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Introduction: Identification of latent safety threats (LSTs) in the emergency department is an important aspect of quality improvement that can lead to improved patient care. In situ simulation (ISS) takes place in the real clinical environment and multidisciplinary teams can participate in diverse high acuity scenarios to identify LSTs. The purpose of this study is to examine the influence that the profession of the participant (i.e. physician, registered nurse, or respiratory therapist) has on the identification of LSTs during ISS. Methods: Six resuscitation- based adult and pediatric simulated scenarios were developed and delivered to multidisciplinary teams in the Kingston General Hospital ED. Each ISS session consisted of a 10- minute scenario, followed by 3-minutes of individual survey completion and a 7- minute group debrief led by ISS facilitators. An objective assessor recorded LSTs identified during each debrief. Surveys were completed prior to debrief to reduce response bias. Data was collected on participant demographics and perceived LSTs classified in the following categories: medication; equipment; resources and staffing; teamwork and communication; or other. Two reviewers evaluated survey responses and debrief notes to formulate a list of unique LSTs across scenarios and professions. The overall number and type of LSTs from surveys was identified and stratified by health care provider. Results: Thirteen ISS sessions were conducted with a total of 59 participants. Thirty- four unique LSTs (8 medication, 15 equipment, 5 resource, 4 communication, and 2 miscellaneous issues) were identified from surveys and debrief notes. Overall, MDs (n = 12) reported 19 LSTss (n = 41) reported 77 LSTs, and RTs (n = 6) reported 4 LSTs based on individual survey data. The most commonly identified category of LSTs reported by MDs (36.8%) and RTs (75%) was equipment issues while RNs most commonly identified medication issues (36.4%). Participants with □5 years of experience in their profession, on average identified more LSTs in surveys than participants with >5 years experience (1.9 LSTs vs 1.5 LSTs respectively). Conclusion: Nursing staff identified the highest number of LSTs across all categories. There was fairly unanimous identification of major LSTs across professions, however each profession did identify unique perspectives on LSTs in survey responses. ISS programs with the purpose of LST identification would benefit from multidisciplinary participation.
To examine the relationship between food insecurity and coping strategies (actions taken to manage economic stress) hypothesized to worsen glucose control in patients with diabetes.
Using a cross-sectional telephone survey and clinical data, we compared food-insecure and food-secure individuals in their use of coping strategies. Using logistic regression models, we then examined the association between poor glucose control (glycated Hb, HbA1c≥8·0 %), food insecurity and coping strategies.
An urban medical centre, between June and December 2013.
Four hundred and seven adults likely to be low income (receiving Medicaid or uninsured and/or residing in a zip code with >30 % of the population below the federal poverty level) with type 2 diabetes.
Of respondents, 40·5 % were food insecure. A significantly higher percentage of the food-insecure group reported use of most examined coping strategies, including foregone medical care, participation in the Supplemental Nutrition Assistance Program (SNAP)) and use of emergency food programmes. Food insecurity was associated with poor glucose control (OR=2·23; 95 % CI 1·22, 4·10); coping strategies that were more common among the food insecure were not associated with poor glucose control. Among the food insecure, receipt of SNAP was associated with lower risk of poor glucose control (OR=0·27; 95 % CI 0·09, 0·80).
While food insecurity was associated with poor glucose control, most examined coping strategies did not explain this relationship. However, receipt of SNAP among food-insecure individuals was associated with better diabetes control, suggesting that such programmes may play a role in improving health.
Exercise-induced pulmonary haemorrhage (EIPH) is a major health concern in performance horses, but the presence and severity of this condition in racing greyhounds has received little attention. While equids and greyhounds share many physiological attributes, there are important structural and functional differences that may help protect greyhounds from EIPH. We tested the hypothesis that greyhounds performing a simulated 503 m race would experience EIPH and that the time course of recovery would be similar to the horse, even though the severity or relative extent as indexed by the concentration of red blood cells [RBCs] in bronchoalveolar lavage (BAL) fluid would be lower in comparison with that demonstrated previously in horses. Greyhound dogs (n = 6) raced on two occasions (separated by 7 weeks) and BAL was performed 1 week before, 2 h after and each week for 4 weeks following each race to examine the [RBC], concentration of white blood cells [WBCs], WBC differentials and haemosiderophages in the lungs. Racing increased 10 min post-exercise venous blood [lactate] to 18.6 ± 0.4 mmol l− 1. No epistaxis or pink froth was observed at the nose or mouth of any of the dogs. The [RBC] in the BAL fluid was increased significantly 2 h post-race (baseline = 109.6 ± 11.7 × 103; post-race = 292.3 ± 69.9 × 103 RBC ml− 1 BAL fluid, P < 0.05) and returned to baseline 1 week post-race (149.2 ± 46.2 × 103 RBC ml− 1 BAL fluid, P>0.05 versus baseline). The number of haemosiderophages was not different for any of the measurement periods. The [WBC] in the BAL fluid decreased from baseline and race values at 2, 3 and 4 weeks post-exercise (all P < 0.05). Alveolar neutrophil concentrations were also decreased from baseline and immediate post-race values for 4 weeks post-race. The increased [RBC] in the BAL fluid post-exercise is consistent with the presence of EIPH in these greyhounds. However, the relative extent of EIPH in greyhounds (as indexed by [RBC] in the BAL fluid), as compared with that in the horse, was mild, and the lack of elevation of WBC suggests that, unlike their equine counterparts, inflammatory airway disease was absent.
In the present chapter we explore how mothers' internal working models of their seven-month-old infants organize emotions in the parenting context, and ultimately, influence infant emotion regulation. We propose that mothers' internal working models of their infants function as emotion regulators, and influence a variety of components of the affective organization of parenting, including a) maternal emotion activation, b) qualities of maternal emotional engagement with their infants, and c) emotion regulation strategies mothers employ during emotionally challenging interactions. Results underscore the important role played by emotional processes in explaining the correspondence between maternal and infant emotion regulation strategies.
The relationship with a primary caregiver is the emotional cocoon from which the infant's social and emotional self develops and emerges. Developmentalists from a range of theoretical perspectives have underscored the centrality of the parent–infant relationship for early infant emotional development and emphasize the belief that parent–infant interaction during the earliest months may serve as the foundation for the differentiation of the self (Fonagy, 1999; Mahler, Pine, & Bergman, 1975; Sameroff & Emde, 1989; Winnicott, 1965). In other words, the self is born out of relationships and develops as part of, and within, a specific relational context.
Relationships are inherently affective bonds between individuals, and thus, not surprisingly, affective processes play a central role in the attachment and caregiving behavioral systems.
Extracellular matrix components are known to influence the growth and differentiation of cultured cells, often causing them to behave more like their in vivo counterparts than cells grown on plastic. To develop an in vitro model in which to study the interaction of pathogenic microorganisms with the lung epithelium, we have undertaken a morphological study of the effects of extracellular matrix components on the human lung alveolar epithelial cell line A549. A549 cells were grown for varying amounts of time on plastic; Costar polycarbonate membrane filter inserts; or on Matrigel coated polycarbonate filter inserts. Cells were fixed for 1 h in 2% glutaraldehyde in 0.1 M cacodylate buffer, post-fixed in 1 % OsO4 for 45 min, dehydrated in ascending ethanol, and embedded in Spurr’s resin.
A549 cells grown on a plastic slide formed an even monolayer with cells connected by wellformed junctional complexes or separated by interdigitating microvilli. The cytoplasm showed many polyribosomes, rough endoplasmic reticulum, small golgi complexes, mitochondria, occasional lysosomes and bundles of microfilaments.
This work examines the usefulness of the single-fiber fragmentation test in studying the durability of fiber/matrix interfaces/interphases. This test measures the critical length/diameter ratio (L/D) of the fiber fragments formed in the test and relates this length to the interface's strength, or ability to transfer load. In the work reported here, we immersed samples of epoxy containing a single-glass fiber - that was previously sized with an epoxy-compatible coating - in either 65 or 75 °C water and tested after different times of exposure. In general, this ratio increased as a function of time of exposure to water. During exposure at 75 °C, the fibers' L/D in the samples did not increase significantly until after the sample reached its “apparent” equilibrium content of water ∼ (3.0 wt%). Because there was no significant measurable change in the tensile modulus between wet and dry samples, we cannot attribute these differences in L/D to changes in the resin's properties due to plasticizing by water. A small percentage of samples exposed at 65 °C did not show a significant increase in L/D, and in these cases the moisture produced a marked roughening of the fiber surface along the fiber/matrix interface. One possible explanation is that the attack by moisture degrades the interface, thus reducing its strength with a corresponding increase in the L/D. To varying degrees, however, the attack by moisture also degrades the E-glass fiber. This attack by moisture roughened the surfaces of the fibers and increased the distribution and/or size of the critical flaws, thus reducing both the strength of the fiber and the L/D. Based on our preliminary results, it appears that the singlefiber test has the potential to be useful for studying the durability of the resin/matrix interface providing that the influence of the environmental agent on all of the components of the model composite: resin, fiber, and interface/phase, is considered.
A two-choice type bioassay has been used to screen extracts from a number of plants of the sagebrush community for their antifeeding properties against the Colorado potato beetle, Leptinotarsa decemlineata Say. The extracts of Artemisia tridentata, Purshia tridentata and Chrysothamnus nauseosus have been fractionated for their antifeeding constituents. Known constituents of these plants (deacetalmatricarin, coumarins, cucurbitacins, polyphenols, polyacetylenes, and essential oils) were also screened. The results indicate that several chemical classes of compounds are responsible for antifeeding activity in each plant. Water soluble substances present in the waste marc after steam distillation of peppermint oil were highly active, too.
Theoretically the money stock could be controlled by targeting, either a reserve aggregate or the Federal funds rate. In practice, however, one strategy might be more effective than the other if the relationship between its operating variable and the money stock was more predictable.
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