Personal protective equipment training & lived experience for healthcare staff during COVID-19.

Objectives: To describe the lived experience of healthcare staff during the Coronavirus Disease 2019 (COVID-19) pandemic relating to the use of personal protective equipment (PPE) and investigate risks associated with PPE use, error mitigation and acceptability of mindfulness incorporation into PPE practice. Methods: A qualitative human factors' study at two Irish hospitals occurred in late 2020. Data was collected by semi-structured interview and included role description, pre-COVID-19 PPE experience, the impact of COVID-19 on lived experience, risks associated with PPE use, contributory factors to errors, error mitigation strategies and acceptability of incorporating mindfulness into PPE practice. Results: Of 45 participants, 23 of whom were nursing staff (51%), 34 (76%) had previously worn PPE and 25 (56%) used a buddy system. COVID-19 lived experience impacted most on social life/home-work interface (n=36, 80%). Nineteen staff (42%) described mental health impacts. The most cited risk concerned 'knowledge of procedures' (n=18, 40%). Contributory factors to PPE errors included time (n=15, 43%) and staffing pressures (n=10, 29%). Mitigation interventions included training/education (n=12, 40%). The majority (n=35, 78%) supported mindfulness integration into PPE practice. Conclusions: PPE training should address healthcare staff lived experiences and consider incorporation of mindfulness and key organisational factors contributing to safety.

Searching for Monomeric Nickel Tetrafluoride: Unravelling Infrared Matrix Isolation Spectra of Higher Nickel Fluorides.

Binary transition metal fluorides are textbook examples combining complex electronic features with most fundamental molecular structures. High-valent nickel fluorides are among the strongest known fluorinating and oxidizing agents, but there is a lack of experimental structural and spectroscopic investigations on molecular NiF3 or NiF4 . Apart from their demanding synthesis, also their quantum-chemical description is difficult due to their open shell nature and low-lying excited electronic states. Distorted tetrahedral NiF4 (D2d ) and trigonal planar NiF3 (D3h ) molecules were produced by thermal evaporation and laser ablation of nickel atoms in a fluorine/noble gas mixture and spectroscopically identified by a joint matrix-isolation and quantum-chemical study. Their vibrational band positions provide detailed insights into their molecular structures.

Tracking the Pliensbachian-Toarcian Karoo firewalkers: Trackways of quadruped and biped dinosaurs and mammaliaforms.

The Karoo igneous rocks represent one of the largest continental flood basalt events (by volume) on Earth, and are not normally associated with fossils remains. However, these Pliensbachian-Toarcian lava flows contain sandstone interbeds that are particularly common in the lower part of the volcanic succession and are occasionally fossiliferous. On a sandstone interbed in the northern main Karoo Basin, we discovered twenty-five tridactyl and tetradactyl vertebrate tracks comprising five trackways. The tracks are preserved among desiccation cracks and low-amplitude, asymmetrical ripple marks, implying deposition in low energy, shallow, ephemeral water currents. Based on footprint lengths of 2-14 cm and trackway patterns, the trackmakers were both bipedal and quadrupedal animals of assorted sizes with walking and running gaits. We describe the larger tridactyl tracks as "grallatorid" and attribute them to bipedal theropod dinosaurs, like Coelophysis, a genus common in the Early Jurassic of southern Africa. The smallest tracks are tentatively interpreted as Brasilichnium-like tracks, which are linked to synapsid trackmakers, a common attribution of similar tracks from the Lower to Middle Jurassic record of southern and southwestern Gondwana. The trackway of an intermediate-sized quadruped reveals strong similarities in morphometric parameters to a post-Karoo Zimbabwean trackway from Chewore. These trackways are classified here as a new ichnogenus attributable to small ornithischian dinosaurs as yet without a body fossil record in southern Africa. These tracks not only suggest that dinosaurs and therapsids survived the onset of the Drakensberg volcanism, but also that theropods, ornithischians and synapsids were among the last vertebrates that inhabited the main Karoo Basin some 183 Ma ago. Although these vertebrates survived the first Karoo volcanic eruptions, their rapidly dwindling habitat was turned into a land of fire as it was covered by the outpouring lavas during one of the most dramatic geological episodes in southern Africa.

Retinal safety evaluation of two-photon laser scanning in rats.

Safe use of retinal imaging with two-photon excitation in human eyes is crucial, as the effects of ultrashort pulsed lasers on the retina are relatively unknown. At the time of the study, the laser safety standards were inadequate due to the lack of biological data. This article addresses the feasibility of two-photon retinal imaging with respect to laser safety. In this study, rat retinas were evaluated at various laser exposure levels and with different laser parameters to determine the effects of laser-induced optical damage. The results were experimentally verified using confocal reflectance imaging, two-photon fluorescein angiography, immunohistochemistry, and correlated to the IEC 60825-1 laser safety standard.

Psychiatric Disorders and Crime in the US Population: Results From the National Epidemiologic Survey on Alcohol and Related Conditions Wave III.

OBJECTIVE: Current knowledge regarding the intersection of psychiatric disorders and crime in the United States is limited to psychiatric, forensic, and youth samples. This study presents nationally representative data on the relationship of DSM-5 psychiatric disorders, comorbid substance and mental health disorders, and multimorbidity (number of disorders) with criminal behavior and justice involvement among non-institutionalized US adults. METHODS: Data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions Wave III (NESARC-III; 2012-2013; N = 36,309). Logistic regressions were used to examine the association of specific disorders (eg, mood, anxiety, eating, posttraumatic stress, substance use), comorbid substance use and mental health disorders, and multimorbidity with lifetime criminal behavior, incarceration experience, and past-12-month general, alcohol-related, and drug-related legal problems. RESULTS: Overall, 28.5% of participants reported a history of criminal behavior, 11.4% reported a history of incarceration, 1.8% reported current general legal problems, 0.8% reported current alcohol-related legal problems, and 2.7% reported current drug-related legal problems. The presence of any disorder was associated with a 4 to 5 times increased risk of crime outcomes. Drug use disorders were associated with the highest risk of lifetime crime (adjusted odds ratio [AOR] = 6.8; 95% CI, 6.1-7.6) and incarceration (AOR = 4.7; 95% CI, 4.1-5.3) and current legal problems (AOR = 3.3; 95% CI, 2.6-4.2). Multimorbidity and comorbid substance use and mental health disorders were associated with additional risk. Controlling for antisocial personality disorder did not change the findings. CONCLUSIONS: Community adults with substance use disorders, comorbid substance use and mental health disorders, and increasing multimorbidity are most at risk of crime and justice involvement, highlighting the importance of community-based addiction treatment.

Haptic tuck for reverse optic capture of a single-piece acrylic toric or other single-piece acrylic intraocular lenses.

We describe a new technique for capsule fixation of 1-piece acrylic toric intraocular lens (IOL) or other 1-piece acrylic IOLs in the presence of a large posterior capsule tear resulting in an open capsule. To keep the thick haptics out of the sulcus, reverse optic capture is necessary, with the haptics below the capsule and the optic edges above the capsule. This is done by placing the IOL in the sulcus and if it is a toric IOL, with the toric marks on the optic aligned with the corneal marks. Then, each haptic is separately tucked through the anterior continuous curvilinear capsulorhexis (CCC) opening, leaving the optic edges above the capsule. This technique achieves reverse optic capsulorhexis capture without the challenge of injecting the IOL through the CCC with an open posterior capsule. We propose the term haptic tuck for reverse optic capture for this technique.

Incidence of implantable Collamer lens-induced cataract.

OBJECTIVE: Although the literature on the implantable Collamer lens (ICL) suggests an increasing rate of anterior subcapsular cataract (ASC) development with increasing age and decreasing anterior chamber depth (ACD), the exact correlation is not known. We performed a retrospective observation study of 1653 eyes and calculated the incidence of ICL removal with cataract extraction and intraocular lens placement (CE-IOL) as a result of ASC, in correlation to patient's age and ACD. DESIGN: Retrospective observation study. SETTING: The Gimbel Eye Centre, Calgary, Alberta, Canada. METHODS: We analyzed ICL V4 model (Visian ICL; STAAR Surgical, Monrovia, CA) implanted in 1653 eyes with myopia from 2000 to 2012 at the Gimbel Eye Centre, Calgary. Myopic patients aged 19 years and older with no history of cataracts were included. The rate of ICL removal with cataract extraction was calculated. Parameters such as age, sex, refractive sphere, refractive cylinder, length of follow-up, and ACD were collected. Cataract-free survival with comparison of FDA and non-FDA cohorts was conducted using Kaplan-Meier survival curves with the log-rank test. In addition, covariates adjusted hazards ratios and 95% confidence intervals were calculated using Cox regression. RESULTS: Of the 1653 eyes included in this study, a total of 46 eyes underwent ICL removal with CE-IOL. The length of follow-up varied between 2 and 14 years. CONCLUSIONS: This retrospective study demonstrated that the rate of developing ASCs positively correlated with age and negatively correlated with ACD.

In vivo two-photon imaging of retina in rabbits and rats.

The purpose of this study was to evaluate the retina using near-infrared (NIR) two-photon scanning laser ophthalmoscopy. New Zealand white rabbits, albino rats, and brown Norway rats were used in this study. An autofluorescence image of the retina, including the retinal cells and its associated vasculatures was obtained by a real-time scan using the ophthalmoscope. Furthermore, the retinal vessels, nerve fiber layers and the non-pigmented retina were recorded with two-photon fluorescein angiography (FA); and the choroidal vasculatures were recorded using two-photon indocyanine green angiography (ICGA). Two-photon ICGA was achieved by exciting a second singlet state at ∼398 nm. Simultaneous two-photon FA and two-photon ICGA were performed to characterize the retinal and choroidal vessels with a single injection. The minimum laser power threshold required to elicit two-photon fluorescence was determined. The two-photon ophthalmoscope could serve as a promising tool to detect and monitor the disease progression in animal models. Moreover, these high-resolution images of retinal and choroidal vessels can be acquired in a real-time scan with a single light source, requiring no additional filters for FA or ICGA. The combination of FA and ICGA using the two-photon ophthalmoscope will help researchers to characterize the retinal diseases in animal models, and also to classify the types (classic, occult or mixed) of choroidal neovascularization (CNV) in macular degeneration. Furthermore, the prototype can be adapted to image the retina of rodents and rabbits.

Geriatrics and the Legal System.

Correctional systems, already struggling to meet the basic and functional requirements of older prisoners, will be further challenged by the increasing medical and psychiatric needs of this population. Mental health and general medical care for older adults requires specific on-site or consultation expertise in geriatric medicine and psychiatry, as well as potential changes in infrastructure, both of which may be prohibitively expensive. However, compassionate and effective treatment of older prisoners requires that prison and legal systems facilitate this expert care. To address this situation, strategic revisions of the criminal justice system are needed to alleviate prison overcrowding and consequent inadequate medical care for inmates, especially the elder ones. The unique, age-related demands of this older population predict an increased need for forensic psychiatrists with a thorough knowledge and expertise in geriatrics, as more forensic psychiatric evaluations will be needed before trial in both civil and criminal cases, during incarceration, and at the time of parole. In this article, we review the current state of elder inmates in correctional institutions and advocate for increased geriatric training for forensic psychiatrists in anticipation of this growing need.

Association of stroke risk biomarkers with stroke symptoms: the Reasons for Geographic and Racial Differences in Stroke cohort.

Essentials Stroke symptom history predicts future stroke and may indicate prior unrecognized stroke. We studied associations of stroke symptoms with stroke risk biomarkers. Several stroke risk biomarkers were independently associated with stroke symptom history. Findings support a hypothesis that stroke symptoms may represent unrecognized stroke. SUMMARY: Background History of stroke symptoms in the absence of prior diagnosed stroke or transient ischemic attack (TIA) is associated with future stroke risk, as are biomarkers of inflammation, cardiac function and hemostasis. Objective To better elucidate the pathobiology of stroke symptoms, we studied associations of these biomarkers with history of stroke symptoms. Methods The Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort enrolled 30 239 black and white Americans age 45 years and older in 2003-7. In cross-sectional analyses in a random sample of 960 participants without prior stroke or TIA, levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), fibrinogen, factor VIII (FVIII), factor XI (FXI), C-reactive protein (CRP) and D-dimer were studied in relation to self-reported history of six sudden onset stroke symptoms. Results There were 190 participants with at least one stroke symptom and 770 without. Adjusting for age, race, sex and stroke risk factors, NT-proBNP, FXI, CRP and D-dimer in the top vs. bottom quartile were associated with prevalent stroke symptoms with odds ratios 2.69 (95% confidence interval [CI], 1.45-4.98), 1.65 (95% CI, 1.00-2.73), 2.21 (95% CI, 1.32-3.71) and 2.14 (95% CI, 1.22-3.75), respectively. Conclusions Strong associations of stroke risk biomarkers with stroke symptoms in persons without a clinical history of cerebrovascular disease support a hypothesis that some of these stroke symptoms represent unrecognized cerebrovascular disease. Future work is needed to determine whether these biomarkers identify persons with stroke symptoms who have a particularly high stroke risk.

Localized axillary milia en plaque: a rare cutaneous case presentation of systemic amyloidosis.

Systemic AL amyloidosis is known to be associated with plasma cell dyscrasias, including multiple myeloma. The cutaneous manifestations of systemic AL amyloidosis are varied, but typically include waxy plaques or subcutaneous nodules. We report a woman who presented with bilateral eruptions of hyperpigmented plaques in her axillae, which were diagnosed as milia en plaque. She had a history of multiple myeloma, for which she was under the care of a haematologist. This is the first documented case, to our knowledge, of an eruption in the axillae being milia en plaque.

Angle-supported phakic intraocular lenses for the correction of myopia: Three-year follow-up.

PURPOSE: To evaluate patient safety and refractive outcomes in eyes with an angle-supported phakic intraocular lens (pIOL), and to assess the correlation between rotation and corneal endothelial cell damage. SETTING: Gimbel Eye Centres, Calgary and Edmonton, Alberta, Canada. DESIGN: Retrospective cohort study. METHODS: This study included patients with moderate to high myopia (range -6.50 to -19.50 diopters [D]) who received the Acrysof Cachet pIOL. Outcome measures included uncorrected distance visual acuity (UDVA), corrected distance visual acuity, manifest refraction spherical equivalent (MRSE), endothelial cell density (ECD), and IOL rotation. RESULTS: This study evaluated 119 eyes of 61 patients. The mean ECD decrease from preoperative measurements was 3.11% (n = 46), with a mean IOL rotation of 10.6 degrees (n = 35) at the 3-year postoperative visit. Of the 49 eyes at the 3-year visit measured for UDVA, 98.0% were 20/40 or better and 77.6% were 20/20 or better. The MRSE improved from a preoperative mean of -9.26 diopters (D) ± 2.43 (SD) (range -19.50 to -5.63 D) to -0.33 ± 0.61 D (range -3.12 to +0.71 D) at the 3-year visit. The residual refractive error was within ±0.50 D of the target refraction for 78.4% and within ±1.00 D for 92.2% of the 51 eyes. The study included one bilateral pIOL removal due to endothelial cell loss, one case of synechia, and one case of subtle pupil ovalization. CONCLUSIONS: No correlation between IOL rotation and ECD decrease was found (R(2) = 0.0143); the pIOL provided promising refractive outcomes and acceptable safety in patients with moderate to high myopia. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Double jeopardy and global extinction risk in corals and reef fishes.

Coral reefs are critically important ecosystems that support the food security and livelihoods of hundreds of millions of people in maritime tropical countries, yet they are increasingly threatened by overfishing, coastal pollution, climate change, and other anthropogenic impacts, leading to concerns that some species may be threatened with local or even global extinction. The concept of double jeopardy proposes that the risk of species extinction is elevated if species that are endemic (small range) are also scarce (low local abundance). Traditionally, marine macroecology has been founded on patterns of species richness and presence-absence data, which provide no information on species abundances or on the prevalence of double jeopardy. Here we quantify the abundances of >400 species of corals and fishes along one of the world's major marine biodiversity gradients, from the Coral Triangle hotspot to French Polynesia, a distance of approximately 10,000 km. In contrast to classical terrestrial studies, we find that the abundance of these species bears no relationship to the size of their geographic ranges. Consequently, double jeopardy is uncommon because endemics are often locally abundant, and conversely many pandemics are rare. The Coral Triangle hotspot has more numerically rare species (both endemic and pandemic) but also encompasses more species with intermediate and higher abundances. We conclude that conservation efforts in the sea should focus less on extinction risk and more on maintaining and rebuilding key ecological functions that are highly vulnerable to human pressures, even if species can avoid extinction.

Crime and psychiatric disorders among youth in the US population: an analysis of the National Comorbidity Survey-Adolescent Supplement.

OBJECTIVE: Current knowledge regarding psychiatric disorders and crime in youth is limited to juvenile justice and community samples. This study examined relationships between psychiatric disorders and self-reported crime involvement in a sample of youth representative of the US population. METHOD: The National Comorbidity Survey-Adolescent Supplement (N = 10,123; ages 13-17 years; 2001-2004) was used to examine the relationship between lifetime DSM-IV-based diagnoses, reported crime (property, violent, other), and arrest history. Logistic regression compared the odds of reported crime involvement with specific psychiatric disorders to those without any diagnoses, and examined the odds of crime by psychiatric comorbidity. RESULTS: Prevalence of crime was 18.4%. Youth with lifetime psychiatric disorders, compared to no disorders, had significantly greater odds of crime, including violent crime. For violent crime resulting in arrest, conduct disorder (CD) (odds ratio OR = 57.5; 95% CI = 30.4, 108.8), alcohol use disorders (OR = 19.5; 95% CI = 8.8, 43.2), and drug use disorders (OR = 16.1; 95% CI = 9.3, 27.7) had the greatest odds with similar findings for violent crime with no arrest. Psychiatric comorbidity increased the odds of crime. Youth with 3 or more diagnoses (16.0% of population) accounted for 54.1% of those reporting arrest for violent crime. Youth with at least 1 diagnosis committed 85.8% of crime, which was reduced to 67.9% by removing individuals with CD. Importantly, 88.2% of youth with mental illness reported never having committed any crime. CONCLUSION: Our findings highlight the importance of improving access to mental health services for youthful offenders in community settings, given the substantial associations found between mental illness and crime in this nationally representative epidemiological sample.