Impact of Standardized Multidisciplinary Critical Care Training on Confidence with Critical Illness and Attitudes Towards Interprofessional Education and Multidisciplinary Care.

INTRODUCTION: The Fundamental Critical Care Support Course (FCCS) is a standardized multidisciplinary program designed to educate participants on the basics of identification and management of patients with critical illness. Our objective was to evaluate the effect of FCCS participation on confidence in the assessment and management of critically ill patients and attitudes towards multidisciplinary education and interprofessional care in a multidisciplinary group of participants. METHODS: Participants enrolled in the FCCS course from May 2018 to November 2019 were solicited to participate in a series of surveys evaluating their course experience and confidence in critical care. Attitudes towards multidisciplinary education and interprofessional care were evaluated using the Student Perceptions of Interprofessional Clinical Education-Revised Instrument version 2 (SPICE-R2) tool. A prospective pre- and post-design with a self-report survey including retrospective pre-training assessment and a 3-month follow-up was conducted. Statistical analysis was performed using descriptive statics and non-parametric methods. RESULTS: 321 (97.9%) of the course participants enrolled in the study and completed the confidence survey and SPICE-R2 tool pre-course. Nurses (113, 35.4%) and physicians (110, 34.4%) made up the largest groups of participants, although physician assistants and paramedics were also well represented. Confidence in recognition and management of critical illness significantly improved across all studied domains after course completion, with the mean total confidence score improving from 32.96 pre-course to 41.10 post-course, P < 0.001. Attitudes towards multidisciplinary education and interprofessional care also improved (mean score 41.37 pre-course vs 42.71 post-course, P < 0.001), although pre-course numbers were higher than expected which limited the significance to only certain domains. DISCUSSION: In a multidisciplinary group, completion of FCCS training led to increased confidence in all aspects of critical illness measured. A modest increase in attitudes regarding multidisciplinary education and interprofessional care was also demonstrated. Further study is needed to assess whether this increased confidence translates to improvements in patient care and outcomes.

Timing of withdrawal of life-sustaining therapy in traumatic brain injury: exploring indicators of poor prognosis in adult and geriatric populations.

OBJECTIVE: The lack of objective prognostication tools for severe traumatic brain injury (TBI) causes variability in the application of withdrawal of life-saving treatment (WLST). We aimed to determine whether WLST in persons with severe TBI is associated with known indicators of poor prognosis. METHODS: This retrospective descriptive study focused on adult (18-64 years) and geriatric (≥65 years) patients with severe TBI who were admitted between August 1, 2018 and July 31, 2021 at a Level I trauma center and subsequently underwent WLST. The data collected from the Trauma Registry and electronic health records included information regarding demographic characteristics, injury severity, clinical variables, and length of hospital stay and were used to examine the indicators of poor prognosis and WLST. RESULTS: Among the 164 participants with TBI who met the inclusion criteria, 61.0% were geriatric, and 122 (74.4%) patients had 0 or only 1 of the poor prognostic indicators prior to WLST. The non-geriatric group had more indicators of poor prognosis than the geriatric group. Participants with fewer indicators of poor prognosis had a longer length-of-stay. CONCLUSION: In severe TBI cases, standardized prognostication tools can help guide informed WLST decisions, particularly in geriatric patients, improving care consistency.

Exploring PAH kinetics in wild vs. transplanted triploid and diploid oysters at a contaminated field site using immunological techniques.

Crassostrea virginica is a well-established bivalve species for biomonitoring persistent organic pollutants such as polycyclic aromatic hydrocarbons (PAH) in aquatic environments. Differing biomonitoring methods employing either wild oysters inhabiting sites of interest or naïve cultured oysters deployed to sites for extended periods can be used for site evaluations. However, important differences in total contaminant concentrations accumulated have been observed between the wild and transplanted groups. Furthermore, although rearing cultured triploid oysters is widely popular in commercial farming, the difference in contaminant bioaccumulation potential between triploid and diploid cultured oysters is vastly understudied, particularly for organic contaminants such as PAH. This study explores differences in PAH kinetics between transplanted triploid and diploid cultured oysters and wild oysters at a PAH-impacted site during a 6-week field exposure study using novel immunological techniques: antibody-based biosensor technology and immunofluorescence visualization. Conventional chemical analysis of oyster tissue was also conducted for comparison. While differences were observed in the oyster interstitial fluid between the wild and transplanted oysters throughout the study, whole tissue analysis revealed differing trends at each time point. Our findings suggest that insufficient equilibration time may contribute to the differences observed between groups. Furthermore, when combined with visual evidence via immunofluorescence, internal partitioning of contaminants may be an important determinant for total concentrations measured. A better understanding of the differences observed between wild and transplanted oyster groups is necessary for improved biomonitoring. Our study highlights the value in employing novel immunological techniques to explore possible mechanisms driving these differences.

Decreasing Trauma Readmission Rates by Implementing a Callback Program.

Decreasing hospital lengths of stay increases the burden on trauma patients after discharge. Our hypothesis was that a discharge callback protocol would decrease readmission rates. A retrospective quality improvement study evaluated all trauma patients admitted from 2012 to 2016 at a Level I trauma center. A postdischarge callback protocol was implemented in 2014, with a mature protocol in place in 2015. The precall and callback groups were compared regarding demographics, injury severity, and trauma readmission. Callback data included length of call, unsolicited patient comments, and education provided. Chi-square and Fisher's exact tests were used to compare categorical variables, whereas an independent-samples t test was used to compare continuous data. The precall program group included 4,470 admissions, and the call program group included 4,647 admissions. The precall program group had a higher injury severity score (ISS; 11.7 vs. 10.3; p < .001) and fewer males (62% vs. 65%, p = .002). In the call program group, there was a significant decrease in readmission rates (1.42% vs. 0.81%; p = .04). Patients with an unplanned readmission had a higher ISS (14.9 vs. 11.0, p < .01), a longer mean hospital length of stay during initial admission (9.3 days vs. 4.8 days, p < .01), and were more often discharged to locations with medical oversight (37.4% vs. 26.7%, p = .03). Of the patients in the call program group, 27.9% were reached. An average of 5.8 ± 2.9 min per call was calculated, equating to a 0.2 full-time equivalent. A discharge callback program for approximately 2,500 trauma patients per year leads to fewer readmissions, which financially supports the callback position.

Impact of a TeamSTEPPS Trauma Nurse Academy at a Level 1 Trauma Center.

PROBLEM: Nurses are crucial members of the team caring for the acutely injured trauma patient. Until recently, nurses and physicians gained an understanding of leadership and supportive roles separately. With the advent of a multidisciplinary team approach to trauma care, formal team training and simulation has transpired. METHODS: Since 2007, our Level I trauma system has integrated TeamSTEPPS (Team Strategies & Tools to Enhance Performance & Patient Safety; Agency for Healthcare Research and Quality, Rockville, MD) into our clinical care, joint training of nurses and physicians, using simulations with participation of all health care providers. With the increased expectations of a well-orchestrated team and larger number of emergency nurses, our program created the Trauma Nurse Academy. This academy provides a core of experienced nurses with an advanced level of training while decreasing the variability of personnel in the trauma bay. Components of the academy include multidisciplinary didactic education, the Essentials of TeamSTEPPS, and interactive trauma bay learning, to include both equipment and drug use. Once completed, academy graduates participate in the orientation and training of General Surgery and Emergency Medicine residents' trauma bay experience and injury prevention activities. RESULTS: Internal and published data have demonstrated growing evidence linking trauma teamwork training to knowledge and self-confidence in clinical judgment to team performance, patient outcomes, and quality of care. IMPLICATIONS FOR PRACTICE: Although trauma resuscitations are stressful, high risk, dynamic, and a prime environment for error, new methods of teamwork training and collaboration among trauma team members have become essential.

Progressive Mobility Protocol Reduces Venous Thromboembolism Rate in Trauma Intensive Care Patients: A Quality Improvement Project.

The intensive care unit (ICU) trauma population is at high risk for complications associated with immobility. The purpose of this project was to compare ICU trauma patient outcomes before and after implementation of a structured progressive mobility (PM) protocol. Outcomes included hospital and ICU stays, ventilator days, falls, respiratory failure, pneumonia, or venous thromboembolism (VTE). In the preintervention cohort, physical therapy (PT) consults were placed 53% of the time. This rose to more than 90% during the postintervention period. PT consults seen within 24 hr rose from a baseline 23% pre- to 74%-94% in the 2 highest compliance postintervention months. On average, 40% of patients were daily determined to be too unstable for mobility per protocol guidelines-most often owing to elevated intracranial pressure. During PM sessions, there were no adverse events (i.e., extubation, hypoxia, fall). There were no significant differences in clinical outcomes between the 2 cohorts regarding hospital and ICU stays, average ventilator days, mortality, falls, respiratory failure, or pneumonia overall or within ventilated patients specifically. There was, however, a difference in the incidence of VTE between the preintervention cohort (21%) and postintervention cohort (7.5%) (p = .0004). A PM protocol for ICU trauma patients is safe and may reduce patient deconditioning and VTE complications in this high-risk population. Multidisciplinary commitment, daily protocol reinforcement, and active engagement of patients/families are the cornerstones to success in this ICU PM program.

Systematic investigation of factors controlling supercritical fluid extraction (SFE) of spiked and aged PCBs from edible tissues of the blue crab (Callinectes sapidus).

Systematic investigation of factors controlling supercritical fluid extraction (SFE) of spiked and naturally incurred (aged) PCBs from edible tissues of the Blue Crab (Callinectes sapidus) was undertaken. Effects of extraction pressure, temperature and time, CO2 flow rate and total volume, and collection temperature were assessed. Temperature dramatically impacted extraction efficiency, especially at lower pressures. Surprisingly, extraction of both spiked and aged PCBs was flow rate dependent, counter to prevailing views regarding the relative ease of SFE of spiked versus aged contaminants from environmental matrices. PCBs were optimally trapped on a 1:1 mixture of C18-modified and porous silica at 0°C and eluted with <2 mL isooctane at 90°C. A combined 10 min static/30 min dynamic extraction at 35.5 MPa and 150°C with a CO2 flow rate of 3 mL min(-1) yielded maximum (quantitative) recoveries of spiked and aged PCBs. Resulting solvent extracts required no cleanup and could be analyzed directly by halogen-selective GC with MS confirmation.

Use of Six Sigma strategies to pull the line on central line-associated bloodstream infections in a neurotrauma intensive care unit.

The creation of a consistent culture of safety and quality in an intensive care unit is challenging. We applied the Six Sigma Define-Measure-Analyze-Improve-Control (DMAIC) model for quality improvement (QI) to develop a long-term solution to improve outcomes in a high-risk neurotrauma intensive care unit. We sought to reduce central line utilization as a cornerstone in preventing central line-associated bloodstream infections (CLABSIs). This study describes the successful application of the DMAIC model in the creation and implementation of evidence-based quality improvement designed to reduce CLABSIs to below national benchmarks.

Polybrominated diphenyl ether accumulation in an agricultural soil ecosystem receiving wastewater sludge amendments.

Few studies have addressed bioaccumulation of organic pollutants associated with land-application of biosolids. We thus examined PBDE burdens within a soil ecosystem receiving long-term sludge amendments and a reference soil ecosystem receiving only manure inputs. No PBDEs were detected in reference site samples, but sludge-amended soils contained 17 600 ± 2330 µg/kg ∑3-7PBDE (total organic carbon (TOC) basis). ∑3-7PBDE burdens were highest in soil invertebrates with the greatest contact with sludge-amended soil (e.g., ∑3-7PBDE of 10 300 ± 2670 and 3000 ± 200 µg/kg lipid for earthworms and detritivorous woodlice, respectively). PBDEs were below quantitation limits in vegetation from the sludge-amended site. Surprisingly, we measured quantifiable PBDE burdens in only a single sample of predaceous ground spiders from the sludge-amended site. BDE-209 burdens in sludge-amended soil and earthworms were 7500 ± 2800 µg/kg TOC and 6500 ± 4100 µg/kg lipid, respectively. BDE 209 was detected in fewer taxa, but the burden in a detritivorous millipede composite was high (86 000 µg/kg lipid). PBDE congener patterns differed among species, with worms and ground beetles exhibiting Penta-BDE-like patterns. Penta-BDE biota-soil accumulation factors (BSAFs) ranged from 0.006 to 1.2, while BDE-209 BSAFs ranged from 0.07 to 10.5. δ(13)C and δ(15)N isotope signatures were poorly correlated with PBDE burdens, but sludge-amended samples were significantly δ(15)N enriched.

Twenty years later: PBDEs in fish from U.S. sites with historically extreme contamination.

Shortly after their production ban PBDE environmental levels retreated from their peak (circa 2000), but rates of decrease appear to be slowing. Therefore, to update environmental PBDE trends, this study re-examined a U.S. riverine system found in 1999 to have the highest PBDE fish tissue (fillet) burdens in the world. Archived 2018-2020 fish tissues were analyzed for PBDEs and results compared to 1999-2000 and 2007 levels. On a positive note, levels decreased by >75% over 20 years. However, PBDEs were still detectable at each collection site (n = 16) and in 93% of the samples. The highest PBDE level (16,300 ng g-1 lipid weight) was observed in fish from the Dan R., downstream from the Hyco R. (where the world's highest level was previously reported). Levels within Hyco R. fish have declined at an annual rate of 30% through 2007. However, reductions during the subsequent 12 years have diminished to only 1.2%. Fillet levels since 2007 actually increased at an estimated annual rate of 8% immediately downstream from the Hyco R. Congener profiles varied between species, likely due to hepatic enzyme debromination, indicating single congener-based health risk evaluations may not be sufficiently protective. Within North America, PBDE fish levels in this freshwater system were twice those of North America's Great Lakes and exceeded by 10-fold those in carp examined from Illinois, USA., another historical hotspot. Average fish PBDE levels also exceed maxima observed in European and Asian riverine systems and were 1000's of times higher than the environmental quality standard (EQS) set by European Parliament (0.0085 ng g-1 wet weight, aquatic biota). Therefore, to protect human health and the environment, PBDE monitoring should remain a priority for regulatory agencies with the goal to identify and eliminate their source and to consider their potential health impacts in the context of other co-existing (emerging and legacy) contaminants.

Polybrominated diphenyl ether (PBDE) accumulation by earthworms (Eisenia fetida) exposed to biosolids-, polyurethane foam microparticle-, and Penta-BDE-amended soils.

Polybrominated diphenyl ether (PBDE) flame retardants have been used in consumer polymers at up to percent levels. While long viewed as biologically inaccessible therein, PBDEs may become bioaccessible following volatilization or polymer deterioration. PBDEs may then enter soils via polymer fragmentation or following land application of sewage sludge-derived biosolids. Studies of direct PBDE uptake from these materials by soil organisms are scarce. We thus exposed earthworms ( Eisenia fetida ) to artificial soil amended with a Class B anaerobically digested biosolid (ADB), an exceptional quality composted biosolid (CB), PBDE-containing polyurethane foam (PUF) microparticles, and Penta-BDE-spiked artificial soil (SAS). Worms accumulated mg/kg (lipid) ∑Penta-PBDE burdens from all substrates. Biota-soil accumulation factors (BSAFs) for worms exposed to ADB- and CB-amended soils were comparable after 28 d. BSAFs generally decreased with increasing congener KOW and substrate dosage. Biosolids-associated PBDE bioavailability was lower than spiked PBDEs. BSAFs for worms exposed to PUF microparticles ranged from 3.9 to 33.4, with ∑Penta-PBDE tissue burdens reaching 3740 mg/kg lipid. Congener accumulation patterns were similar in worms and polyethylene passive sampling devices immersed in ADB-amended soil coincident with exposed worms. However, passive sampler accumulation factors were lower than BSAFs. Our results demonstrate that PBDEs may accumulate in organisms ingesting soils containing biosolids or waste plastics. Such organisms may then transfer their burdens to predators or translocate them from the site of application/disposal.

TeamSTEPPS(®) simulation-based training: an evidence-based strategy to improve trauma team performance.

Initial assessment and treatment of critically injured patients is time sensitive, creating a high-stress environment for trauma team members and patients. Effective leadership, communication, and clinical acumen are essential team dynamics for best patient outcomes. Innovative multidisciplinary TeamSTEPPS(®) simulation-based training is an effective model for teams in high-risk health care settings. Use of this simulation model has led to improved trauma team performance and patient outcomes while incorporating new physician and nursing personnel into a time-sensitive, high-stress environment.

Reducing external ventricular drain associated ventriculitis: An improvement project in a level 1 trauma center.

BACKGROUND: External ventricular drain (EVD)-associated infections have a negative impact on healthcare cost and patient outcomes. Practice variation in EVD management may place patients at increased risk for EVD-associated infection. This project aimed to evaluate the impact of implementing an interprofessional evidence-based EVD bundle of care on reduction of EVD-related ventriculitis rates. METHODS: An interprofessional team developed an evidence based EVD care bundle and order set to eliminate practice inconsistencies. Standardization of EVD equipment and optimization of the electronic health record occurred. Education and competency validation were completed with neurosurgical providers and nurses. Interprofessional rounds occur weekly for observation, recognition, and in-the-moment education. RESULTS: A pre/post intervention design was used to show that the rate of EVD-associated ventriculitis decreased from 8.8 per reported EVD days in 2019 to 0 per reported EVD days in 2021 after implementation of the EVD care bundle. CONCLUSION: Through an interprofessional team approach, reduction in EVD-associated infection rates is feasible with implementation of an evidence based EVD care bundle.

In situ accumulation of HBCD, PBDEs, and several alternative flame-retardants in the bivalve (Corbicula fluminea) and gastropod (Elimia proxima).

Alternative brominated flame-retardants (BFRs), 2-ethylhexyl 2,3,4,5-tetrabromobenzoate (TBB), 2-ethylhexyl 2,3,4,5-tetrabromophthalate (TBPH), 1,2-bis(2,4,6-tribromophenoxy) ethane (BTBPE) and decabromodiphenyl ethane (DBDPE), are now being detected in the environment. However, contaminant bioavailability is influenced by the organisms' ecology (i.e., route of uptake) and in situ environmental factors. We observed that the filter-feeding bivalve (Corbicula fluminea) and grazing gastropod (Elimia proxima), collected downstream from a textile manufacturing outfall, exhibited TBB, TBPH, and BTBPE concentrations from 152 to 2230 ng g(-1) lipid weight (lw). These species also contained additional BFRs. Maximum levels of total hexabromocyclododecane diastereomers (∑HBCDs) in these species were 363,000 and 151,000 ng g(-1) lw, and those of polybrominated diphenyl ethers (∑PBDEs) were 64,900 and 47,200 ng g(-1) lw, respectively. These concentrations are among the highest reported to date worldwide. While BDE-209 was once thought to be nonbioavailable and resistant to degradation, it was the dominant BFR present and likely debromination products were detected. Contributions of α- and ß-HBCD were higher in tissues than sediments, consistent with γ-HBCD bioisomerization. Mollusk bioaccumulation factors were similar between HBCD and PBDEs with 4 to 6 bromines, but factors for TBB, TBPH, and BTBPE were lower. Despite different feeding strategies, the bivalves and gastropods exhibited similar BFR water and sediment accumulation factors.

Polybrominated diphenyl ethers in U.S. sewage sludges and biosolids: temporal and geographical trends and uptake by corn following land application.

Polybrominated diphenyl ethers (PBDEs) have been used extensively to flame-retard polymers and textiles. These persistent chemicals enter wastewater streams following manufacture, use, and disposal, concentrating in the settled solids during treatment. Land application of stabilized sewage sludge (known as biosolids) can contribute PBDEs to terrestrial systems. Monitoring sludge/biosolids contaminant burdens may be valuable in revealing trends in societal chemical usage and environmental release. In archived Chicago area sludges/biosolids from 1975 to 2008, penta-BDE concentrations increased and then plateaued after about 2000. Penta-BDE manufacture in the United States ended in December 2004. Deca-BDE concentrations in biosolids rose from 1995 to 2008, doubling on a 5-year interval. Evaluation of U.S. Environmental Protection Agency Targeted National Sewage Sludge Survey data from 2006 to 2007 revealed highest penta-BDE biosolids levels from western and lowest from northeastern wastewater treatment plants (2120 and 1530 µg/kg, respectively), consistent with patterns reported in some recent indoor dust and human blood studies. No significant regional trends were observed for deca-BDE concentrations. Congener patterns in contemporary Chicago biosolids support the contention that BDE-209 can be dehalogenated to less brominated congeners. Biosolids application on agricultural fields increased PBDE soil concentrations. However, corn grown thereon did not exhibit measurable PBDE uptake; perhaps due to low bioavailability of the biosolids-associated flame retardants.

A novel antibody-based biosensor method for the rapid measurement of PAH contamination in oysters.

Conventional PAH analytical methods are time-consuming and expensive, limiting their utility in time sensitive events (i.e. oil spills and floods) or for widespread environmental monitoring. Unreliable and inefficient screening methods intended to prioritize samples for more extensive analyses exacerbate the issue. Antibody-based biosensor technology was implemented as a quantitative screening method to measure total PAH concentration in adult oysters (Crassostrea virginica) - a well-known bioindicator species with ecological and commercial significance. Individual oysters were analyzed throughout the historically polluted Elizabeth River watershed (Virginia, USA). Significant positive association was observed between biosensor and GC-MS measurements that persisted when the method was calibrated for different regulatory subsets of PAHs. Mapping of PAH concentrations in oysters throughout the watershed demonstrates the utility of this technology for environmental monitoring. Through a novel extension of equilibrium partitioning, biosensor technology shows promise as a cost-effective analysis to rapidly predict whole animal exposure to better assess human health risk as well as improve monitoring efforts.

Do temporal and geographical patterns of HBCD and PBDE flame retardants in U.S. fish reflect evolving industrial usage?

Polybrominated diphenyl ethers (PBDEs) and hexabromocyclododecane (HBCD) are common flame retardants in polymers and textiles. Recognition of the persistent, bioaccumulative, and toxic properties of PBDEs has prompted reductions in their use. In contrast, HBCD has received less scrutiny. The U.S has historically been a dominant BFR consumer. However, the few publications on HBCD in wildlife here suggest modest levels compared to Asian and European studies. In contrast, the HBCD concentrations we detected in U.S. fish are among the highest reported in the world. The temporal trends observed suggest that HBCD use may have risen, and that of Penta-BDE declined, following the 2004 termination of its U.S. manufacture. For example, Hyco River carp collected in 1999-2002 exhibited a mean ∑HBCD (sum of α-, ß- and γ-HBCD) concentration of only 13 ng/g (lipid weight basis), but was 4640 ng/g in fish collected in 2006-2007. In contrast, the mean ∑PBDE level in these same fish decreased from 40,700 ng/g in 1999-2002 to 9140 ng/g in 2006-2007. Concentrations of HBCD and PBDEs in several Hyco River fish species exceeded those from rivers less influenced by manufacturing outfalls. Results support the contention that textile-related production, relative to its BFR market share, may release disproportionately large amounts of HBCD to the environment.

Scanning for safety: an integrated approach to improved bar-code medication administration.

This is a review of lessons learned in the postimplementation evaluation of a bar-code medication administration technology implemented at a major tertiary-care hospital in 2001. In 2006, with a bar-code medication administration scan compliance rate of 82%, a near-miss sentinel event prompted review of this technology as part of an institutional recommitment to a "culture of safety." Multifaceted problems with bar-code medication administration created an environment of circumventing safeguards as demonstrated by an increase in manual overrides to ensure timely medication administration. A multiprofessional team composed of nursing, pharmacy, human resources, quality, and technical services formalized. Each step in the bar-code medication administration process was reviewed. Technology, process, and educational solutions were identified and implemented systematically. Overall compliance with bar-code medication administration rose from 82% to 97%, which resulted in a calculated cost avoidance of more than $2.8 million during this time frame of the project.

Scanning for safety: an integrated approach to improved bar-code medication administration.

This is a review of lessons learned in the postimplementation evaluation of a bar-code medication administration technology implemented at a major tertiary-care hospital in 2001. In 2006, with a bar-code medication administration scan compliance rate of 82%, a near-miss sentinel event prompted review of this technology as part of an institutional recommitment to a "culture of safety." Multifaceted problems with bar-code medication administration created an environment of circumventing safeguards as demonstrated by an increase in manual overrides to ensure timely medication administration. A multiprofessional team composed of nursing, pharmacy, human resources, quality, and technical services formalized. Each step in the bar-code medication administration process was reviewed. Technology, process, and educational solutions were identified and implemented systematically. Overall compliance with bar-code medication administration rose from 82% to 97%, which resulted in a calculated cost avoidance of more than $2.8 million during this time frame of the project.

Polybrominated diphenyl ether flame retardants in Chesapeake Bay region, U.S.A., peregrine falcon (Falco peregrinus) eggs: urban/rural trends.

A total of 23 peregrine falcon (Falco peregrinus) eggs were obtained between 1993 and 2002 from 13 nests, encompassing 11 locations in the Chesapeake Bay region, U.S.A. When multiple eggs were available from the same clutch, average clutch contaminant concentrations were calculated. An overall median total polybrominated diphenyl ether (PBDE) level of 201 ng/g wet weight was determined for the eggs/clutches examined. The maximum in an individual egg, from an urban highway bridge site, was 354 ng/g. This egg also exhibited the highest BDE 209 burden (48.2 ng/g). Compared to distributions reported in fish and piscivorous birds, falcon eggs were enriched in the more brominated congeners. The BDE congeners 153, 99, and 100 constituted 26.0, 24.8, and 13.1%, respectively, of total PBDEs. In most aquatic species, BDE 47 is the most abundant congener reported; however, it constituted only 4.4% of total PBDEs in the eggs of the present study. The median BDE 209 concentration was 6.3 ng/g. The sum of the octa- to nonabrominated congeners (BDEs 196, 197, 206, 207, and 208) contributed, on average, 14.0% of total PBDEs, exceeding the contribution of BDE 209 (5.9%). Concentrations of polychlorinated biphenyls (PCBs) and 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (4,4'-DDE) also were determined in a subset of 16 eggs (collected in 2001-2002 from six nests) and were an order of magnitude greater than the corresponding PBDEs. Median BDE 209 concentrations were significantly correlated (p < 0.01, Spearman R = 0.690) with the human population density of the area surrounding the nest. Total PBDEs, total PCBs, and 4,4'-DDE levels were not correlated to human population density.