Two-photon laser-induced fluorescence study of the CO B 1Σ+ (v' = 0) state in a 4850 K plasma plume: Modified molecular constants, evidence of predissociation, and J'-dependent photoionization.

We report the two-photon absorption laser-induced fluorescence rotational spectrum of the CO B 1Σ+ ← X 1Σ+ Hopfield-Birge system (v' = 0, v″ = 0) Q-branch in an ∼4850 K, atmospheric pressure plasma torch plume at thermal equilibrium in both the quenching-dominated (low laser intensity) and photoionization-dominated (high laser intensity) regimes. We provide a detailed analysis of the photophysics in these two regimes using a rate equation approach and propose modeling considerations for them as well. In the experimental spectra, distinct rotational transitions up to J″ = 83 are observed, allowing analysis over a very large range of rotational states. Evidence of predissociation is observed for J' ≥ 64 and is likely due to the interaction with the D'1Σ+ electronic state, which has been proposed in the literature but never observed in the v' = 0 state. The line positions of higher rotational states show disagreement with line positions calculated from molecular constants in the available literature, suggesting the need for modifications to the constants, which are reported here. A shift in the B 1Σ+ ← X 1Σ+ absorption spectrum toward higher two-photon energy as a result of the second-order Stark shift was observed in the photoionization-dominated spectrum, and the second-order Stark shift cross section was estimated to be 7 ± 3 × 10-18 cm2. The mean photoionization cross section of the excited upper state was inferred by comparing the line broadening of the two spectra and was estimated to be 11 ± 7 × 10-18 cm2. In addition, weak J'-dependent variations of the photoionization cross section were observed and are reported here.

Nitrogen thermometry in an inductively coupled plasma torch using broadband nanosecond coherent anti-Stokes Raman scattering.

The development of atmospheric hypersonic flight and re-entry capabilities requires the characterization of the thermo-chemical state of representative test environments. This study demonstrates the usage of multiplex nanosecond N 2 coherent anti-Stokes Raman scattering (CARS) to measure temperatures in an atmospheric, high-temperature (>6000K), air plasma plume, generated by an inductively coupled plasma torch. These are some of the highest temperatures ever accessed via gas-phase CARS, to our knowledge. Temperatures of N 2 in the equilibrium plasma plume are determined via theoretical fits to measured CARS spectra. We discuss the practical implementation of CARS at very high temperatures, including the scaling of the N 2 CARS signal strength from 300 to 6700 K, where the expected peak signal from the high-temperature plasma torch gases is two orders of magnitude less than commonly encountered in combustion environments. An intensified CCD camera enables single-laser-shot detection at temperatures as high as 6200 K, by increasing sensitivity and providing a time gate against intense background luminosity. We also discuss the impacts of unwanted two-beam CARS contributions from outside the nominal three-beam measurement volume. We present mean axial and radial temperature profiles, as well as time-series data derived from both single-laser-shot and accumulated CARS spectra. The single-laser-shot precision is 1.7%-2.6% at temperatures of 3500 to 6200 K. The presented results pave the way for the use of CARS at very high temperatures and the measurement of spatially resolved interface processes in high-enthalpy flows.

The Scope of Mental Illness and Status of Psychiatric Care in Uganda.

Mental illness in Uganda affects over one-third of the population. Less than half of these individuals seek intervention because of the lack of mental health services, including providers of care, such as nurses; psychotropic medicines; psychosocial interventions; and psychotherapies. Stigma associated with mental illness also is a significant barrier to care. The purpose of this article is to describe the scope of mental illness and the status of psychiatric care in Uganda as well as to provide implications for mental health nursing.

An Integrative Review of Pediatric Early Warning System Scores.

Increasingly, early warning system scores are being introduced into pediatric clinical practice to support the early recognition of and intervention for clinical deterioration in hospitalized children at risk. This integrative review explored what is known about early warning system scores with pediatric patients. Twenty-eight publications, including research, clinical practice articles, and conference abstracts, were identified. Five major concepts emerged from analysis of retrieved documents: overview of pediatric early warning system scores, supplementary benefits, facilitators to successful implementation, barriers to successful implementation, and needed research. Greater psychometric testing of tools is needed before any recommendations can be made regarding extensive implementation with the pediatric population.

Medical device-related hospital-acquired pressure ulcers in children: an integrative review.

The management, cost, physical and emotional suffering associated with pressure ulcers have a significant impact on the health status of patients-especially infants and children. The purpose of this integrative review was to identify factors associated with medical device-related (MDR) hospital acquired pressure ulcers (HAPUs) in the pediatric population. Pediatric MDR HAPUs are becoming more prevalent and require further exploration in terms of describing devices which cause injury and preventive interventions to improve patient outcomes. Opportunities to uncover new methods for addressing this important problem and to inform and advance the state of the science in this evolving area exist.

Understanding the clinical handoff perspective of pediatric emergency nurses.

In 2007, The Joint Commission began requiring health care organizations to develop and implement a standardized approach to clinical handoff. The goal is to improve patient safety across the health care continuum. While accurate and complete handoff communication is essential in all areas of patient care, it is of critical importance where patients require the most complex care, such as in the emergency department. This quality improvement study used a focus group to begin to understand the clinical handoff perspective of pediatric emergency nurses. Eight nurses of varying levels of practice who work a variety of shifts participated to explore the clinical handoff process in the emergency department of a pediatric teaching hospital. Perceptions and beliefs regarding the process of clinical handoff (who is involved, what variations exist, where they occur) and barriers to the clinical handoff process were explored. Recurring themes included provider-directed handoff, interruptions--impediment to care, and envisioning the ideal process.

Creating a Process for the Implementation of Tiered Huddles in a Veterans Affairs Medical Center.

INTRODUCTION: In 2019, the Veteran's Health Administration began its journey in pursuit of becoming an enterprise-wide High Reliability Organization (HRO). Improving the delivery of safe, high quality patient care is a central focus of HROs. Requisite to meeting this goal is the timely identification and resolution of problems. This is best achieved by empowering and engaging both clinical and non-clinical staff across the healthcare organization through the promotion of robust collaboration and communication between various disciplines. Improved care coordination and increased accountability are two important subsequent outcomes. One method for accomplishing this is through the implementation of tiered huddles. MATERIALS AND METHODS: An extensive review of the current literature from 2013 until June 2021 was conducted for evidence highlighting the experiences of other healthcare organizations during implementation of huddles. Following the review, a tiered huddle proposal was developed and presented to the executive leadership team of a healthcare system for approval. Pilot testing of the tiered huddle implementation plan began in October 2021 over a 12-week period with three services. On average, the pilot services had between three to four tiers from frontline staff to the executive level of leadership. RESULTS: Over the 12-week period, out of the possible 120 tiered huddles that could have been conducted, 68% (n = 81) were completed. Of the tiered huddles conducted, 99% (n = 80) started and ended on time. During the pilot test, seven issues were identified by frontline staff: coordination of pre-procedural coronavirus testing, equipment/computer issues, rooms out of service, staffing levels, and lack of responsiveness from other departments. Issues related to staffing, unresponsiveness from other departments, and equipment concerns required elevation to a higher-level tier with no issues remaining open. Delays in patient care, or prolongation of shift hours for staff because of tiered huddles, was low at 2.5% (n = 2). For the duration of the pilot test, a total of 75 minutes accounted for shifts being extended among five staff members. CONCLUSIONS: The success of this initiative demonstrates the importance of thoughtfully creating a robust process when planning for the implementation of tiered huddles. The findings from this initiative will be of immense value with the implementation of tiered huddles across our healthcare system. We believe that this approach can be used by other healthcare institutions along their journey to improving patient safety and quality.

Requirements for implementing a 'just culture' within healthcare organisations: an integrative review.

PURPOSE: To identify requirements for implementing a 'just culture' within healthcare organisations. METHODS: Using Whittemore and Knafl's methodology for integrative reviews, we searched PubMed, PsychInfo, Cumulative Index of Nursing and Allied Health Literature, ScienceDirect, Cochrane Library and ProQuest Dissertations and Theses. Publications were considered eligible when reporting requirements for implementing a 'just culture' within healthcare organisations. RESULTS: After screening for inclusion and exclusion criteria, 16 publications were included in the final review. Four main themes were identified: leadership commitment, education and training, accountability and open communication. CONCLUSION: The themes identified in this integrative review provide some insight into the requirements for implementing a 'just culture' within healthcare organisations. To date, most of the published literature on 'just culture' is theoretical in nature. Additional efforts are needed to conduct research to explore further what requirements must be addressed in order to successfully implement a 'just culture' which is needed to promote and sustain a culture of safety.

Promoting Psychological Safety in Healthcare Organizations.

Healthcare organizations across the United States have begun the journey to high reliability as one method for improving patient safety. Being a High Reliability Organization (HRO) requires constant vigilance for ensuring the delivery of system-wide excellence in patient quality and safety. Establishing a foundation for high reliability requires the engagement of personnel across the organization from frontline staff to executive leadership. Staff must feel comfortable voicing concerns in order to be fully engaged. However, we believe this is easier said than done. The purpose of this article is to describe the importance of psychological safety along the journey to becoming an HRO. Additionally, strategies for promoting a psychologically safe work environment are provided.

Implementing Just Culture to Improve Patient Safety.

INTRODUCTION: The number of deaths in the United States related to medical errors remains unacceptably high. Further complicating this situation is the problem of underreporting due to the fear of the consequences. In fact, the most commonly reported cause of underreporting worldwide is the fear of the negative consequences associated with reporting. As health care organizations along the journey to high-reliability strive to improve patient safety, a concerted effort needs to be focused on changing how medical errors are addressed. A paradigm shift is needed from immediately assigning blame and punishing individuals to one that is trusting and just. Staff must trust that when errors occur, organizations will respond in a manner that is fair and appropriate. MATERIALS AND METHODS: An extensive review of the literature from 2017 until January 2022 was conducted for the most current evidence describing the principles and practices of "just culture" in health care organizations. Additionally, recommendations were sought on how health care organizations can go about implementing "just culture" principles. RESULTS: Twenty sources of evidence on "just culture' were retrieved and reviewed. The evidence was used to describe the concept and principles of "just culture" in health care organizations. Furthermore, five strategies for implementing "just culture" principles were identified. CONCLUSIONS: Improving patient safety requires that high-reliability organizations strive to ensure that the culture of the organization is trusting and just. In a trusting and just culture, adverse events are recognized as valuable opportunities to understand contributing factors and learn rather than immediately assign blame. Moving away from a blame culture is a paradigm shift for many health care organizations yet critically important for improving patient safety.

A High-reliability Organization Mindset.

In 2020, the US Department of Veterans Affairs Connecticut Healthcare System began its journey to becoming a high-reliability organization as part of Veterans Affairs efforts to become an enterprise-wide high-reliability organization through the Veterans Health Administration. The initiative was launched to create safe enterprise-wide health care systems and environments with robust continuous process improvements as a method for providing patients with safer and higher quality care. In this article, the authors describe a continuous process improvement initiative aimed at implementing system-wide initiatives along the journey to becoming a high-reliability organization. The initiatives are described from the perspectives of individuals representing staff from the frontline to executive leadership. The authors believe that the processes, strategies, and example initiatives described can be readily adopted and implemented in other health care organizations along the journey to high reliability.

Walter Reed National Military Medical Center: simulation on the cutting edge.

Walter Reed National Military Medical Center is implementing state-of-the-art technologies in the National Capital Region. In partnership with local and federal entities, advanced simulation and web-based computer training for a broad spectrum of military healthcare professionals will improve healthcare delivery and patient safety for service members and their families. This article describes the evolving formation of simulation technology under Joint Task Force National Capital Region Medical.

Joint Task Force National Capital Region Medical: integration of education, training, and research.

In 2005, the U.S. Department of Defense announced that two of the Department's largest medical centers (the Army's Walter Reed Army Medical Center and the Navy's National Naval Medical Center) would integrate. This integration, which also includes the Air Force's Malcolm Grow Medical Center, Fort Belvoir Community Hospital, and the Uniformed Services University, will establish a model for future military health care, education, training, and research. This article describes an evolving transformation of health services in the National Capital Region through the establishment of the Joint Task Force National Capital Region Medical.

Workplace bullying in nursing: a problem that can't be ignored.

Workplace bullying is a serious problem affecting nursing. Abusive workplaces result in lack of job satisfaction, poor retention, and adverse patient outcomes. The purpose of this article is to present the history of this problem in nursing and offer potential solutions.

Toxic stress and child refugees.

The purpose of this article was to describe the phenomenon of toxic stress and its impact on the physical and mental health of child refugees. Almost two decades ago, researchers found that recurring adverse childhood events (ACEs; e.g., physical, psychological, and sexual abuse, neglect, and household dysfunction such as substance abuse, mental illness, and criminal behavior) were associated with a significant increase in serious illnesses during adulthood. Illnesses include heart, lung, and liver disease, cancer, and bone fractures. The scientists reported that experiencing four or more ACEs during childhood significantly increases the risk for toxic stress. Toxic stress is defined as the exposure to extreme, frequent, and persistent adverse events without the presence of a supportive caretaker. There is a paucity of literature related to toxic stress and child refugees. However, it has been clearly established that the prolonged brutal and traumatizing war in Syria is having a profound impact on the physical and mental health of child refugees at a distressing rate. Prevention of toxic stress should be a primary goal of all pediatric healthcare professionals working with child refugees. While this seems daunting given the population, and the seemingly insurmountable stressors they experience, some basic interventions should be considered. Providing basic anticipatory guidance to parents and caregivers of child refugees, to encourage positive parenting and strengthening support networks, will be highly effective in developing the requisite buffers that mitigate the effects of stress and avoid toxic stress. Efforts should also be focused on addressing caregiver stress and improving their ability to provide safe, reliable, and nurturing care that will help to mitigate any stress response experienced by a child. PRACTICE IMPLICATIONS: It is critical that greater awareness be placed on the effects of toxic stress on child refugees who are exposed to significant adverse events early in life.

Understanding Zika virus.

PURPOSE: This article describes what pediatric healthcare professionals should know about Zika virus (ZIKV). LITERATURE REVIEW: ZIKV is classified as an arthropod-borne, single-stranded RNA virus of the Flaviviridae family and genus Flavivirus. ZIKV is not new. The virus was first discovered almost 70 years ago in Uganda. The first isolate of the virus was found in rhesus monkeys in the Zika Forrest, hence the nomenclature. The primary route of ZIKV transmission to humans is through the bite of an infected Aedes species mosquito-primarily Aedes aegypti. When the mosquito bites individuals infected with the virus, mosquitos then become the vector of transmitting the infection to others. Women can also pass ZIKV to their fetus during pregnancy and at the time of delivery. ZIKV can also be transmitted through sexual activity from an individual who is infected with the virus to his or her partners. It is estimated that approximately 18% of individuals infected with ZIKV will go on to develop symptoms. When symptoms develop, it is usually within 3-12 days, although this may vary. Most often, symptoms are mild and self-limited. The most common symptoms are fever, arthralgia, maculopapular rash, and conjunctivitis lasting up to seven days. Less frequent symptoms include headache, vertigo, myalgia, vomiting, and diarrhea. At present, there is no vaccine available to prevent ZIKV and no specific antiviral treatment. Supportive care consisting of rest, hydration, analgesics, antihistamines, and antipyretics is recommended as needed. Given that there is no vaccine or treatment for ZIKV, considerable efforts must be focused on prevention. One of the most effective ways of preventing ZIKV infection is through avoiding mosquito bites, especially when traveling to or residing in areas where transmission is present. Precautions should include wearing appropriate attire with the objective of having as little skin exposed as possible, use of screens for windows and doors, and use of insect repellent. PRACTICE IMPLICATIONS: What is known about ZIKV changes continually. An infectious threat that was relatively obscure just a few months ago has now become a topic of heightened interest worldwide. Pediatric healthcare professionals must remain cognizant of evolving developments and emerging new evidence.

Displaced and forgotten child refugees: A humanitarian crisis.

PURPOSE: To describe where child refugees are located, the risks they face, leading health problems, and how pediatric healthcare professionals can help. CONCLUSIONS: Children constitute approximately 46% of refugees worldwide. These refugees fled their home countries due to conflict and persecution, and cannot return because of race, religion, nationality, political opinion, or membership in a particular social group. PRACTICE IMPLICATIONS: Pediatric nurses have an unprecedented opportunity to advocate for child refugees by contributing to the international conversation on the human rights of immigrants.

Ethical considerations: pediatric short-term medical missions in developing countries.

For many years pediatric healthcare experts have debated how much benefit was derived by host nations from the well intentioned efforts of Pediatric Short-Term Medical Missions (STMMs). Most of the literature on STMMs, while limited, has focused on frameworks for the delivery of care. Today the focus of these endeavors is on the ethical implications. The purpose of this article is to describe how the focus of STMMs has changed over the past 15 years from delivery of care frameworks to ethical considerations.