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This study sought to assess undergraduate students’ knowledge and attitudes surrounding perceived self-efficacy and threats in various common emergencies in communities of higher education.
Methods
Self-reported perceptions of knowledge and skills, as well as attitudes and beliefs regarding education and training, obligation to respond, safety, psychological readiness, efficacy, personal preparedness, and willingness to respond were investigated through 3 representative scenarios via a web-based survey.
Results
Among 970 respondents, approximately 60% reported their university had adequately prepared them for various emergencies while 84% reported the university should provide such training. Respondents with high self-efficacy were significantly more likely than those with low self-efficacy to be willing to respond in whatever capacity needed across all scenarios.
Conclusions
There is a gap between perceived student preparedness for emergencies and training received. Students with high self-efficacy were the most likely to be willing to respond, which may be useful for future training initiatives.
Evidence-based insertion and maintenance bundles are effective in reducing the incidence of central line-associated bloodstream infections (CLABSI) in intensive care unit (ICU) settings. We studied the adoption and compliance of CLABSI prevention bundle programs and CLABSI rates in ICUs in a large network of acute care hospitals across Canada.
Pragmatic trials aim to speed translation to practice by integrating study procedures in routine care settings. This study evaluated implementation outcomes related to clinician and patient recruitment and participation in a trial of community paramedicine (CP) and presents successes and challenges of maintaining pragmatic study features.
Methods:
Adults in the pre-hospital setting, emergency department (ED), or hospital being considered for referral to the ED/hospital or continued hospitalization for intermediate-level care were randomized 1:1 to CP care or usual care. Referral and enrollment data were tracked administratively, and patient characteristics were abstracted from the electronic health record (EHR). Enrolled patients completed baseline surveys, and a subset of intervention patients were interviewed. All CPs and a sample of clinicians and administrators were invited to complete a survey and interview.
Results:
Between January 2022 and February 2023, 240 enrolled patients (42% rural) completed surveys, and 22 completed an interview; 63 staff completed surveys and 20 completed an interview. Ninety-three clinicians in 27 departments made at least one referral. Factors related to referrals included program awareness and understanding the CP practice scope. Most patients were enrolled in the hospital, but characteristics were similar to the primary care population and included older and medically complex patients. Challenges to achieving representativeness included limited EHR infrastructure, constraints related to patient consenting, and clinician concerns about patient randomization disrupting preferred care.
Conclusion:
Future pragmatic trials in busy clinical settings may benefit from regulatory policies and EHR capabilities that allow for real-world study conduct and representative participation. Trial registration: NCT05232799.
Dysphagia can lead to morbidity including weight loss and aspiration pneumonia. Effective triage of patients and streamlining of pathways to expedite diagnosis and treatment is therefore imperative.
Objectives
The goals of this research were to measure the referral to treatment time for dysphagia patients in a newly established pathway and compare with existing UK national and local referral to treatment times, and to evaluate patient feedback.
Methods
Speech and language therapy advanced clinical practitioners were trained in nasendoscopy and assessment of swallow. Referral to treatment times were measured and patient satisfaction questionnaires completed.
Results
A decrease in triage to treatment time (from 24 to 6 weeks). Patients reported high understanding of the condition and minimal discomfort during assessments. Radiation exposure was reduced (2 per cent of patients undergoing soluble contrast swallows, previously 100 per cent).
Conclusion
The new pathway expedites treatment and achieves high patient satisfaction. It empowers speech and language therapy in efficiently managing low-complexity cases and supports multidisciplinary care for dysphagia patients.
During their northward migration, Red Knots Calidris canutus rufa stop at the Lagoa do Peixe National Park in the extreme south of Brazil to build up fat reserves for their journey to their Canadian breeding grounds. We tracked five Red Knots with PinPoint Argos-75 GPS transmitters to investigate differences in migration strategies from this stopover. Tracked birds used two different routes: the Central Brazil route and the Brazilian Atlantic Coast route. One bird flew 8,300 km straight from Lagoa do Peixe to the Delaware Bay (USA). Another bird stopped in Maranhão (north-east Brazil) and a third one used a yet unknown environment for the species, the mouth of the Amazon River at Baía Santa Rosa, Brazil. These two birds made short flights, covering stretches of 1,600 km to 3,600 km between stop-overs, where they stayed from 4 to 18 days. Our study highlights the occurrence of intrapopulation variation in migratory strategies and reveals the connectivity of environments that are essential for the viability of rufa Red Knot populations.
We present detailed characterization of laser-driven fusion and neutron production ($\sim {10}^5$/second) using 8 mJ, 40 fs laser pulses on a thin (<1 μm) D${}_2$O liquid sheet employing a measurement suite. At relativistic intensity ($\sim 5\times {10}^{18}$ W/cm${}^2$) and high repetition rate (1 kHz), the system produces deuterium–deuterium (D-D) fusion, allowing for consistent neutron generation. Evidence of D-D fusion neutron production is verified by a measurement suite with three independent detection systems: an EJ-309 organic scintillator with pulse-shape discrimination, a ${}^3\mathrm{He}$ proportional counter and a set of 36 bubble detectors. Time-of-flight analysis of the scintillator data shows the energy of the produced neutrons to be consistent with 2.45 MeV. Particle-in-cell simulations using the WarpX code support significant neutron production from D-D fusion events in the laser–target interaction region. This high-repetition-rate laser-driven neutron source could provide a low-cost, on-demand test bed for radiation hardening and imaging applications.
We recently reported on the radio-frequency attenuation length of cold polar ice at Summit Station, Greenland, based on bi-static radar measurements of radio-frequency bedrock echo strengths taken during the summer of 2021. Those data also allow studies of (a) the relative contributions of coherent (such as discrete internal conducting layers with sub-centimeter transverse scale) vs incoherent (e.g. bulk volumetric) scattering, (b) the magnitude of internal layer reflection coefficients, (c) limits on signal propagation velocity asymmetries (‘birefringence’) and (d) limits on signal dispersion in-ice over a bandwidth of ~100 MHz. We find that (1) attenuation lengths approach 1 km in our band, (2) after averaging 10 000 echo triggers, reflected signals observable over the thermal floor (to depths of ~1500 m) are consistent with being entirely coherent, (3) internal layer reflectivities are ≈–60$\to$–70 dB, (4) birefringent effects for vertically propagating signals are smaller by an order of magnitude relative to South Pole and (5) within our experimental limits, glacial ice is non-dispersive over the frequency band relevant for neutrino detection experiments.
A recent literature review revealed no studies that explored teams that used an explicit theoretical framework for multiteam systems in academic settings, such as the increasingly important multi-institutional cross-disciplinary translational team (MCTT) form. We conducted an exploratory 30-interview grounded theory study over two rounds to analyze participants’ experiences from three universities who assembled an MCTT in order to pursue a complex grant proposal related to research on post-acute sequelae of COVID-19, also called “long COVID.” This article considers activities beginning with preliminary discussions among principal investigators through grant writing and submission, and completion of reviews by the National Center for Advancing Translational Sciences, which resulted in the proposal not being scored.
Methods:
There were two stages to this interview study with MCTT members: pre-submission, and post-decision. Round one focused on the process of developing structures to collaborate on proposal writing and assembly, whereas round two focused on evaluation of the complete process. A total of 15 participants agreed to be interviewed in each round.
Findings:
The first round of interviews was conducted prior to submission and explored issues during proposal writing, including (1) importance of the topic; (2) meaning and perception of “team” within the MCTT context; and (3) leadership at different levels of the team. The second round explored best practices-related issues including (1) leadership and design; (2) specific proposal assembly tasks; (3) communication; and (4) critical events.
Conclusion:
We conclude with suggestions for developing best practices for assembling MCTTs involving multi-institutional teams.
The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery (WCPCCS) will be held in Washington DC, USA, from Saturday, 26 August, 2023 to Friday, 1 September, 2023, inclusive. The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery will be the largest and most comprehensive scientific meeting dedicated to paediatric and congenital cardiac care ever held. At the time of the writing of this manuscript, The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery has 5,037 registered attendees (and rising) from 117 countries, a truly diverse and international faculty of over 925 individuals from 89 countries, over 2,000 individual abstracts and poster presenters from 101 countries, and a Best Abstract Competition featuring 153 oral abstracts from 34 countries. For information about the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery, please visit the following website: [www.WCPCCS2023.org]. The purpose of this manuscript is to review the activities related to global health and advocacy that will occur at the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery.
Acknowledging the need for urgent change, we wanted to take the opportunity to bring a common voice to the global community and issue the Washington DC WCPCCS Call to Action on Addressing the Global Burden of Pediatric and Congenital Heart Diseases. A copy of this Washington DC WCPCCS Call to Action is provided in the Appendix of this manuscript. This Washington DC WCPCCS Call to Action is an initiative aimed at increasing awareness of the global burden, promoting the development of sustainable care systems, and improving access to high quality and equitable healthcare for children with heart disease as well as adults with congenital heart disease worldwide.
OBJECTIVES/GOALS: This report evaluates participants’experiences from three universities who assembled a complex grant proposal related to research on post-acute sequala of COVID-19 (PASC), also called long COVID. Activities reviewed ranged from the assembly of the team to responses to reviews by the National Center for Advancing Translational Sciences (NCATS). METHODS/STUDY POPULATION: Data were collected by means of semi-structured interviews, conducted and recorded on Zoom, with a sample of 15 scientists and staff both during proposal assembly and following proposal review. The sample comprised 40% of the total team equally selected from the 3 universities, The interview protocol was reviewed by the IRB at UTMB and the interviews were recorded on Zoom, and analyzed by means of the constant comparative strategy in the grounded theory method of qualitative research. Given the relatively small number of interviews in this project, we paid special attention to preserving the confidentiality of respondents. Only the verbal tracks of the interviews were professionally transcribed. Respondents were asked to suggest changes for future inter-organizational proposals. RESULTS/ANTICIPATED RESULTS: FIRST INTERVIEWS *LEADERSHIP: The scope of leadership opportunities was expanded as sub-teams in specific areas such as community engagement were formed. *TEAM: Each university’s community engagement team specializes in a different ethnic clientele, precluding a singular statement for the proposal. SECOND INTERVIEWS *LEADERSHIP: Staff members noted that the team concept too easily evolved into a bureaucratic format, resulting in less negotiation and more direction. *ASSEMBLY TASKS: The Writing Team turned out to be one of the most critical staff teams. *COMMUNICATION: The behavioral scientists in community engagement do not necessarily share paradigms (e.g., public health, psychology, and social work). They had difficulty generating productive communication and a unified statement for the proposal. DISCUSSION/SIGNIFICANCE: The scientists, as a group, suggested that future proposals should focus on one general topic, such as the microbiome, as opposed to attempting to integrate widely divergent interests. The scientists as a group should decide a priori whether to treat innovative ideas such as machine learning science as a science or a service.
Distributed Acoustic Sensing (DAS) is increasingly recognised as a valuable tool for glaciological seismic applications, although analysing the large data volumes generated in acquisitions poses computational challenges. We show the potential of active-source DAS to image and characterise subglacial sediment beneath a fast-flowing Greenlandic outlet glacier, estimating the thickness of sediment layers to be 20–30 m. However, the lack of subglacial velocity constraint limits the accuracy of this estimate. Constraint could be provided by analysing cryoseismic events in a counterpart 3-day record of passive seismicity through, for example, seismic tomography, but locating them within the 9 TB data volume is computationally inefficient. We describe experiments with data compression using the frequency-wavenumber (f-k) transform ahead of training a convolutional neural network, that provides a ~300-fold improvement in efficiency. In combining active and passive-source and our machine learning framework, the potential of large DAS datasets could be unlocked for a range of future applications.
Hot executive functioning (EF) – EF under emotionally or motivationally salient conditions – is a putative etiology of attention-deficit/hyperactivity disorder (ADHD), disruptive behavior problems (DBPs), and their related impairments. Despite two decades of research, the present study is the first review of the construct in youth ADHD, with a particular focus on the role of task design, age, and DBPs, as well as relevant conceptual and methodological considerations. While certain hot EF tasks have been investigated extensively (e.g., choice impulsivity), substantial inconsistency in measurement of the broader construct remains, severely limiting conclusions. Future research should a) consider the extent to which various hot EF tasks relate to one another, a higher order factor, and other related constructs; b) further investigate task design, particularly the elicitation of emotion or motivation and its anticipated effect on EF; and c) incorporate multiple levels of analysis to validate similarities and differences among tasks with regard to the affective experiences and cognitive demands they elicit. With improved measurement and conceptual clarity, hot EF has potential to advance the literature on etiological pathways to ADHD, DBPs and associated impairments and, more broadly, may represent a useful tool for understanding the influence of emotion and motivation on cognition.
This paper evaluates the impact of a higher court articulating doctrine as either a “rule” or a “standard.” The legal doctrine we evaluate concerns police searches based upon information supplied by confidential informants. The Supreme Court’s Aguilar-Spinelli test was a rule, and its Illinois v. Gates “totality of the circumstances” test is a standard. Using a data set of circuit court opinions from 1951 to 1999, we compare circuit-level implementation of these two doctrines. The results suggest that rules are more effective than standards at constraining ideological voting in lower courts.
We examine gender bias in political institutions through a novel lens: oral arguments at the US Supreme Court. We ask whether female lawyers are afforded less speaking time during oral arguments compared to male lawyers. We posit that justices, while highly educated and more aware than most of laws requiring equal treatment, may be influenced by gender schemas that result in unconscious biased treatment of male and female lawyers. Applying automated content analysis to the transcripts of 3,583 oral arguments, we find that female lawyers are interrupted earlier, allowed to speak for less time between interruptions, and subjected to more and longer speeches by the justices compared to their male counterparts. However, this pattern is reversed during oral arguments involving gender-related cases. Our most novel and significant theoretical finding is that gender negates the well-documented positive effect of being on the winning side of a case.
We assessed the prevalence of antibiotic prescriptions among ambulatory patients tested for coronavirus disease 2019 (COVID-19) in a large public US healthcare system and found a low overall rate of antibiotic prescriptions (6.7%). Only 3.8% of positive severe acute respiratory coronavirus virus 2 (SARS-CoV-2) tests were associated with an antibiotic prescription within 7 days.
The Canadian Nosocomial Infection Surveillance Program conducted point-prevalence surveys in acute-care hospitals in 2002, 2009, and 2017 to identify trends in antimicrobial use.
Methods:
Eligible inpatients were identified from a 24-hour period in February of each survey year. Patients were eligible (1) if they were admitted for ≥48 hours or (2) if they had been admitted to the hospital within a month. Chart reviews were conducted. We calculated the prevalence of antimicrobial use as follows: patients receiving ≥1 antimicrobial during survey period per number of patients surveyed × 100%.
Results:
In each survey, 28−47 hospitals participated. In 2002, 2,460 (36.5%; 95% CI, 35.3%−37.6%) of 6,747 surveyed patients received ≥1 antimicrobial. In 2009, 3,566 (40.1%, 95% CI, 39.0%−41.1%) of 8,902 patients received ≥1 antimicrobial. In 2017, 3,936 (39.6%, 95% CI, 38.7%−40.6%) of 9,929 patients received ≥1 antimicrobial. Among patients who received ≥1 antimicrobial, penicillin use increased 36.8% between 2002 and 2017, and third-generation cephalosporin use increased from 13.9% to 18.1% (P < .0001). Between 2002 and 2017, fluoroquinolone use decreased from 25.7% to 16.3% (P < .0001) and clindamycin use decreased from 25.7% to 16.3% (P < .0001) among patients who received ≥1 antimicrobial. Aminoglycoside use decreased from 8.8% to 2.4% (P < .0001) and metronidazole use decreased from 18.1% to 9.4% (P < .0001). Carbapenem use increased from 3.9% in 2002 to 6.1% in 2009 (P < .0001) and increased by 4.8% between 2009 and 2017 (P = .60).
Conclusions:
The prevalence of antimicrobial use increased between 2002 and 2009 and then stabilized between 2009 and 2017. These data provide important information for antimicrobial stewardship programs.
Using physiological markers to detect patients at risk of deterioration is common. Deaths at music festivals in Australia prompted scrutiny of tools to identify critically unwell patients for transport to hospital. This study evaluated initial physiological parameters to identify patients selected for transport to hospital from a music festival.
Methods:
A retrospective audit of 2045 presentations at music festivals in Victoria, Australia, was performed. Presentation heart rate, systolic blood pressure, respiratory rate, oxygen saturation, temperature, and Glasgow Coma Scale were assessed using area under the receiver operating characteristic curve (AUROC) analysis, with a prespecified threshold of 0.7.
Results:
The only measured variable to exceed the prespecified cutpoint was initial systolic blood pressure, with an AUROC of 0.72 and optimal cutpoint of 122 mmHg. Using commonly accepted cutpoints for variables did not improve detection performance to acceptable levels, nor did using combination systems of cutpoints.
Conclusions:
Initial physiological variables are poor predictors of the decision to transport to hospital from music festivals. Systolic blood pressure was significant, but only at a clinically insignificant value. Decisions on which patients to transport from an event site should incorporate more information than initial physiology. Senior clinicians should lead decision-making about hospital transport from music festivals.
Bacillus pumilus SAFR-032, an endospore-forming bacterial strain, was investigated to determine its methylation pattern (methylome) change, compared to ground control, after direct exposure to space conditions onboard the International Space Station (ISS) for 1.5 years. The resulting ISS-flown and non-flown strains were sequenced using the Nanopore MinION and an in-house method and pipeline to identify methylated positions in the genome. Our analysis indicated genomic variants and m6A methylation increased in the ISS-flown SAFR-032. To complement the broader omics investigation and explore phenotypic changes, ISS-flown and non-flown strains were compared in a series of laboratory-based chamber experiments using an X-ray irradiation source (doses applied at 250, 500, 750, 1000 and 1250 Gy); results show a potentially higher survival fraction of ISS-flown DS2 at the two highest exposures. Taken together, results from this study document lasting changes to the genome by methylation, potentially triggered by conditions in spaceflight, with functional consequences for the resistance of bacteria to stressors expected on long-duration missions beyond low Earth orbit.
Rice is consumed by nearly half of the global population and a significant source of energy and nutrients. However, rice consumption can also be a significant pathway of inorganic arsenic (iAs) exposure, thus requiring a risk–benefit assessment. This study assessed nutrient element (NE) densities in fifty-five rice types (white, brown and wild rice) marketed in the UK. Densities of essential NE were used to rank rice types in meeting daily NE targets under different consumption scenarios through a newly developed optimisation approach. Using iAs data from these rice types, we assessed the margin of exposure (MOE) for low (the UK) and high (Bangladesh) rice intake scenarios. Our results showed that brown and wild rice are significantly higher in many NE and significantly contribute to dietary reference value (DRV). Our modelling showed that switching to brown or wild rice could increase the intake of several essential nutrients by up to eight times that of white rice. Using rice consumption data for mid-to-high-consumption countries, we estimate that brown rice could provide 100 % adult DRV for Fe, Mg, Cr, P and Mo, and substantial contributions for Zn, Se and K. Our results show that the amount of rice primarily determines risk from iAs consumed rather than the type of rice. Therefore, switching from white to brown or wild rice could be beneficial, provided iAs concentration in rice is within the recommended limits.
Two school strikers − Niamh and Harriet − come together with two environmental education academics − Peta and Joseph − to explore what it means to be young people enacting politics for the environment in Australia, and what this might mean for re-imagining education. Niamh and Harriet are leaders of, and were integral to initiating, the highly effective School Strike 4 Climate − Australia (SS4C) movement, enacting ‘principled disobedience’. Peta and Joseph work in teacher education, preparing future teachers who will teach students who are increasingly climate savvy and politically active. In coming together and through the lens of pragmatism, we highlight the political nature of what Niamh and Harriet have been undertaking as they negotiate social, cultural, educational and environmental issues implicated in the climate crisis. Collaborative autoethnography framed our exploration of motivations for action, politics and education within our communities. Through Niamh’s and Harriet’s experiences, we explore how young people express agency while developing identity. Our autoethnographic conversations highlighted the experience and political agency that many of our young people demonstrate and led to us reflecting on the resulting opportunity for educators to ‘dare to think’ differently about education.