradation rate of 1:3 faster for fragments over beads. Signal reduction and carbonyl index were correlated to show that polypropylene with a carbonyl index of ≥13 has a significantly reduced 2,4-dimethyl-1-heptene signal when compared to virgin material. Consequently, the quantification of polypropylene subjected to weathering under harsh conditions may be underestimated by 42% (fragments, carbonyl index: 18) to 49% (beads, carbonyl index: 30) when quantified by Pyr-GC/MS and using virgin polypropylene calibration standards. Pyrolysis at a lower temperature (350 °C) identified six degradation specific markers (oxidation products) that increased in concentration with weathering. Further comparisons between virgin and weathered microplastics may need to be considered to avoid underestimation of microplastic concentrations in future studies.

Plastics in biosolids from 1950 to 2016: A function of global plastic production and consumption.

Plastics are ubiquitous contaminants that leak into the environment from multiple pathways including the use of treated sewage sludge (biosolids). Seven common plastics (polymers) were quantified in the solid fraction of archived biosolids samples from Australia and the United Kingdom from between 1950 and 2016. Six plastics were detected, with increasing concentrations observed over time for each plastic. Biosolids plastic concentrations correlated with plastic production estimates, implying a potential link between plastics production, consumption and leakage into the environment. Prior to the 1990s, the leakage of plastics into biosolids was limited except for polystyrene. Increased leakage was observed from the 1990s onwards; potentially driven by increased consumption of polyethylene, polyethylene terephthalate and polyvinyl chloride. We show that looking back in time along specific plastic pollution pathways may help unravel the potential sources of plastics leakage into the environment and provide quantitative evidence to support the development of source control interventions or regulations.

Identification and quantification of selected plastics in biosolids by pressurized liquid extraction combined with double-shot pyrolysis gas chromatography-mass spectrometry.

The identification and quantification of selected plastics (polystyrene (PS), polycarbonate (PC), poly-(methyl methacrylate) (PMMA), polypropylene (PP), polyethylene terephthalate (PET), polyethylene (PE) and polyvinyl chloride (PVC)) in biosolids (treated sewage sludge) was performed by pressurized liquid extraction (PLE) combined with double-shot pyrolysis gas chromatography-mass spectrometry. Validation of the method yielded recoveries of between 85 and 128% (mean RSD 11%) at a linear range of between 0.01 and 2 µg. The distribution of plastics within 25 biosolid samples from a single wastewater treatment plant in Australia was assessed. The mass concentration of PE, PVC, PP, PS and PMMA was between 0.1 and 4.1 mg/g dry weight (dw) across all samples, with a total plastic concentration Æ©Plastics of between 2.8 and 6.6 mg/g dw (median = 4.1 mg/g dw). PE was the predominant plastic detected (mean concentration of 2.2 mg/g dw), contributing to 50% of the total of all plastics. Overall, this study demonstrates that pressurized liquid extraction (PLE) combined with double-shot pyrolysis gas chromatography-mass spectrometry can be used to identify and quantify PE, PP, PVC, PS, and PMMA in biosolids.

Airborne emissions of microplastic fibres from domestic laundry dryers.

An emission source of microplastics into the environment is laundering synthetic textiles and clothing. Mechanical drying as a pathway for emitting microplastics, however, is poorly understood. In this study, emissions of microplastic fibres were sampled from a domestic vented dryer to assess whether mechanical drying of synthetic textiles releases microplastic fibres into the surrounding air or are captured by the inbuilt filtration system. A blue polyester fleece blanket was repeatedly washed and dried using the 'Normal Dry' program of a common domestic dryer operated at temperatures between 56 and 59 °C for 20 min. Microfibres in the ambient air and during operation of the dryer were sampled and analysed using microscopy for particle quantification and characterisation followed by Fourier-Transform Infrared Spectroscopy (FTIR) and Pyrolysis Gas Chromatography-Mass Spectrometry (Pyr-GC/MS) for chemical characterisation. Blue fibres averaged 6.4 ± 9.2 fibres in the room blank (0.17 ± 0.27 fibres/m3), 8.8 ± 8.5 fibres (0.05 ± 0.05 fibres/m3) in the procedural blank and 58 ± 60 (1.6 ± 1.8 fibres/m3) in the sample. This is the first study to measure airborne emissions of microplastic fibres from mechanical drying, confirming that it is an emission source of microplastic fibres into air - particularly indoor air.

The Prevalence and Predictors of Dietary Supplement Use in the Australian Population.

Current dietary supplement use in Australia is not well described. We investigated the prevalence and predictors of supplement use in the Australian population (n = 19,257) using data from the 2014-2015 National Health Survey. We reported the prevalence of supplement use by sex and age group and investigated the independent predictors of supplement use in adults, adolescents, and children using multiple logistic regression models. A total of 43.2% of adults (34.9% of males, 50.3% of females), 20.1% of adolescents (19.7% of males, 20.6% of females), and 23.5% of children (24.4% of males, 22.5% of females) used at least one dietary supplement in the previous two weeks. The most commonly used supplements were multivitamins and/or multiminerals and fish oil preparations. In adults, independent predictors of supplement use included being female, increasing age, being born outside Australia and other main English-speaking countries, having a higher education level, having a healthy BMI compared to those who were obese, being physically active, and being a non-smoker. To our knowledge, this is the first detailed investigation of dietary supplement use in a nationally-representative sample of the Australian population. Future studies investigating the contribution of supplements to overall dietary intakes of vitamins, minerals, and omega-3 fatty acids are warranted.

Benign breast diseases and body mass index: is there a correlation?

Breast cancer is the leading cancer affecting women in America. Body mass index (BMI) is a known risk factor for the development of breast cancer. The relationship of BMI to benign breast disease is less clear. In addition, certain benign pathologies are associated with an increased risk of cancer. We sought to measure the incidence of benign pathologies and to correlate these findings with BMI and age. All patients undergoing breast biopsy at our center from 2000 to 2005 were identified (n = 1717). Age, BMI, family history, sex, and diagnosis were determined. Patients were grouped into BMI, age, and intervention groups. χ(2) (P < 0.05) was used to identify statistical significance. Fibrocystic disease and fibroadenoma were seen with a lower incidence for patients older than 55 years of age, whereas pathologies requiring further surgical intervention were seen in higher proportions in patients older than 55 years of age. All pathologies were noted to decrease with increasing BMI, except for fibroadenoma, which peaked in BMI group 25 to 29.9 kg/m(2). The presence of benign pathologies was associated with age as expected. Interestingly, although BMI is associated with increased risk of breast cancer, increasing BMI was not associated with benign pathologies that are associated with increased risk of breast cancer. Further study of this area is warranted.