A comparison of population-level exposure and equity tradeoffs across strategies to reduce fine particulate matter emissions from transportation sources in the northeastern US.

BACKGROUND: Many climate mitigation policies to reduce transportation emissions have public health benefits related to ambient air pollution. However, few health analyses consider the equity implications of alternative policies. Equity can be conceptualized in many different ways that may be relevant to communities, decision-makers, and other stakeholders. OBJECTIVES: To evaluate alternative transportation emissions reduction scenarios across the northeastern United States considering population exposure reductions and multiple equity constructs. METHODS: We developed four quantitative indicators reflecting equity constructs that aligned with stakeholder perspectives, including racial/ethnic exposure inequities, proportion of benefits in environmental justice communities, distribution of benefits among participating states, and rural/urban share of benefits. We analyzed numerous transportation emissions reduction scenarios for directly emitted fine particulate matter (primary PM2.5) covering 12 Northeast states and the District of Columbia. We used the Community Multiscale Air Quality model with the decoupled direct method to estimate the reduction in population-weighted primary PM2.5 exposure and the impact on equity for each scenario. RESULTS: Scenarios that yielded greater reductions in population-weighted primary PM2.5 exposure generally emphasized emissions reductions in urban areas or states with large urban centers, with a more than threefold difference in benefits across scenarios. The higher exposure-benefit scenarios typically also had greater reductions in racial/ethnic exposure inequities but led to higher between-state or rural/urban inequality. Scenarios that targeted uniform percentage emission reductions from light or heavy-duty trucks best addressed rural/urban inequalities but led to the smallest reductions in racial/ethnic inequity. CONCLUSION: There are intrinsic tradeoffs among equity constructs, where focusing resources on distributing benefits across states or between urban and rural populations could come at the expense of less reduction in racial/ethnic exposure inequities or in environmental justice communities. Future health benefits analyses should incorporate multiple equity indicators that reflect different stakeholder perspectives and articulate the underlying constructs and tradeoffs.

Assessment of the health benefits to children of a transportation climate policy in New York City.

BACKGROUND: Assessments of health and environmental effects of clean air and climate policies have revealed substantial health benefits due to reductions in air pollution, but have included few pediatric outcomes or assessed benefits at the neighborhood level. OBJECTIVES: We estimated benefits across a suite of child health outcomes in 42 New York City (NYC) neighborhoods under the proposed regional Transportation and Climate Initiative. We also estimated their distribution across racial/ethnic and socioeconomic groups. METHODS: We estimated changes in ambient fine particulate matter (PM2.5) and nitrogen dioxide (NO2) concentrations associated with on-road emissions under nine different predefined cap-and-invest scenarios. Health outcomes, including selected adverse birth, respiratory, and neurodevelopmental outcomes, were estimated using a program similar to the U.S. EPA BenMAP program. We stratified the associated monetized benefits across racial/ethnic and socioeconomic groups. RESULTS: The benefits varied widely over the different cap-and-investment scenarios. For a 25% reduction in carbon emissions from 2022 to 2032 and a strategy prioritizing public transit investments, NYC would have an estimated 48 fewer medical visits for childhood asthma, 13,000 avoided asthma exacerbations not requiring medical visits, 640 fewer respiratory illnesses unrelated to asthma, and 9 avoided adverse birth outcomes (infant mortality, preterm birth, and term low birth weight) annually, starting in 2032. The total estimated annual avoided costs are $22 million. City-wide, Black and Hispanic children would experience 1.7 times the health benefits per capita than White and Non-Hispanic White children, respectively. Under the same scenario, neighborhoods experiencing the highest poverty rates in NYC would experience about 2.5 times the health benefits per capita than the lowest poverty neighborhoods. CONCLUSION: A cap-and-invest strategy to reduce carbon emissions from the transportation sector could provide substantial health and monetized benefits to children in NYC through reductions in criteria pollutant concentrations, with greater benefits among Black and Hispanic children.

The use of dermoscopy to support the diagnosis of sarcoptic mange in two dogs.

Two unrelated adult dogs presenting with chronic pruritic dermatitis were diagnosed with sarcoptic mange through the in vivo dermoscopic visualisation of Sarcoptes scabiei mites. The species of mite was confirmed via microscopy of superficial skin scrapings taken from lesional skin. Dermoscopy offers rapid point-of-care, noninvasive screening for dogs with sarcoptic mange.

Deux chiens adultes non apparentés présentant une dermatite prurigineuse chronique ont été diagnostiqués avec une gale sarcoptique par la visualisation dermoscopique in vivo d'acariens Sarcoptes scabiei. L'espèce d'acarien a été confirmée par microscopie de raclages cutanés superficiels prélevés sur la peau lésionnelle. La dermoscopie offre un dépistage rapide et non invasif au chevet du patient pour les chiens atteints de gale sarcoptique.

Dois cães adultos apresentando dermatite pruriginosa crônica foram diagnosticados com sarna sarcóptica através da visualização dermatoscópica in vivo dos ácaros Sarcoptes scabiei. A espécie de ácaro foi confirmada por avaliação microscópica de raspados cutâneos superficiais coletados de pele lesional. A dermatoscopia é um método diagnóstico que oferece triagem ambulatorial rápida e não invasiva para cães com sarna sarcóptica.

Dos perros adultos no relacionados que presentaban dermatitis pruriginosa crónica fueron diagnosticados con sarna sarcóptica a través de la visualización dermatoscópica in vivo de los ácaros Sarcoptes scabiei. La especie de ácaro se confirmó mediante microscopía de raspados cutáneos superficiales tomados de la piel lesionada. La dermatoscopia ofrece una detección rápida y no invasiva en el punto de atención primaria para perros con sarna sarcóptica.

What is known about paediatric nurse burnout: a scoping review.

Burnout in healthcare providers has impacts at the level of the individual provider, patient, and organization. While there is a substantial body of literature on burnout in healthcare providers, burnout in pediatric nurses has received less attention. This subpopulation may be unique from adult care nurses because of the specialized nature of providing care to children who are typically seen as a vulnerable population, the high potential for empathetic engagement, and the inherent complexities in the relationships with families. Thus, the aim of this scoping review was to investigate, among pediatric nurses, (i) the prevalence and/or degree of burnout, (ii) the factors related to burnout, (iii) the outcomes of burnout, and (iv) the interventions that have been applied to prevent and/or mitigate burnout. This scoping review was performed according to the PRISMA Guidelines Scoping Review Extension. CINAHL, EMBASE, MEDLINE, PsycINFO, ASSIA, and The Cochrane Library were searched on 3 November 2018 to identify relevant quantitative, qualitative, and mixed-method studies on pediatric nurse burnout. Our search identified 78 studies for inclusion in the analysis. Across the included studies, burnout was prevalent in pediatric nurses. A number of factors were identified as impacting burnout including nurse demographics, work environment, and work attitudes. Similarly, a number of outcomes of burnout were identified including nurse retention, nurse well-being, patient safety, and patient-family satisfaction. Unfortunately, there was little evidence of effective interventions to address pediatric nurse burnout. Given the prevalence and impact of burnout on a variety of important outcomes, it is imperative that nursing schools, nursing management, healthcare organizations, and nursing professional associations work to develop and test the interventions to address key attitudinal and environmental factors that are most relevant to pediatric nurses.

Decision aids available for parents making end-of-life or palliative care decisions for children: A scoping review.

AIM: To identify and assess the quality of decision aids that align the decision, values and information provided for parents making end-of-life or palliative care decisions for children with life-threatening conditions. METHODS: Six databases and the grey literature were searched in December 2018. Two reviewers independently reviewed database citations, and one reviewed grey literature citations. Citation chaining via Scopus was conducted. Quality was assessed using IPDAS Collaboration Criteria. RESULTS: After reviewing 18 671 database citations and 10 988 grey literature citations, 18 citations describing 11 decision aids remained. Decision aids targeted premature infants, children requiring airway management, children with cancer and children with scoliosis. Three aids underwent testing beyond initial development. Quality scores averaged 27 of 50 points. CONCLUSIONS: There are few high-quality decision aids available for use and a lack evidence of widespread clinical use. Additional research is needed to support systematic development and the use of decision aids with families.

Characteristics and behavioral health needs of patients with patterns of high hospital use: implications for primary care providers.

BACKGROUND: A small percentage of patients relies extensively on hospital-based care and account for a disproportionately high share of health care spending in the United States. Evidence shows that behavioral health conditions are common among these individuals, but understanding of their behavioral health needs is limited. This study aimed to understand the behavioral health characteristics and needs of patients with high hospital utilization patterns in Camden, New Jersey. METHODS: The sample consisted of patients in a care management intervention for individuals with patterns of high hospital utilization who were referred for behavioral health assessments (N = 195). A clinical psychologist conducted the assessments, which informed a multiaxial evaluation with diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders and a Mental Status Examination, to facilitate accurate diagnosis. Demographic characteristics, housing instability, exposure to trauma, and health care service utilization data were also collected through self-report and chart reviews. RESULTS: Ninety percent of patients were diagnosed with a psychiatric and/or active substance use disorder. Depression was the most common psychiatric disorder and alcohol use was the most common substance use disorder. However, only 10% of patients with an active substance use disorder were in treatment, and only 17% of patients with a mental health diagnosis were receiving mental health treatment. Nearly all (91%) patients reported having a primary care provider at the time of assessment and most had seen their primary care provider within three months of their last hospital discharge. Non-medical barriers to health and wellness, specifically housing instability and exposure to trauma, were also common (35 and 61% of patients, respectively) among patients. CONCLUSION: Findings highlight the importance of identifying and treating patients with behavioral health needs in the primary care setting. Developing connections with community agencies who provide behavioral health and substance use treatment can enhance primary care providers' efforts to address their patients' non-medical barriers to treatment, as can embedding behavioral health providers within primary care offices. The study also underscores the need for trauma-informed care in primary care settings.

Tunable Chiral Second-Order Nonlinear Optical Chromophores Based on Helquat Dications.

Fourteen new dipolar cations have been synthesized, containing methoxy or tertiary amino electron donor groups attached to helquat (Hq) acceptors. These Hq derivatives have been characterized as their TfO- salts by using various techniques including NMR and electronic absorption spectroscopies. UV-vis spectra show intense, relatively low energy absorptions with λmax ≈ 400-600 nm, attributable to intramolecular charge-transfer (ICT) excitations. Single-crystal X-ray structures have been solved for two of the chromophores, one as its PF6- salt, revealing centrosymmetric packing arrangements (space groups Pbca and P1̅). Molecular quadratic nonlinear optical (NLO) responses have been determined directly by using hyper-Rayleigh scattering (HRS) with a 800 nm laser, and indirectly via Stark (electroabsorption) spectroscopy for the low energy absorption bands. The obtained static first hyperpolarizabilities ß0 range from moderate to large: (9-140) × 10-30 esu from HRS in MeCN and (44-580) × 10-30 esu from the Stark data in PrCN. The magnitude of ß0 increases upon either extending the π-conjugation length or replacing a methoxy with a tertiary amino electron donor substituent. Density functional theory (DFT) and time-dependent DFT calculations on selected tertiary amino chromophores confirm that the low energy absorptions have ICT character. Relatively good agreement between the simulated and experimental UV-vis absorption spectra is achieved by using the CAM-B3LYP functional with the 6-311G(d) basis set. The ßtot values predicted by using DFT at the same level of theory are large ((472-1443) × 10-30 esu in MeCN). Both the theoretical and experimental results show that para-conjugation between Hq and electron donor fragments is optimal, and enlarging the Hq unit is inconsequential with respect to the molecular quadratic NLO response.

A pilot study comparing in vitro efficacy of topical preparations against veterinary pathogens.

BACKGROUND: Topical antimicrobial agents are important for the management of cutaneous infections. For topical antimicrobial agents, in vitro efficacy data are limited. OBJECTIVES: To determine and compare the minimum bactericidal/fungicidal concentrations (MBCs/MFCs) of several topical antimicrobial agents against veterinary pathogens. MATERIALS AND METHODS: Two chlorhexidine, two oxychlorine based products (NaOCl & HOCl) lime sulfur (LS), manuka honey (MH) and hydrocortisone aceponate (HCA) were tested against American Type Culture Collection (ATCC) and clinical isolates: meticillin susceptible and resistant Staphylococcus pseudintermedius (MSSP), qac A/B carrying MSSP, antimicrobial susceptible and extended spectrum beta-lactamase producing Escherichia coli, multidrug-resistant Pseudomonas aeruginosa and Malassezia pachydermatis. The MBCs/MFCs were measured, where available, using a broth microdilution method; isolates were incubated for 3 and 10 min. RESULTS: Chlorhexidine and isopropyl alcohol (Chl(1) ) showed significantly lower MBCs (0.46 mg/L -937.50 mg/L, P = 0.027) compared to chlorhexidine and climbazole (Chl², 58.59 mg/L-1875 mg/L). NaOCl and HOCl showed excellent antimicrobial activity with HOCl having significantly lower MBCs compared to NaOCl (0.03 mg/L-1.72 mg/L and 0.03 mg/L-1.95 mg/L, respectively, P = 0.042). The detectable MBCs for LS and HCA were high, being close to the starting concentration (5,000 mg/L and 146 mg/L, respectively). The MBC/MFC for MH was not detectable. Amongst all test products there was no significant effect of contact time or isolate resistance status. CONCLUSIONS AND CLINICAL IMPORTANCE: Chlorhexidine, NaOCl and HOCl demonstrated low MBCs against tested organisms, suggesting potential in vivo efficacy. The selection of an appropriate antimicrobial agent, however, cannot be based exclusively upon MBC/MFC data; other factors should be considered.

What is known about nurse retention in peri-COVID-19 and post-COVID-19 work environments: protocol for a scoping review of factors, strategies and interventions.

INTRODUCTION: The pandemic has highlighted a worsening of nurses' working conditions and a global nursing shortage. Little is known about the factors, strategies and interventions that improve nurse retention in the peri-COVID and post-COVID time period. An improved understanding of approaches implemented to support and retain nurses will provide a blueprint for sustaining the nursing workforce. The objectives of this scoping review are to investigate and describe the following: (a) factors associated with nurse retention; (b) strategies suggested to support nurse retention and (c) interventions trialled to support nurse retention, during and after the COVID-19 pandemic. METHODS AND ANALYSIS: Medline, Embase, CINAHL and Scopus will be searched. The included studies will be qualitative, quantitative, mixed methods and grey literature studies of nurses including factors, strategies and/or interventions to support nurse retention in the peri-COVID and post-COVID time period (2019 to present) that are in English or can be translated into English. The excluded studies will be those that focus on nurse managers, educators, students or those in advanced practice roles and studies where the population cannot be segmented to identify which data came from nurses. Systematic, scoping reviews and meta-syntheses will be excluded, but their reference lists will be hand-screened for suitable studies. Data will be evaluated for quality and synthesised qualitatively to map the current evidence available. The relevant studies will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. ETHICS AND DISSEMINATION: Approval for the broader research study, including this scoping review, has been obtained from the university health sciences research board (protocol #00042510). All data for this scoping review will be collected from published literature, and findings will be published in a peer-reviewed journal and presented at relevant conferences. TRIAL REGISTRATION NUMBER: The protocol was registered on Open Science Framework (4 April 2024) https://doi.org/10.17605/OSF.IO/XWH45.

Lifetime trauma and mortality risk: A systematic review.

OBJECTIVE: Various literature are suggestive of a relation between lifetime trauma and mortality risk in adulthood, however, findings seem unclear and inconsistent. In our preregistered review, we conducted a systematic review to examine the association between lifetime trauma and mortality risk in adulthood. METHOD: Six databases (Scopus, Web of Science, CINAHL [EBSCO], PsycInfo [EBSCO], Embase, and Medline [PubMed]); were searched up to April 2023 for studies reporting adult mortality outcomes associated with traumatic events accumulated across the lifespan. Five studies were found, and a narrative review of the literature was conducted. RESULTS: Five studies met the inclusion criteria, including 5,506 individuals. Two studies with men/male-only samples reported no relation between lifetime trauma and mortality risk; however, three studies with a mixed-sex sample found a positive relation between lifetime trauma and mortality risk, indicating that the more traumatic events a person has across their lifespan, the greater their mortality risk. CONCLUSION: Lifetime trauma appears to be associated with mortality risk during adulthood. The strongest evidence stems from larger samples. However, research is sparse and inconclusive. A plethora of additional research is needed to address several limitations within the current literature, which includes utilizing standardized measures of lifetime trauma, replication of effects, and the examination of vulnerable and underrepresented populations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Tris-EDTA significantly enhances antibiotic efficacy against multidrug-resistant Pseudomonas aeruginosa in vitro.

BACKGROUND: Multidrug-resistant Pseudomonas aeruginosa commonly complicates chronic bacterial otitis in dogs. HYPOTHESIS/OBJECTIVES: The aim of this in vitro study was to determine the effect of ethylenediaminetetraacetic acid-tromethamine (Tris-EDTA) on the minimal bactericidal concentrations (MBCs) and minimal inhibitory concentrations (MICs) of marbofloxacin and gentamicin for multidrug-resistant P. aeruginosa isolates from cases of canine otitis. METHODS: Eleven isolates were identified as multidrug resistant on disc diffusion; 10 were resistant to marbofloxacin and two were resistant to gentamicin. Isolates were incubated for 90 min with each antibiotic alone and in combination with Tris-EDTA at concentrations of 0.075 µg/mL to 5 mg/mL for marbofloxacin, 0.001 µg/mL to 10 mg/mL for gentamicin and 17.8:4.7 to 0.14:0.04 mg/mL for Tris-EDTA. Positive and negative controls were included. Aliquots of each antibiotic and/or Tris-EDTA concentration were subsequently transferred to sheep blood agar to determine the MBCs, and tryptone soy broth was added to the remaining suspensions to determine the MICs. RESULTS: Tris-EDTA alone was bacteriostatic but not bactericidal at any concentration. The addition of Tris-EDTA significantly reduced the median MBC (from 625 to 468.8 µg/mL; P < 0.001) and MIC (from 29.3 to 2.4 µg/mL; P = 0.008) of marbofloxacin, and the median MBC (from 625 to 39.1 µg/mL) and MIC (from 19.5 to 1.2 µg/mL) of gentamicin (both P < 0.001). CONCLUSIONS AND CLINICAL IMPORTANCE: Tris-EDTA significantly reduced the MBCs and MICs of marbofloxacin and gentamicin for multidrug-resistant P. aeruginosa in vitro. This may be of use to clinicians managing these infections in dogs.

Cross-reaction and co-sensitization among related and unrelated allergens in canine intradermal tests.

BACKGROUND: Intradermal tests are used to identify allergens for avoidance and immunotherapy in atopic dogs. HYPOTHESIS/OBJECTIVES: To evaluate cross-reaction or co-sensitization among 53 intradermal test allergens. ANIMALS: Six hundred and fifty-one client-owned dogs with atopic dermatitis. METHODS: Intradermal tests were performed with 53 house dust/storage mite, epidermal, insect, tree, weed and grass pollen and mould allergens. Pairwise comparisons were used to calculate the odds ratios (ORs), 95% confidence intervals (CIs) and statistical significance for the results of each allergen pair, with significance at P < 0.0006 (Holm-Bonferroni correction to reduce the false-detection rate). RESULTS: Apart from cotton, cockroach, red clover, grain smut and Penicillium, the results for the allergens within each group were statistically associated [ORs from 4.7 (CI 2.5-8.9) to 1229.4 (CI 166.5-1795.1); P = 0.0005 to P < 0.0001]. Excluding red clover and cotton, 94% of results between tree, weed and grass pollens were also statistically associated [ORs from 8.3 (CI 3.6-24.7) to 117 (CI 29.1-341); P = 0.0005 to P < 0.0001]. In contrast, few allergens from unrelated groups were statistically associated [ORs from 0.12 (CI 0.03-1.1) to 27.7 (CI 0.2-93); P = 1.0 to P < 0.0001]. The mean (SD) of the log e transformed ORs for the related and statistically associated allergens [5.3 (1.3)] was significantly greater than those for related but nonstatistically associated [1.7 (1.6)] or unrelated allergens [1.4 (1.4); P < 0.0001]. CONCLUSIONS AND CLINICAL IMPORTANCE: This suggests that there is cross-reaction or co-sensitization between related allergens. This could have implications for allergen selection in testing and immunotherapy, but further studies are required to differentiate cross-reaction from co-sensitization.

Teacher Questioning to Promote Extended Language Use for Preschool Emergent Bilinguals.

PURPOSE: Emergent bilinguals (EBs) from Spanish-speaking households are a sizable and quickly growing segment of the preschool population in the United States. However, there is limited research on the provision of opportunities for EBs to engage in language-rich classroom discussion, particularly in English-dominant contexts where most EBs attend preschool. This study focused on teacher and Spanish-English EBs' language interactions in an English-dominant preschool program to better understand whether and, if so, how teachers' use of questioning strategies provided extended oral language use opportunities for Spanish-speaking EBs in their classrooms. METHOD: We adopted a sequential-explanatory mixed-methods design to examine audio recordings from whole-group instruction across seven preschool classrooms and investigate how EBs responded to teachers' conversationally responsive questioning strategies, with a specific focus on how they used Spanish as they composed extended responses. Researchers coded 31 audio recordings from 12 EB students to identify teachers' (n = 7) use of questioning strategies (closed-response, open-response, and single-word-response), as well as students' responses to questions (one-word-response or extended response) and Spanish use. RESULTS: Teachers' use of closed-response and single-word-response questions emerged as most important in supporting Spanish-English EBs' extended language use during whole-group instruction. Furthermore, the majority of student responses that included Spanish utterances were extended responses, underscoring the value of Spanish use for students to develop extended responses. CONCLUSION: Findings suggest that equitable opportunities to enter into classroom dialogue for EBs might require more explicitly scaffolded questioning strategies and might necessitate the purposeful and intentional use of Spanish.

Neuroticism facets and mortality risk in adulthood: A systematic review and narrative synthesis.

OBJECTIVE: This systematic review sought to summarize comprehensively the research investigating the association between facets of neuroticism and mortality risk. METHODS: A systematic review of prospective cohort studies utilizing rigorous reporting methods was conducted. Six electronic bibliographic databases, MEDLINE [Ovid], Embase, PsycINFO, CINAHL, Web of Science, and SCOPUS, were searched for eligible studies using keywords encompassing personality traits and mortality. Articles from inception to January 2023 were reviewed. The risk of bias was also assessed. RESULTS: Six of the 2358 identified studies met the inclusion criteria for extraction. Included studies had 335,715 participants, of whom 3.23% died. Participants ages at baseline ranged from 20 to 102, and 54% were female. Five of the six studies reported statistically significant associations between facets of neuroticism and mortality risk. Several underlying facets were reported to be associated with an increased mortality risk, namely vulnerability, cynicism, pessimistic, anxious, and depressive facets. Inadequacy, and worried-vulnerable were reported as protective. One study reported protective effects for impulsiveness, but this was not observed in a further follow-up study. CONCLUSIONS: Various facets related to neuroticism are associated with an increased or decreased mortality risk. Encompassing all facets in a broad trait likely masks very important personality-health relations, which later impact longevity. Based on these findings, recommendations and future considerations are discussed.

Comparative in vitro efficacy of antimicrobial shampoos: a pilot study.

This study compared the antimicrobial efficacy of shampoos against meticillin-sensitive Staphylococcus pseudintermedius (MSSP), meticillin-resistant S. pseudintermedius (MRSP), antibiotic-sensitive Pseudomonas aeruginosa (PA), multidrug-resistant P. aeruginosa (MDR-PA) and Malassezia pachydermatis. Three isolates were incubated for 10, 30 and 60 min with each shampoo diluted in phosphate-buffered saline. Aliquots were then incubated for 16-18 h on sheep blood agar (bacteria) or for 3 days on Sabouraud's dextrose agar (Malassezia). The minimal bactericidal concentrations (MBCs) for chlorhexidine products (Malaseb(®), Pyoderm(®)/Microbex(®) and Hibiscrub(®)) were 1:1,024-1:2,048 for MSSP and MRSP, 1:512-1:1,024 for PA and MDR-PA, and 1:2,048-1:5,096 for Malassezia at all time points. The MBCs for benzoyl peroxide (Paxcutol(®)) for MSSP and MRSP were 1:2-1:8 at 10 min, and 1:256 after 30 and 60 min. A 1:2 dilution was effective against Pseudomonas, and 1:512-1:1,024 dilutions were effective against Malassezia at all time points. The MBCs for ethyl lactate (Etiderm(®)) for MSSP and MRSP were 1:2 at 10 min, and 1:2-1:16 after 30 and 60 min. A 1:2 dilution was effective against Pseudomonas, and a 1:512 dilution was effective against Malassezia at all time points. Chloroxylenol (Coatex(®)) and acetic acid-boric acid (Malacetic(®)) were not effective against MSSP, MRSP or Pseudomonas. Both were effective against Malassezia at 1:8-1:16 dilution at 10 min, and at 1:8-1:32 dilution after 30 and 60 min. In conclusion, chlorhexidine appeared to be the most effective topical biocide, and MRSP and MDR-PA were no less susceptible than antibiotic-sensitive organisms. These results should, however, be confirmed with larger numbers of isolates.

Efficacy of a 0.0584% hydrocortisone aceponate spray in presumed feline allergic dermatitis: an open label pilot study.

This study evaluated the efficacy of a 0.0584% hydrocortisone aceponate (HCA) spray (Cortavance(®); Virbac SA) in 10 cats with presumed allergic dermatitis. The cats initially received two sprays/100 cm(2) of skin once daily. Clinical lesions (a Feline Dermatitis Extent and Severity Index; FeDESI), pruritus (10 cm visual analog scale with grade descriptors) and owner assessments of efficacy, tolerance and ease of use (from 1=very poor to 5=excellent) were assessed every 14 days. The frequency of treatment was reduced after day 28 in cats with a >50% reduction in FeDESI and pruritus scores. One cat was lost to follow up at day 28 and two at day 42. Intention-to-treat data were analysed. The FeDESI [mean (SD): day 0, 42.2 (15.7) and day 56, 9.9 (11.7); P<0.0001] and pruritus scores [day 0, 61.2 mm (20.1) and day 56, 14.6 mm (16.1); P<0.0001] significantly decreased throughout the trial. The owner scores for tolerance [median (range): day 14, 4 (1-5) and day 56, 4 (3-5); P=0.003] and ease of administration [day 14, 3 (2-5) and day 56, 4 (2-5); P=0.02] significantly increased during the trial, but there was no significant change in efficacy scores [day 14, 4 (3-5) and day 56, 4 (2-5); P=0.5]. There were no adverse effects attributable to the HCA spray, no significant changes in weight [mean (SD): day 0, 5.0 kg (1.4) and day 56, 5.0 kg (1.6); P=0.51] and no significant changes in haematology, biochemistry or urinalysis (n=4). Six cats required every-other-day treatment and four required daily treatment. In conclusion, HCA spray appeared to be effective and safe in these cats, although it is not licensed for use in this species.

Exploring Pediatric Nurses' Perspectives on Their Work Environment, Work Attitudes, and Experience of Burnout: What Really Matters?

Background: Pediatric nurses care for some of the most vulnerable patients in our healthcare system and are vulnerable to the impact of the stress of their work on their well-being. Burnout is a potential response to chronic interpersonal stressors and a negative work outcome linked to personal and professional consequences. A thorough understanding of the experience and factors associated with burnout in this population is an important part of developing interventions to mitigate or prevent this workplace outcome. Therefore, our study objectives were to: (1) explain and expand our understanding of pediatric critical care nurses experience of burnout in relation to their work environment and work engagement; (2) provide recommendations for nursing administrators to improve nurses' work environment, work attitudes, and work outcomes. Methods: A convenience sample of pediatric critical care nurses from a large pediatric quaternary care hospital in Ontario, Canada were invited to participate in this second phase of a sequential explanatory mixed-methods study. Semi-structured interviews were conducted, with and main themes and subthemes distilled through the method of interpretive description. Results: A total of 18 PICU/CCCU/NICU nurses participated. Derived themes included the experience and identification of burnout, including its prevalence and elusiveness. Their experiences of quality of work-life included themes such as compensation, emotional support at work, respect, their professional identity, and spill over into home life. They discussed components of work engagement, including the work itself, investment into their growth and development, and the meaning of their work. The self-care subthemes included the importance of preparation and recovery, and the use of physical and mental separation as a preservation strategy. The participants' recommendations for strategies to mitigate burnout were also summarized. Conclusion: Burnout is a complex and regularly occurring experience for pediatric critical care nurses. Although the experience may be difficult to self-identify, the impacts on the individuals are profound. Further research and organizational support are needed to test practical and evidence-based interventions to improve the well-being of this population.

Up to the Challenge: Adapting Pediatric Intensive Care During a Global Pandemic.

Background: The COVID-19 pandemic has strained health systems world wide. In our region, surging numbers of critically ill adult patients demanded urgent system-wide responses. During the peak of the pandemic, our Pediatric Intensive Care Unit (PICU) team redesigned the existing educational resources and processes of care to ensure for adult patients for the first time in the hospital's history. Aim: Describe the experiences and impacts of the rapidly initiated Adult COVID-19 Program on health care providers (HCP) and family members. Havelock's Theory of Change framed the examination of Adult COVID-19 Program participant experiences and surfaced lessons learned. Materials and Methods: A quality improvement review was employed to collect feedback about the program experience from the health care team and patient's family members. HCP completed a questionnaire 10 months following the implementation of the program and feedback from family members was provided during the program was obtained. Havelock's Theory of Change was used to explore trends and frame participants' experiences. Results: Pediatric Intensive Care Unit bedside team members and clinical leaders (n = 17), adult hospital partners (n = 3), and family members (n = 8) participated. HCP describe; motivation and readiness; concern for personal safety and uncertainty experienced in the early program phases; the importance of supports and resources; use of relationships and collaboration to facilitate change; the emotional impacts of this unique experience; and opportunities for individual and team growth. An overarching theme of 'doing our part to help' emerged. Family members described the positive impacts of family-centered interventions offered, individualized care, and shock at their family member's illness. Conclusion: The PICU team rapidly adapted to provide care for adults at the peak of the pandemic. Family members expressed feeling grateful for the care their loved ones received in the pediatric setting. The experience of caring for adult patients with COVID-19 was a source of tension, personal growth, and meaning for the pediatric intensive care team.

The Relationships Amongst Pediatric Nurses' Work Environments, Work Attitudes, and Experiences of Burnout.

Background: Pediatric nurses care for some of the most vulnerable patients in our healthcare system. Research on health care provider organizational behavior shows that the quality of care nurses provide is directly related to their well-being, influenced by Burnout and job stress, in the workplace. However, most of the research conducted on nursing populations neglects to separately study nurses who care for children. In a resource limited system where health care provider well-being is recognized as a priority, it is important for administrators to understand the environmental and attitudinal work factors most influential to pediatric nurse work outcomes in order to target optimization strategies. The aim of the study was to identify which modifiable work environment factors, e.g., [Incivility, Perceived Organizational Support, Quality of Work-life] make the greatest contribution to the work outcome of Burnout (i.e., Personal Accomplishment, Emotional Exhaustion, Depersonalization) in pediatric nurses. Methods: A cross-sectional survey design was used at a large quaternary care pediatric hospital in Toronto, Canada. We administered a survey to a convenience sample of all registered nurses with >3 months experience in the Pediatric, Cardiac, and Neonatal Intensive Care Units from January 2021-March 2021. Path analysis was used to test our proposed model which was specified a priori based on a review of the literature. Results: 143 nurses completed the survey. Path analysis of the tested model resulted in good fit. Quality of Work-life had the largest direct effect on Work Engagement (ß = 0.582, S.E. = 0.111, p < 0.001). Work Engagement had the largest direct effect on Personal Accomplishment (ß = 0.68, S.E. = 0.53, p < 0.001). Quality of Work-life had the largest indirect effect on Personal Accomplishment (ß = 0.4, S.E. = 0.65, p < 0.001), Emotional Exhaustion (ß = -0.33, S.E. = 0.87, p < 0.001), and Depersonalization (ß =-0.17, S.E. = 0.41, p = 0.006), respectively. Work Engagement had the largest total effect on Personal Accomplishment (ß = 0.68, S.E. = 0.64, p < 0.001) and the third largest total effect on Emotional Exhaustion (ß = -0.57, S.E. = 0.83, p < 0.001). Quality of Work-life had the second largest total effect on Work Engagement (ß = 0.58, S.E. = 0.11, p < 0.001) indicating that Quality of Work-life is mediated through Work Engagement for its effect on Burnout. Conclusions: Our results indicate work environment and work attitude factors that can provide organizational leadership with a targeted focus to reduce pediatric critical care nurse Burnout, and thus improve provider well-being, in a resource limited system.

Factors predicting long-term survival after T-cell depleted reduced intensity allogeneic stem cell transplantation for acute myeloid leukemia.

BACKGROUND: Reduced intensity conditioning regimens permit the delivery of a potentially curative graft-versus-leukemia effect in older patients with acute myeloid leukemia. Although T-cell depletion is increasingly used to reduce the risk of graft-versus-host disease its impact on the graft-versus-leukemia effect and long-term outcome post-transplant is unknown. DESIGN AND METHODS: We have characterized pre- and post-transplant factors determining overall survival in 168 patients with acute myeloid leukemia transplanted using an alemtuzumab based reduced intensity conditioning regimen with a median duration of follow-up of 37 months. RESULTS: The 3-year overall survival for patients transplanted in CR1 or CR2/CR3 was 50% (95% CI, 38% to 62%) and 44% (95% CI, 31% to 56%), respectively compared to 15% (95% CI, 2% to 36%) for patients with relapsed/refractory disease. Multivariate analysis demonstrated that both survival and disease relapse were influenced by status at transplant (P=0.008) and presentation cytogenetics (P=0.01). Increased exposure to cyclosporine A (CsA) in the first 21 days post-transplant was associated with an increased relapse risk (P<0.0001) and decreased overall survival (P<0.0001). CONCLUSIONS: Disease stage, presentation karyotype and post-transplant CsA exposure are important predictors of outcome in patients undergoing a T-cell depleted reduced intensity conditioning allograft for acute myeloid leukemia. These data confirm the presence of a potent graft-versus-leukemia effect after a T-cell depleted reduced intensity conditioning allograft in acute myeloid leukemia and identify CsA exposure as a manipulable determinant of outcome in this setting.