Severity of Illness Scoring for Pediatric Interfacility Transport: A North American Survey.

OBJECTIVE: Severity of illness scoring during pediatric critical care transport may provide objective data to determine illness trajectory and disposition and contribute to quality assurance data for pediatric transport programs. The objective of this study was to ascertain the breadth of severity of illness scoring tool application among North American pediatric critical care transport teams. METHODS: A cross-sectional quantitative survey using REDCap was distributed to 137 North American pediatric transport programs. Baseline team characteristics were established along with questions related to severity of illness tool application.Descriptive statistics were used for analysis. RESULTS: There were 55 responses (40%), and of those, 13 (24%) use a severity of illness scoring tool within their practice. A variety of tools were used including: Transport Risk Index of Physiologic Stability, Children's Hospital Medical Center Cincinnati, Canadian Triage and Acuity Score, Transport Risk Assessment in Pediatrics, Pediatric Early Warning Scores, Levels of Acuity, Transport Pediatric Early Warning Scores, and an unspecified tool. The timing of scoring, team personnel who applied the score, and the frequency of analysis varied between transport programs. CONCLUSIONS: Severity of illness scoring is not consistently performed by pediatric interfacility transport programs in North America. Among the programs that use a scoring tool, there is variability in its application. There is no universally accepted or performed severity of illness scoring tool for pediatric interfacility transport.Future research to validate and standardize a pediatric transport severity of illness scoring tool for North America is necessary.

Brain Death Criteria: Medical Dogma and Outliers.

The diagnosis of brain death (BD) is legally and medically accepted. Recently, several high-profile cases have led to discussions regarding the integrity of current criteria, and many physiologic problems have been identified to support the necessity for their reevaluation. These include a global variability of the criteria, the suggestion of a clinical "hierarchy," and the resultant approximation of BD. Further ambiguity has been exposed through case reports of reversible BD, and an inconsistent understanding from physicians who are viewed as experts in this domain. Meeting BD criteria clearly does not equate to a physiologic "death" of the brain, and a greater community perspective should be considered as the dialogue moves forward.

Conceptual framework for increasing legitimacy and trust of sustainability governance.

While the quantity of sustainability governance initiatives and systems has increased dramatically, crises persist over whether specific governance systems can be trusted as legitimate regulators of the sustainability of economic activities. This paper focuses on conceptual tools to improve our understanding of these crises as well as the facilitating factors and barriers for sustainability governance to play a role in transitioning to profoundly more sustainable societies than those that currently exist. Bioenergy is used throughout the paper as an example to aid contextually in understanding the theoretical and abstract arguments. We first define eight premises upon which our argumentation is developed. We then define sustainability, sustainability transition, legitimacy, and trust as a premise for obtaining effectiveness in communication and minimising risks associated with misunderstanding key terms. We proceed to examine the literature on "good governance" in order to reflect upon what defines "good sustainability governance" and what makes governance systems successful in achieving their goals. We propose input, output, and throughput legitimacy as three principles constituting "good" sustainability governance and propose associated open-ended criteria as a basis for developing operational standards for assessing the quality of a sustainability governance system or complex. As sustainability governance systems must develop to remain relevant, we also suggest an adaptive governance model, where continuous re-evaluation of the sustainability governance system design supports the system in remaining "good" in conditions that are complex and dynamic. Finally, we pull from the literature in a broad range of sciences to propose a conceptual "governance research framework" that aims to facilitate an integrated understanding of how the design of sustainability governance systems influences the legitimacy and trust granted to them by relevant actors. The framework is intended to enhance the adaptive features of sustainability governance systems so as to allow the identification of the causes of existing and emerging sustainability governance crises and finding solutions to them. Knowledge generated from its use may form a basis for providing policy recommendations on how to practically solve complex legitimacy and trust crises related to sustainability governance. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13705-021-00280-x.