A Scoping Review of Validated Tools to Measure Incivility in Healthcare Settings.

OBJECTIVE: To identify and compare validated tools used to assess incivility in healthcare settings. BACKGROUND: Incivility in the workforce is associated with poor quality outcomes, increased employee turnover, and decreased job satisfaction. Validated tools are essential for accurate measurement of incivility. The aim of this study was to compare characteristics of validated tools for use in a busy clinical setting. METHODS: In a scoping review, English language research studies using incivility tools published in PubMed or CINAHL between March 1, 2013, and March 14, 2018, were assessed for sound psychometric properties and feasibility of use (eg, short, easy to administer). RESULTS: After screening 869 articles and full text review of 244, 5 identified tools met the criteria; the Short Negative Acts Questionnaire seemed best suited for use in a busy healthcare setting. CONCLUSION: Adoption of a standardized and validated incivility tool makes it possible to compare across clinical settings and track progress over time.

Density Functional Theory and Experimental Studies of the Molecular, Vibrational, and Crystal Structure of Bis-Oxadiazole-Bis-Methylene Dinitrate (BODN).

Density function theory (DFT) and experimental characterization of energetic materials play important roles in understanding molecular structure-property relations and validating models for their predictive capabilities. Here, we report our modeling and experimental results on the molecular, vibrational, and crystal structure of energetic bis-oxadiazole-bis-methylene dinitrate (BODN) obtained by molecular DFT (M-DFT) at the B3LYP- 6-31G** level, crystal DFT (C-DFT) using the Perdew-Burke-Ernzerhof functional optimized with norm-conserving pseudopotentials, X-ray diffractometry, infrared and Raman spectroscopy, and thermogravimetric analysis. Both models predict well the experimental bond lengths, bond angles, and torsion angles of BODN. The C-DFT lattice constant values are in excellent agreement with those determined experimentally, with unit cell length and angle values differing by less than 1.2 and 0.7%, respectively. BODN presents van der Waals O···H and O···C bifurcated intramolecular contacts and short N···H and O···O intermolecular contacts. Overall, the predicted vibrational energies of both models are in line with experiment. M-DFT thermodynamic calculations predict well the experimentally derived lattice energy (-131 kJ/mol) and the M-DFT electrostatic potential calculations reveal a low sensitivity to impact. In addition, C-DFT band gap calculations predict a value of 3.80 eV for BODN, resulting predominantly from the ring O and N atoms, suggesting it is insensitive to impact. These results are compared and contrasted with those obtained in this study or reported previously for 3,3-bis-isoxazole-5,5'-bis-methylene dinitrate (BIDN).

Assessment of the national school lunch program in a subset of schools in San Juan, Puerto Rico: participants vs. non-participants.

OBJECTIVE: Extensive evaluations of the national school lunch program (NSLP) have been carried out on the U.S. mainland. Puerto Rico, a commonwealth of the U.S. is a participant in this program, but has never been included in assessment studies. Herein, we present assessment information and compare results with comparable mainland studies. METHODS: Multiple 24-hr recall questionnaires were administered to groups of participating (P) and non-participating (NP) children in the lunch program at 3 educational levels. Comparisons were made for children within the study as well as between comparable children in mainland studies for total intake of several macro- and micro-nutrients, contribution of the lunch to the total daily intake and adherence to U.S. Recommended Dietary Allowances (RDA's) or to Dietary Reference Intakes (DRI's) including acceptable macronutrient distribution ranges (AMDR's). RESULTS: Target intakes were met by P for % of the RDA of energy from protein, for all water soluble vitamins, iron, zinc and cholesterol. P did not achieve target intakes for total energy, energy from carbohydrates and fat nor for fat soluble vitamins, calcium, magnesium, phosphorus, potassium and fiber. Recommended levels were exceeded for sodium, total fat and saturated fat. Comparing P vs NP, the vast majority of both groups fell within AMDR recommendations for macronutrients but not all micronutrients. CONCLUSION: For the most part, our results parallel those obtained in the National sample however, results suggest that P in the lunch program in Puerto Rico have a healthier intake of several nutrients than NP students. The unique feature of this study is that it is the first assessment of the NSLP in a completely Hispanic population.

Releasing chemical energy in spatiallyprogrammed ferroelectrics.

Chemical energy ferroelectrics are generally solid macromolecules showing spontaneous polarization and chemical bonding energy. These materials still suffer drawbacks, including the limited control of energy release rate, and thermal decomposition energy well below total chemical energy. To overcome these drawbacks, we report the integrated molecular ferroelectric and energetic material from machine learning-directed additive manufacturing coupled with the ice-templating assembly. The resultant aligned porous architecture shows a low density of 0.35 g cm-3, polarization-controlled energy release, and an anisotropic thermal conductivity ratio of 15. Thermal analysis suggests that the chlorine radicals react with macromolecules enabling a large exothermic enthalpy of reaction (6180 kJ kg-1). In addition, the estimated detonation velocity of molecular ferroelectrics can be tuned from 6.69 ± 0.21 to 7.79 ± 0.25 km s-1 by switching the polarization state. These results provide a pathway toward spatially programmed energetic ferroelectrics for controlled energy release rates.

Validation and reproducibility of a semi-quantitative food frequency questionnaire for use in Puerto Rican children.

OBJECTIVE: Knowledge of the diet of specific populations is of importance in the assessment of nutrient intake. Herein, we assess the reproducibility and validity of an interviewer-administered food frequency questionnaire (FFQ) in Puerto Rican children at two educational levels--elementary (ES) and high school (HS). METHODS: The FFQ contained 97 items including supplements. It was administered twice (FFQ1 and FFQ2) within a 2 week interval between which three dietary food records (DFR's) were collected. In all, 94 ES children (40 boys and 54 girls) and 89 HS children (42 boys and 47 girls) participated in this IRB-approved study. RESULTS: Results showed correlations between FFQ1 and FFQ2 for representative macro- and micronutrients lower than reported in the literature. Correlation coefficients were higher for HS (mean R = 0.43) compared to ES (mean R = 0.21) and higher for girls than for boys at both school levels. Results for validation also showed lower correlations between the FFQ2 and DFR's compared to other studies, which was higher in HS students (mean R = 0.34) compared to ES students (mean R = 0.10). However, these same nutrients were cross-classified into equivalent quartiles for both the FFQ and DFR with an accuracy of about 66%. CONCLUSION: We have designed and validated a FFQ, appropriate for use in Puerto Rican schoolchildren to estimate energy intake in younger students and energy and micronutrients in older students. The significance of this research is that there is now an updated instrument for use in dietary studies in Puerto Rican youth.

Chemically driven energetic molecular ferroelectrics.

Chemically driven thermal wave triggers high energy release rate in covalently-bonded molecular energetic materials. Molecular ferroelectrics bridge thermal wave and electrical energy by pyroelectric associated with heating frequency, thermal mass and heat transfer. Herein we design energetic molecular ferroelectrics consisting of imidazolium cations (energetic ion) and perchlorate anions (oxidizer), and describe its thermal wave energy conversion with a specific power of 1.8 kW kg-1. Such a molecular ferroelectric crystal shows an estimated detonation velocity of 7.20 ± 0.27 km s-1 comparable to trinitrotoluene and hexanitrostilbene. A polarization-dependent heat transfer and specific power suggests the role of electron-phonon interaction in tuning energy density of energetic molecular ferroelectrics. These findings represent a class of molecular ferroelectric energetic compounds for emerging energy applications demanding high power density.

Carcinoma epidermoide de conjuntiva ocular / Squamous Cell Carcinoma of the Ocular Conjunctiva

El carcinoma epidermoide de conjuntiva ocular es un tumor raro de crecimiento lento, con malignidad de bajo grado, que puede aparecer de nevus o a partir de una neoplasia intraepitelial conjuntival o corneal previa. Es más frecuente en pacientes con xeroderma pigmentario y síndrome de...(AU

Crystal structures of 5,5'-bis(-hydroxy-methyl)-3,3'-biisoxazole and 4,4',5,5'-tetrakis-(hydroxy-methyl)-3,3'-biisoxazole.

The mol-ecular structure of 5,5'-bis(-hydroxy-methyl)-3,3'-biisoxazole, C8H8N2O4 (1), is composed of two trans planar isoxazole rings [r.m.s deviation = 0.006 (1) Å], each connected with a methyl hydroxyl group. Similarly, the structure of 4,4',5,5'-tetrakis-(hydroxy-methyl)-3,3'-biisoxazole, C10H12N2O6 (2), is composed of two planar isoxazole rings [r.m.s. deviation = 0.002 (1) Å], but with four hydroxymethyl groups as substituents. Both mol-ecules sit on a center of inversion, thus Z' = 0.5. The crystal structures are stabilized by networks of O-H⋯N [for (1)] and O-H⋯O hydrogen-bonding inter-actions [for (2)], giving rise to corrugated supra-molecular planes. The isoxazole rings are packed in a slip-stacked fashion, with centroid-to-centroid distances of 4.0652 (1) Šfor (1) (along the b-axis direction) and of 4.5379 (Å) for (2) (along the a-axis direction).

Cardiac transplantation in Friedreich Ataxia: Extended follow-up.

Friedreich Ataxia (FRDA) is an autosomal recessive neurodegenerative disorder most commonly caused by guanine-adenine-adenine (GAA) trinucleotide repeat expansions in both alleles of the FXN gene. Although progressive ataxia remains the hallmark clinical feature, patients with FRDA are at high risk of developing cardiomyopathy, often resulting in premature death. There is no specific treatment for FRDA-associated cardiomyopathy; even in advanced cardiac failure cardiac transplantation is not commonly pursued. This case series describes extended follow-up of three FRDA cases with end-stage heart failure but mild neurologic disease who underwent successful heart transplantation. We also review and examine the ethical considerations for heart transplantation in the setting of neurodegenerative disease.

Crystal structure of 3,3'-biisoxazole-5,5'-bis(methyl-ene) dinitrate (BIDN).

The mol-ecular structure of the title energetic compound, C8H6N4O8, is composed of two planar isoxazole rings and two near planar alkyl-nitrate groups (r.m.s deviation = 0.006 Å). In the crystal, the mol-ecule sits on an inversion center, thus Z' = 0.5. The dihedral angle between the isoxazole ring and the nitrate group is 69.58 (8)°. van der Waals contacts dominate the inter-molecular inter-actions. Inversion-related rings are in close slip-stacked proximity, with an inter-planar separation of 3.101 (3) Š[centroid-centroid distance = 3.701 (3) Å]. The measured and calculated densities are in good agreement (1.585 versus 1.610 Mg m-3).

Pediatric heart transplantation across ABO blood type barriers: a case study.

Heart transplantation with ABO blood type-incompatible donors has historically been contraindicated because of the high risk of an immediate hyperacute humoral graft rejection. The immature neonatal immune system presents an immunologic window that allows for breaching the ABO barrier before the natural development of anti-ABO antibodies. Information from a small series of neonates has demonstrated similar survival rates and posttransplant outcomes compared to ABO-compatible transplantations. In the posttransplant period, particular attention is placed on the surveillance of graft-specific antibody production and monitoring for immunologic signs and symptoms of early graft vasculopathy. This article presents a case study of a neonate with congenital heart disease who underwent one of the first successful ABO-incompatible heart transplantations in the United States.

Outcomes after percutaneous coronary artery revascularization procedures for cardiac allograft vasculopathy in pediatric heart transplant recipients: A multi-institutional study.

BACKGROUND: Cardiac allograft vasculopathy is an important cause of long-term graft loss. In adults, percutaneous revascularization procedures (PRPs) have variable success with high restenosis rates and little impact on graft survival. Limited data exist in pediatric recipients of transplants. METHODS: Data from the Pediatric Heart Transplant Study (PHTS) were used to explore associations between PRPs and outcomes after heart transplant in patients listed ≤18 years old who received a first heart transplant between 1993 and 2009. RESULTS: Revascularization procedures were done in 28 of 3,156 (0.9%) patients; 13 patients had multiple PRPs giving a total of 51 PRPs performed across 15 centers. Mean recipient age at time of transplant was 7.7 ± 6.7 years; mean donor age was 15.9 ± 15.4 years. The mean time to first PRP was 5.7 ± 3.2 years. Vessels involved were left anterior descending artery (41%), right coronary artery (25%), circumflex artery (18%), other coronary branches/unknown (16%). PRPs consisted of 38 (75%) stent implantations and 13 (25%) balloon angioplasties with an overall procedural success rate of 73%. Freedom from graft loss after PRPs was 89%, 75%, and 61% at 1, 3, and 12 months. In addition, patients with transplants from donors >30 years old were found to have less freedom from the need for a revascularization procedure than patients with transplants from younger donors (p < 0.0001). CONCLUSIONS: In this large pediatric heart transplant cohort, use of PRPs for cardiac allograft vasculopathy was rare, likely related to procedural feasibility of the interventions. Despite technically successful interventions, graft loss occurred in 39% within 1 year post-procedure; relisting for heart transplant should be considered.

Quality of life in pediatric heart transplant recipients: a comparison with children with and without heart disease.

BACKGROUND: Little is known about the quality of life (QOL) of children with heart disease who undergo life-saving surgery. The aim of this multicenter study was to examine self- and parent-reported QOL outcomes in pediatric heart transplant recipients. METHODS: Pediatric heart transplant recipients/families (n = 174) from 7 transplant programs completed the Pediatric Quality of Life Inventory Generic Core Scales and Cardiac Module. Scores for the heart transplant sample were compared with non-transplant patients who had undergone conventional cardiac surgery and with a healthy child sample. Within the cardiac surgery group, heart disease/surgery was further categorized by severity/complexity. RESULTS: Heart transplant recipients were a mean age of 10.6 ± 4.7 years at a mean time post-transplant of 6.0 ± 4.1 years. By both self-report and parent proxy report, mean scores for heart transplant recipients were significantly lower than those in healthy children for physical and psychosocial QOL, including emotional and social functioning (p < 0.001), with 31.3% self-reporting significantly impaired psychosocial QOL scores. By self-report, there were no significant differences in emotional and social mean scores between the transplant and cardiac surgery groups. Transplant recipients reported significantly fewer cardiac symptoms than children with cardiac surgery (p < 0.01). Their self-reported school functioning scores were not significantly different from children with moderate to severe disease. CONCLUSION: Although pediatric heart transplant recipients experience significant symptomatic improvement, they remain at-risk for impaired psychosocial QOL, similar to children with residual or palliated heart disease. Assessment is needed to identify children at-risk and improve psychosocial outcomes.