Developing and implementing trauma informed care principles: A pilot project

Background: Exposure to childhood trauma have lifelong consequences effecting the health and well-being of the individuals who experienced or witnessed the trauma. As healthcare providers, we must recognize patients who have been exposed to trauma and ensure that it is responded to appropriately. This approach is known as trauma informed care. Objective: The purpose of this quality improvement project was to increase knowledge, opinion, and self-rated competence related to trauma informed care through the use of an educational intervention. Application of trauma informed care into daily practice was monitored through semi-structured interviews with project participants. Methods: Registered nurses from the women’s and children’s division of a Magnet designated, community hospital in Virginia were invited to attend an instructor led class on the key aspects of trauma informed care. Training was developed using Substance Abuse and Mental Health Service Administration (SAMHSA) trauma informed care guidelines and facility data collected during a 2018 organizational assessment. Lewin’s change theory was the theoretical framework for the project. Results: Statistically significant changes in nurse’s knowledge, opinions, and competence in applying trauma informed care were noted after attending the trauma informed care educational session. Participants consistently reported the importance of recognizing the effects trauma may have on patients and their families. Accounts of positive nurse driven experiences after the application of trauma informed care principles were also self-reported during post-intervention interviews. Conclusion: This quality improvement project yielded positive results related to using education to increase knowledge, opinions, and competence in providing trauma informed care. After the intervention, participants were also able to apply trauma informed care to daily practice producing positive nurse-patient relationships. This project supports the need for further research in the relationship of the application of trauma informed care and patient outcomes. Key words: trauma informed care, pediatrics, educatio

Developing and Implementing Trauma Informed Care Principles: A Pilot Study at Bon Secours St. Mary’s Hospital in Richmond, Virginia

Background In 1998, Kaiser Permanente published The Adverse Childhood Experiences (ACE) study, that recognized the lifelong effects from exposure to trauma or stressful events. The literature supports the findings of the ACE’s study, confirming that the traumatic experiences and stress that we endure during childhood has negative effects on our bodies and brains. The Centers for Disease Control identifies three major areas of risk for negative health well-being outcomes when there is exposure to adverse childhood experiences: health, behaviors, and life potential. It is imperative that healthcare providers begin to learn to recognize patients who have been exposed to adverse childhood experiences and have the tools needed to assist the patient in developing interventions to assist in reducing the negative effects. This phenomenon is known as trauma informed care (TIC). Local Problem Bon Secours Mercy Health system is a large not-for-profit, Catholic health system spanning across seven states. St. Mary’s Hospital is located in Richmond, Virginia and houses the only dedicated pediatric departments in Bon Secours Mercy Health’s Virginia market. In 2018, needs assessment data was collected via an online survey, focusing on staff perception of current TIC education and practices. The results consistently showed a lack of knowledge and resources related to trauma. Focus group data supported the survey results, but also identified a strong desire from staff to become a trauma informed health system. Methods The purpose of this project is to promote awareness and understanding of trauma and the long-term effects of childhood trauma through the use of a 90-minute educational program. Participants will complete a pre- and post-test to evaluate their knowledge, collect opinions, and gauge employee TIC competence. Participants will also be asked to participate in interviews two months after the intervention to discuss application of trauma informed practices in their daily work. The project focuses on a pilot group consisting of the pediatric leadership team and 72 staff members from across all pediatric areas at St. Mary’s Hospital. Interventions A 90-minute in-person educational program was developed with a focus on increasing knowledge around understanding the widespread effect of trauma, recognizing the effects of trauma on patients and peers, responding using trauma informed approaches, and assisting in preventing or minimizing future trauma exposure. Results Expected results include an increase in knowledge and competence after completion of the 90-minute educational session. Results will be examined for trends based on years of experience, the participant’s unit, and job title. Interviews are expected to yield information regarding early recognition of trauma, as well as examples of interventions that were put into place to decrease or prevent future trauma. Conclusion/Implications Exposure to childhood trauma can leave ever lasting effects on health and well-being. As healthcare providers, trauma exposure needs to be recognized and responded to appropriately. Education is the first step in ensuring a trauma informed care approach is provided with every healthcare encounter. The results of this study will assist in developing and implementing trauma informed education for all staff at St. Mary’s Hospital

Introduction; An Overview: Energy and Policy

Includes an introduction to the theme of the journal issue and an overview of the problem. Introduction: This issue of Carolina planning focuses on energy. The magazine's coverage includes a number of policy alternatives pertinent to state, local, and national decision-makers in their deliberation over the energy problem. To provide some background information, the periodical begins with a short look at energy patterns and the institutional arrangements presently existing in North Carolina to manage resources. Next, an article and comment discusses national and state strategies for combatting a future petroleum crisis like the 1973 Arab oil embargo. Then, the benefits of a peak load pricing scheme are explained and proposed for North Carolina utilities. Following, are three articles on two widely discussed alternative energy forms: the Liquid Metal Fast Breeder Reactor and solar energy. The magazine concludes with an elaboration on energy conservation and the special role local governments might play in the effort. This collection, we feel, provides a broadly-based, yet in-depth assessment of important aspects of the state's and nation's energy problems, from the point of view of the planner, government official, and citizen. An Overview: Over the past three decades, North Carolina, like the rest of the nation, has seen a spectacular rise in the consumption of energy. What are the major forms of energy use in North Carolina? Basically, the state's power comes from four sources: electricity (which is generated from coal, nuclear, hydroelectric, and fuel oil power), natural gas, gasoline, and fuel oil. How do the trends for each source measure up, and what plans are being made for management of the state's energy resources? The following description presents a brief overview of the existing situation, in terms of demand and supply of existing resources, and their management, in order to provide background information for this energy issue

Gamma-ray emission expected from Kepler's SNR

Nonlinear kinetic theory of cosmic ray (CR) acceleration in supernova remnants (SNRs) is used to investigate the properties of Kepler's SNR and, in particular, to predict the gamma-ray spectrum expected from this SNR. Observations of the nonthermal radio and X-ray emission spectra as well as theoretical constraints for the total supernova (SN) explosion energy E_sn are used to constrain the astronomical and particle acceleration parameters of the system. Under the assumption that Kepler's SN is a type Ia SN we determine for any given explosion energy E_sn and source distance d the mass density of the ambient interstellar medium (ISM) from a fit to the observed SNR size and expansion speed. This makes it possible to make predictions for the expected gamma-ray flux. Exploring the expected distance range we find that for a typical explosion energy E_sn=10^51 erg the expected energy flux of TeV gamma-rays varies from 2x10^{-11} to 10^{-13} erg/(cm^2 s) when the distance changes from d=3.4 kpc to 7 kpc. In all cases the gamma-ray emission is dominated by \pi^0-decay gamma-rays due to nuclear CRs. Therefore Kepler's SNR represents a very promising target for instruments like H.E.S.S., CANGAROO and GLAST. A non-detection of gamma-rays would mean that the actual source distance is larger than 7 kpc.Comment: 6 pages, 4 figures. Accepted for publication in Astronomy and Astrophysics, minor typos correcte

Minimal HCN emission from Molecular Clouds in M33

Since HCN emission has been shown to be a linear tracer of ongoing star formation activity, we have searched for HCN (J = 1->0) emission from known GMCs in the nearby galaxy M33. No significant HCN emission has been found along any of the lines of sight. We find two lines of sight where CO-to-HCN integrated intensity ratios up to 280, nearly a factor of 6 above what is found in comparable regions of the Milky Way. Star formation tracers suggest that the HCN-to-star formation rate ratio (L_HCN/M_SFR) is a factor of six lower than what is observed in the Milky Way (on average) and local extragalactic systems. Simple chemical models accounting for the sub-solar N/O ratio suggest that depletion cannot account for the high CO-to-HCN ratios. Given HCN formation requires high extinction (A_V > 4), low metallicity may yield reduced dust shielding and thus a high CO/HCN ratio. The turbulence and structure of GMCs in M33 are comparable to those found in other systems, so the differences are unlikely to result from different GMC properties. Since lower CO-to-HCN ratios are associated with the highest rates of star formation, we attribute the deficits in part to evolutionary effects within GMCs.Comment: Accepted for publication in MNRA

SMASHing the LMC: A Tidally-induced Warp in the Outer LMC and a Large-scale Reddening Map

We present a study of the three-dimensional (3D) structure of the Large Magellanic Cloud (LMC) using ~2.2 million red clump (RC) stars selected from the Survey of the MAgellanic Stellar History. To correct for line-of-sight dust extinction, the intrinsic RC color and magnitude and their radial dependence are carefully measured by using internal nearly dust-free regions. These are then used to construct an accurate 2D reddening map (165 square degrees with ~10 arcmin resolution) of the LMC disk and the 3D spatial distribution of RC stars. An inclined disk model is fit to the 2D distance map yielding a best-fit inclination angle i = 25.86(+0.73,-1.39) degrees with random errors of +\-0.19 degrees and line-of-nodes position angle theta = 149.23(+6.43,-8.35) degrees with random errors of +/-0.49 degrees. These angles vary with galactic radius, indicating that the LMC disk is warped and twisted likely due to the repeated tidal interactions with the Small Magellanic Cloud (SMC). For the first time, our data reveal a significant warp in the southwestern part of the outer disk starting at rho ~ 7 degrees that departs from the defined LMC plane up to ~4 kpc toward the SMC, suggesting that it originated from a strong interaction with the SMC. In addition, the inner disk encompassing the off-centered bar appears to be tilted up to 5-15 degrees relative to the rest of the LMC disk. These findings on the outer warp and the tilted bar are consistent with the predictions from the Besla et al. simulation of a recent direct collision with the SMC.Comment: 25 pages, 15 figures, published in Ap

Nothing but the truth: Consistency and efficiency of the list experiment method for the measurement of sensitive health behaviours

Rationale: Social desirability bias, which is the tendency to under-report socially, undesirable health behaviours, significantly distorts information on sensitive behaviours, gained from self-reports and prevents accurate estimation of the prevalence of those, behaviours. We contribute to a growing body of literature that seeks to assess the performance of the list experiment method to improve estimation of these sensitive health behaviours. Method: We use a double-list experiment design in which respondents serve as the treatment group for one list and as the control group for the other list to estimate the prevalence of two sensitive health behaviours in different settings: condom use among 500 female sex workers in urban Senegal and physical intimate partner violence among 1700 partnered women in rural Burkina Faso. First, to assess whether the list experiment improves the accuracy of estimations of the prevalence of sensitive behaviours, we compare the prevalence rates estimated from self-reports with those elicited through the list experiment. Second, we test whether the prevalence rates of the sensitive behaviours obtained using the double-list design are similar, and we estimate the reduction in the standard errors obtained with this design. Finally, we compare the results obtained through another indirect elicitation method, the polling vote method. Results: We show that the list experiment method reduces misreporting by 17 percentage points for condom use and 16–20 percentage points for intimate partner violence. Exploiting the double-list experiment design, we also demonstrate that the prevalence estimates obtained through the use of the two lists are identical in the full sample and across sub-groups and that the double-list design reduces the standard errors by approximately 40% compared to the standard errors in the simple list design. Finally, we show that the list experiment method leads to a higher estimation of the prevalence of sensitive behaviours than the polling vote method. Conclusion: The study suggests that list experiments are an effective method to improve estimation of the prevalence of sensitive health behaviours

Chandra ACIS Survey of M33 (ChASeM33): The enigmatic X-ray emission from IC131

We present the first X-ray analysis of the diffuse hot ionized gas and the point sources in IC131, after NGC604 the second most X-ray luminous giant HII region in M33. The X-ray emission is detected only in the south eastern part of IC131 (named IC131-se) and is limited to an elliptical region of ~200pc in extent. This region appears to be confined towards the west by a hemispherical shell of warm ionized gas and only fills about half that volume. Although the corresponding X-ray spectrum has 1215 counts, it cannot conclusively be told whether the extended X-ray emission is thermal, non-thermal, or a combination of both. A thermal plasma model of kT_e=4.3keV or a single power law of Gamma=2.1 fit the spectrum equally well. If the spectrum is purely thermal (non-thermal), the total unabsorbed X-ray luminosity in the 0.35-8keV energy band amounts to L_X = 6.8(8.7)x10^35erg/s. Among other known HII regions IC131-se seems to be extreme regarding the combination of its large extent of the X-ray plasma, the lack of massive O stars, its unusually high electron temperature (if thermal), and the large fraction of L_X emitted above 2keV (~40-53%). A thermal plasma of ~4keV poses serious challenges to theoretical models, as it is not clear how high electron temperatures can be produced in HII regions in view of mass-proportional and collisionless heating. If the gas is non-thermal or has non-thermal contributions, synchrotron emission would clearly dominate over inverse Compton emission. It is not clear if the same mechanisms which create non-thermal X-rays or accelerate CRs in SNRs can be applied to much larger scales of 200pc. In both cases the existing theoretical models for giant HII regions and superbubbles do not explain the hardness and extent of the X-ray emission in IC131-se.Comment: 28 pages, 7 figures and 2 tables. Accepted for publication in ApJ. For a high resolution version of the paper see http://hea-www.harvard.edu/vlp_m33_public/publications.htm

A New Collisional Ring Galaxy at z = 0.111: Auriga's Wheel

We report the serendipitous discovery of a collision ring galaxy, identified as 2MASX J06470249+4554022, which we have dubbed 'Auriga's Wheel', found in a SUPRIME-CAM frame as part of a larger Milky Way survey. This peculiar class of galaxies is the result of a near head-on collision between typically, a late type and an early type galaxy. Subsequent GMOS-N long-slit spectroscopy has confirmed both the relative proximity of the components of this interacting pair and shown it to have a redshift of 0.111. Analysis of the spectroscopy reveals that the late type galaxy is a LINER class Active Galactic Nuclei while the early type galaxy is also potentially an AGN candidate, this is very uncommon amongst known collision ring galaxies. Preliminary modeling of the ring finds an expansion velocity of ~200 kms^-1 consistent with our observations, making the collision about 50 Myr old. The ring currently has a radius of about 10 kpc and a bridge of stars and gas is also visible connecting the two galaxies.Comment: 9 pages, 5 figures and 4 tables. Accepted for publication in Ap

Contractive Schroedinger cat states for a free mass

Contractive states for a free quantum particle were introduced by Yuen [Yuen H P 1983 Phys. Rev. Lett. 51, 719] in an attempt to evade the standard quantum limit for repeated position measurements. We show how appropriate families of two- and three component ``Schroedinger cat states'' are able to support non-trivial correlations between the position and momentum observables leading to contractive behavior. The existence of contractive Schroedinger cat states is suggestive of potential novel roles of non-classical states for precision measurement schemes.Comment: 24 pages, 7 encapsulated eps color figures, REVTeX4 style. Published online in New Journal of Physics 5 (2003) 5.1-5.21. Higher-resolution figures available in published version. (accessible at http://www.njp.org/