Paediatric family activation rapid response (FARR) in tertiary healthcare organisations: Protocol for an online, multi-lingual, application (app) intervention development study.

INTRODUCTION: At least 85% of unplanned admissions to critical care wards for children and young people (CYP) are associated with clinical deterioration. CYP and their families play an integral role in the recognition of deterioration. The Paediatric Critical Care Outreach Team (PCCOT) supports the reduction of avoidable harm through earlier recognition and treatment of the deteriorating child, acting as a welcome conduit between the multiprofessional teams, helping ensure that CYP gets the right care, at the right time and in the right place. This positions PCCOT well to respond to families who call for help as part of family activation. AIM: This protocol details the methods and process of developing a family activation rapid response online application. METHODS: This is a single-centre, sequential, multiple methods study design. Firstly, a systematic review of the international literature on rapid response interventions in paediatric family activation was conducted. Findings from the review aimed to inform the content for next stages; interviews/ focus groups and experience-based co-design (EBCD) workshops. PARTICIPANTS: parents / caregivers whose children have been discharged or admitted to an acute care hospital and healthcare professionals who care for paediatric patients (CYP). During interviews and workshops participants' opinion, views and input will be sort on designing a family activation rapid response online-app, detailing content, aesthetics, broad functionality and multi-lingual aspects. Further areas of discussions include; who will use the app, access, appropriate language and terminology for use. A suitable app development company will be identified and will be part of the stakeholders present at workshops. Data obtained will be used to develop a multi-lingual paediatric family activation rapid response web based application prototype. ETHICS AND DISSEMINATION: Full ethical approval was received from the Wales Research Ethics Committee 2. Cardiff; REC reference: 22/WA/0174. The findings will be made available to all stakeholders.

Syphilis Among U.S.-Bound Refugees, 2015 - 2018.

We assessed syphilis screening data from overseas medical examinations among U.S.-bound refugees to characterize seropositive syphilis cases and treatment from January 1, 2015, to December 31, 2018. During this time period, all refugees 15 years and older were required to undergo syphilis screening prior to resettlement to the United States. Of the 160,381 refugee arrivals who had a syphilis screening performed, 697 (434 per 100,000) were diagnosed with any stage (infectious or non-infectious) of syphilis. Among the 697 persons with seropositive syphilis, a majority (63%) were from the Africa region and were male (58%), and 53 (7.6%) were diagnosed with an infectious stage of syphilis. All infectious cases were treated prior to resettlement. This information suggests a comparable risk of infection among U.S.-bound refugees compared to a report of syphilis among U.S.-bound refugees from 2009 to 2013, indicating low rates in this population for at least a decade.

Paediatric family activated rapid response interventions; qualitative systematic review.

BACKGROUND: Failure to recognise deterioration early which results in patient death, is considered failure to rescue and it is identified as one of the leading causes of harm to patients. It is recognised that patients and their families can often recognise changes within the child's condition before healthcare professionals. To mitigate the risk of failure to rescue and promote early intervention, family-activated rapid response systems are becoming widely acknowledged and accepted as part of family integrated care. OBJECTIVE: To identify current family-activated rapid response interventions in hospitalised paediatric patients and understand mechanisms by which family activation works. METHODS: A narrative systematic review of published studies was conducted. Seven online databases; AMED, CINHAL, EMBASE, EMCARE, HMIC, JBI, and Medline were searched for potentially relevant papers. The critical appraisal skills programme tool was used to assess methodological rigor and validity of included studies. RESULTS: Six studies met the predefined inclusion criteria. Five telephone family activation interventions were identified; Call for Help, medical emergency-teams, Condition HELP, rapid response teams, and family initiated rapid response. Principles underpinning all interventions were founded on a principal of granting families access to a process to escalate concerns to hospital emergency teams. Identified interventions outcomes and mechanisms include; patient safety, empowerment of families, partnership working/ family centred care, effective communication and better patient outcomes. Interventions lacked multi-lingual options. CONCLUSION: Family activation rapid response system are fundamental to family integrated care and enhancing patient safety. Underlying principles and concepts in delivering interventions are transferable across global healthcare system.

Quantification of L-abrine in human and rat urine: a biomarker for the toxin abrin.

Abrin is a toxic protein found in the jequirity seed. L-Abrine (N-methyl-tryptophan) is also found in the jequirity seed and can be used as a biomarker for abrin exposure. Analysis of L-abrine was added to an existing method for quantifying ricinine as a marker for ricin exposure in human urine and analytically validated. Accuracy and reproducibility were enhanced by including a newly synthesized (13)C(1)(2)H(3)-L-abrine internal standard. One-milliliter urine samples were processed using solid-phase extraction prior to a 6-min high-performance liquid chromatography separation. Protonated molecular ions were formed via electrospray ionization in a triple-quadrupole mass spectrometer and quantified via multiple reaction monitoring. Method validation included the characterization of two enriched urine pools, which were used as quality control materials. Endogenous levels of L-abrine were quantified in a reference range of 113 random urine samples at 0.72 +/- 0.51 ng/mL. Urinary concentrations of L-abrine were monitored in an intentional rat exposure study for up to 48 h. Comparing the results from the human reference range and the animal exposure study indicates that this method is suitable for quantifying L-abrine within 24 h post-exposure. Quantification of L-abrine beyond 24 h is limited by rapid excretion of the biomarker and the level of the L-abrine dose.

The presence of the top prescribed pharmaceuticals in treated sewage effluents and receiving waters in Southwest Nova Scotia, Canada.

From a list of the top prescribed drugs in Canada, 11 pharmaceuticals and two metabolites were selected for study in municipal sewage treatment plant effluents and receiving waters. Wastewater samples were collected from 16 wastewater treatment plants across Southwest Nova Scotia including the Annapolis Valley, South Shore, and Metropolitan Halifax. Samples were also collected between 100 and 200 m downstream of effluent outflows. Seven pharmaceuticals were found above µg/L levels with their highest concentrations as follows: metformin (10.6 µg/L), acetaminophen (28.9 µg/L), paraxanthine (18.2 µg/L), cotinine (3.10 µg/L), caffeine (115 µg/L), naproxen (29.1 µg/L), and venlafaxine (2.65 µg/L). Metformin, paraxanthine, caffeine, naproxen, ramipril, and venlafaxine were detected in every wastewater effluent sample. Statistical analysis revealed significant differences in pharmaceutical occurrence by treatment methods, weak dependence of pharmaceutical concentrations on populations, and the co-occurrence of some pharmaceuticals. Experimental results might indicate the limitation of primary only treatment methods in breaking down pharmaceuticals.

Worker Injuries Involving the Interaction of Cattle, Cattle Handlers, and Farm Structures or Equipment.

Cattle have been identified as leading sources of injuries to agricultural workers. The present study focused on worker injuries that involved the interaction of cattle, cattle handlers, and farm structures or equipment. The goal of the study was to identify opportunities for injury prevention. We examined 221 reports of injury to cattle handlers from the Consumer Product Safety Commission's National Electronic Injury Surveillance System (NEISS). Expected interactions led to many of the cattle-handling injuries reported in the NEISS database. In almost 30% of cases, cattle pushed workers into structures such as fences, gates, posts, and walls. In another 16% to 19% of injuries, cattle struck gates and other objects, propelling them at the victims. The present research makes several important contributions to the study of cattle-handling injuries. First, the research supports an increased emphasis on the development of safer gate designs (e.g., gates that are remotely operated or that absorb energy to limit the speed at which they may be propelled by animals). Second, the research suggests a need for additional study of energy-absorbing fence and wall structures. We view these two points to be of significance because gates and associated structures (e.g., posts, fences, and walls) accounted for 45% of the injuries in the dataset, based on the associated injury narrative. Finally, the research identifies a previously unexplored source of agricultural injury data, namely the NEISS database.

Time well spent: the association between time and effort allocation and intent to leave among clinical faculty.

PURPOSE: To explore the relationship between clinical faculty members' time/effort in four mission areas, their assessment of the distribution of that time/effort, and their intent to leave the institution and academic medicine. METHOD: Faculty from 14 U.S. medical schools participated in the 2011-2012 Faculty Forward Engagement Survey. The authors conducted multivariate logistic regression analyses to evaluate relationships between clinical faculty members' self-reported time/effort in each mission area, assessment of time/effort, and intent to leave the institution and academic medicine. RESULTS: Of the 13,722 clinical faculty surveyed, 8,349 (60.8%) responded. Respondents reported an average of 54.5% time/effort in patient care. The authors found no relationship between time/effort in patient care and intent to leave one's institution. Respondents who described spending "far too much/too much" time in patient care were more likely to report intent to leave their institution (odds ratio 2.12, P<.001). Those who assessed their time/effort in all mission areas as "about right" were less likely to report intent to leave their institution (64/1,135; 5.6%) than those who reported "far too little/too little" or "far too much/too much" time/effort in one or more mission areas (535/3,671; 14.6%; P<.001). CONCLUSIONS: Although the authors found no relationship between reported time/effort in patient care and intent to leave, the perception of "far too much/too much" time/effort spent in that mission area was correlated with intent to leave the institution. Efforts to align time/effort spent in each mission area with faculty expectations may improve retention.

Characteristics, satisfaction, and engagement of part-time faculty at U.S. medical schools.

PURPOSE: To describe the demographics of part-time faculty at U.S. medical schools and to examine their satisfaction with and perceptions of their workplace. METHOD: Faculty from 14 Liaison Committee on Medical Education-accredited U.S. medical schools participated in the 2011-2012 Faculty Forward Engagement Survey. The authors calculated descriptive statistics of part-time faculty respondents and used ANOVA and t test analyses to assess significant differences between and among demographic groups. RESULTS: The survey yielded an overall response rate of 62% (9,600/15,490). Of the part-time faculty respondents, most had appointments in clinical departments (634/674; 94%) and were female (415/674; 62%). Just over 80% (384/474) reported a full-time equivalent of 0.5 or higher. The majority of part-time faculty respondents reported satisfaction with their department and medical school as a place to work (372/496 [75%] and 325/492 [66%]); approximately half agreed that their institution had clear expectations for part-time faculty (210/456; 46%) and provided the resources they needed (232/457; 51%). Significant differences existed between part- and full-time faculty respondents regarding perceptions of growth opportunities and compensation and benefits, with part-time faculty respondents feeling less satisfied in these areas. CONCLUSIONS: As institutions work to improve the satisfaction of full-time faculty, they should do the same for part-time faculty. Understanding why faculty choose part-time work is important in encouraging the recruitment and retention of the most talented faculty. The findings of this study indicate multiple opportunities to improve the satisfaction and engagement of part-time faculty.

Evaluation of newly synthesized and commercially available charged cyclomaltooligosaccharides (cyclodextrins) for capillary electrokinetic chromatography.

A highly new charged cyclodextrin (CD) derivatives, (6-O-carboxymethyl-2,3-di-O-methyl)cyclomaltoheptaoses (CDM-beta-CDs), was synthesized and characterized as anionic reagents for capillary electrophoresis (CE) in an electrokinetic chromatography mode of separation. Substitution with dimethyl groups at the secondary hydroxyl sites of the CD is aimed at influencing the magnitude and selectivity of analyte-CD interactions, while substitution by carboxymethyl groups at the primary hydroxyl sites provides for high charge and electrophoretic mobility. Full regioselective methylation at the secondary hydroxyl sites was achieved in this work, while substitution at the primary hydroxyl sites generated a mixture of multiply charged products. The separation performance of CDM-beta-CD was evaluated using a variety of analyte mixtures. The results obtained from commercially available negatively charged cyclodextrins, heptakis(2,3-di-O-methyl-6-O-sulfo)cyclomaltoheptaose (HDMS-beta-CD) and O-(carboxymethyl)cyclomaltoheptaose (CM-beta-CD) with an average degree of substitution one (DS 1), were compared to CDM-beta-CD using a sample composed of eight positional isomers of dihydroxynaphthalene. Four hydroxylated polychlorobiphenyl derivatives, a group of chiral and isomeric catchecins, and chiral binaphthyl compounds were also separated with CDM-beta-CD. The effect of adding neutral beta-cyclodextrin (beta-CD) into the running buffer containing charged cyclodextrins was investigated and provided evidence of significant inter-CD interactions. Under certain running buffer conditions, the charged cyclodextrins also appear to adsorb to the capillary walls to various degrees.

Deposition of Cl2 on soils during outdoor releases.

Synthetic soil blends were exposed to dense chlorine (Cl2) plumes released at Dugway Proving Ground, UT, during Spring 2010 with the purpose of determining the magnitude of Cl2 deposition onto soil and assessing its potential for attenuating a high-concentration plume. Samples were exposed at varying distances from the release point to include exposure to the pooling liquid (2-3m) and dense vapor (10-17 m). Following exposure, soil samples were cored, fractionated vertically and analyzed for chloride (Cl(-)) to quantify the integrated amount of Cl2 deposited. Cl(-) was detected as deep as 4 cm in samples exposed to dense Cl2 vapor and in the deepest fractions (13 cm) of samples exposed to liquid Cl2. Chloride concentration, [Cl(-)], in the soil samples positively correlated with soil mass fractions of organic matter and water, and while their individual contributions to Cl2 deposition could not be quantitatively determined, the data suggest that organic matter was the primary contributor. [Cl(-)] results from the top vertical fractions (1.3 cm nearest the surface) were used in an analysis to determine the magnitude of deposition as a loss term under low-wind (≤ 1.6m/s) conditions. The analysis revealed up to 50% of a 1814-kg release could be deposited within 20 m from the release point for soil with high organic matter (43%) and/or water content (29%).

Challenges in academic obstetrics and gynecology departments.

OBJECTIVE: In 2011, the Association of American Medical Colleges conducted a multicenter survey to assess faculty satisfaction, engagement, and retention. This subanalysis describes the perceptions of academic obstetrician-gynecologists (ob-gyns). METHOD: Fourteen U.S. institutions offered voluntary faculty survey participation. We analyzed demographic information and responses to items within the 10 work-related dimensions. This analysis used pooled cohort data for 329 ob-gyn respondents across institutions. RESULTS: The mean response rate was 61.7% (9,600/15,570) overall and 66.9% for ob-gyn respondents. Most ob-gyn respondents reported satisfaction with work-related autonomy (72.2%) and a sense of accomplishment in their day-to-day activities (81.9%), including clarity about how their day-to-day activities fit into their medical school's mission (68.4%). In an average week, ob-gyn respondents reported working 59.4 hours on average. The mean percentage of effort varied by activity: patient care (54.8%), teaching (18.1%), research and scholarship (17.0%), and administration (15%). The mean proportion of ob-gyn respondents reporting that far too much or too much of their time and effort was spent on patient care was 35.1%, with more than half (59.5%) reporting far too little or too little of their time and effort was spent on research and scholarship and a third (33.3%) reporting far too little or too little time and effort devoted to teaching. Although 60.9% of respondents thought a mentor at their institution was important, only 22.2% reported a formal mentoring relationship. In the next 1-2 years, 13.4% reported seriously planning or being undecided (18.8%) about leaving their medical school. CONCLUSION: Academic obstetrics and gynecology departments face challenges balancing faculty members' academic desires and clinical demands. LEVEL OF EVIDENCE: II.

Support for a fluid-continuum model of sexual orientation: a large-scale Internet study.

In a study with 17,785 subjects obtained over the Internet from the United States and 47 other countries, Kinsey's hypothesis that sexual orientation lies on a continuum was supported. Self-identifications of subjects as gay, straight, bisexual, and other corresponded to broad, skewed distributions, suggesting that such terms are misleading for many people. Sexual orientation range-roughly, how much flexibility someone has in expressing sexual orientation-was also measured. The results support a fluid-continuum model of sexual orientation, according to which genetic and environmental factors determine both the size of the sexual orientation range and the point at which an individual's sexual orientation is centered on the continuum.

Predictors of workplace satisfaction for U.S. medical school faculty in an era of change and challenge.

PURPOSE: To examine the current state of satisfaction with the academic medicine workplace among U.S. medical school faculty and the workplace factors that have the greatest influence on global satisfaction. METHOD: The authors used data from the 2009 administration of a medical school faculty job satisfaction survey and used descriptive statistics and χ analyses to assess levels of overall satisfaction within faculty subgroups. Multiple regressions used the mean scores of the 18 survey dimensions and demographic variables to predict three global satisfaction measures. RESULTS: The survey was completed by 9,638 full-time faculty from 23 U.S. medical schools. Respondents were mostly satisfied on global satisfaction measures including satisfaction with their department (6,506/9,128; 71.3%) and medical school (5,796/9,124; 63.5%) and whether they would again choose to work at their medical school (5,968/8,506; 70.2%). The survey dimensions predicted global satisfaction well, with the final models explaining 51% to 67% of the variance in the dependent measures. Predictors across models include organization, governance, and transparency; focus of mission; recruitment and retention effectiveness; department relationships; workplace culture; and nature of work. CONCLUSIONS: Despite the relatively unpredictable environmental challenges facing medical schools today, leaders have opportunities to influence and improve the workplace satisfaction of their faculty. Examples of opportunities include fostering a culture characterized by open communication and occasions for faculty input, and remaining vigilant regarding factors contributing to faculty burnout. Understanding what drives faculty satisfaction is crucial for medical schools as they continue to seek excellence in all missions and recruit and retain high-quality faculty.

Airborne chemistry coupled to Raman spectroscopy.

In this paper, the use of airborne chemistry (acoustically levitated drops) in combination with Raman spectroscopy is explored. We report herein the first Raman studies of crystallization processes in levitated drops and the first demonstration of surface-enhanced Raman scattering (SERS) detection in this medium. Crystallization studies on the model compounds benzamide and indomethacin resulted in the formation of two crystal modifications for each compound, suggesting that this methodology may be useful for investigation of polymorphs. SERS detection resulted in a signal enhancement of 27 000 for benzoic acid and 11 000 for rhodamine 6-G. The preliminary results presented here clearly indicate that several important applications of the combination between Raman spectroscopy and acoustic drop levitation can be expected in the future.