The Providence St. Vincent Emergency Department implementation of a standardized communication tool in patient’s rooms

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Ensuring that the outcome domains proposed for use in burns research are relevant to adult burn patients:a systematic review of qualitative research evidence

Background There have been several attempts to define core outcome domains for use in research focused on adult burns. Some have been based in expert opinion, whilst others have used primary qualitative research to understand patients’ perspectives on outcomes. To date there has not been a systematic review of qualitative research in burns to identify a comprehensive list of patient-centred outcome domains. We therefore conducted a systematic review of qualitative research studies in adult burns. Methods We searched multiple databases for English-language, peer-reviewed, qualitative research papers. We used search strategies devised using the SPIDER tool for qualitative synthesis. Our review utilized an iterative three-step approach: (1) outcome-focused coding; (2) development of descriptive accounts of outcome-relevant issues; and (3) revisiting studies and the broader theoretical literature in order to frame the review findings. Results Forty-one articles were included. We categorized papers according to their primary focus. The category with the most papers was adaptation to life following burn injury (n = 13). We defined 19 outcome domains across the 41 articles: (1) sense of self; (2) emotional and psychological morbidity; (3) sensory; (4) scarring and scar characteristics; (5) impact on relationships; (6) mobility and range of joint motion; (7) work; (8) activities of daily living and self-care; (9) treatment burden; (10) engagement in activities; (11) wound healing and infection; (12) other physical manifestations; (13) financial impact; (14) impact on spouses and family members; (15) analgesia and side effects; (16) cognitive skills; (17) length of hospital stay; (18) access to healthcare; and (19) speech and communication. We suggest that sense of self is a core concern for patients that, to date, has not been clearly conceptualized in the burns outcome domain literature. Conclusions This outcome domain framework identifies domains that are not covered in previous attempts to outline core outcome domains for adult burn research. It does so with reference to existing theoretical perspectives from the sociology and psychology of medicine. We propose that this framework can be used as a basis to ensure that outcome assessment is patient-centred. Sense of self requires further consideration as a core outcome domain

The Elite: A high speed, low-cost general aviation aircraft for Aeroworld

The Elite is a six passenger, general aviation aircraft targeted at the upper middle class private pilot. The Elite is a low wing, conventional monoplane utilizing rudder, ailerons, and a stabilator. The Elite will create a new class of aircraft in Aeroworld. This class of aircraft will demonstrate a substantial improvement in cruise speed over the current existing commercial fleet of aircraft in Aeroworld. This new class will be capable of servicing all existing airstrips in Aeroworld, including rough and short airways. The drivers of this design were aesthetics, a high cruise speed, and take-off distance

Funding Guided Pathways: A Guide for Community College Leaders

This guide is intended to help community college leaders understand the costs involved in implementing guided pathways reforms and develop plans for funding and sustaining them. It is based on research at six institutions that have implemented large-scale changes based on the guided pathways model, which focuses on supporting students to enter and complete programs of study that lead to good jobs and transfer to four-year college programs. The guide explores the following questions: What are the up-front and recurring costs of guided pathways reforms? How are colleges funding these costs? How are colleges sustaining support for guided pathways practices? How can college leaders contemplating guided pathways reforms estimate the costs involved and develop a viable plan for funding and sustaining the reforms? All six case study institutions incurred costs above and beyond the status quo, with the largest costs related to hiring, training, and maintaining an adequate number of advisors for case management advising by field. Significant start-up costs also included purchasing or upgrading information systems to support websites with user-friendly program maps, educational planning, case-management advising, and class scheduling. However, college leaders reported that they do not intend to return to old practices—even in response to a crisis of the magnitude of COVID-19—because guided pathways reforms have led to improved outcomes for students and benefited the colleges as businesses. Four colleges reported increased Integrated Postsecondary Education Data System (IPEDS) retention and graduation rates and reductions in non-degree-applicable credits. Moreover, leaders at every college indicated that they were better positioned to respond to the COVID-19 crisis because of changes they made as part of their pathways reforms. This guide outlines steps that college leaders can take to estimate the costs involved in implementing guided pathways and develop a plan for funding and sustaining these reforms. A companion technical paper estimates the overall costs of implementing guided pathways for colleges of various sizes

Identifying olanzapine induced liver injury in the setting of acute hepatitis C: A case report

Olanzapine is linked to asymptomatic, transient elevations of liver aminotransferases but is historically thought to rarely cause significant hepatotoxicity. Underlying liver disease is a risk factor for drug-induced liver injury and may complicate the differential diagnosis of acute transaminitis in patients taking medications associated with hepatotoxicity. Ms L presented with 2 months of new psychotic symptoms resulting in hospitalizations. Although psychosis previously improved with haloperidol, she reported symptoms concerning for akathisia. Restlessness improved and psychotic symptoms resolved after initiation of olanzapine. Concurrently, her alanine aminotransferase (ALT) was elevated, prompting further workup and new diagnosis of acute hepatitis C. Over the course of hospitalization, her ALT increased exponentially. Initially attributed solely to acute hepatitis C infection, ALT rapidly decreased after holding olanzapine, implying it was contributing to her liver injury. Subsequently, given her prior response, haloperidol was retrialed with close monitoring for adverse effects. Her subjective restlessness was treated with additional agents, and she was then transitioned to monthly haloperidol decanoate injections to further assist her adherence. Prior to discharge, she had resolution of psychosis and transaminitis. Olanzapine may contribute to hepatotoxicity with concurrent viral hepatitis, and clarity can be obtained by a trial of stopping the suspected medication. Furthermore, olanzapine, when combined with underlying liver disease, may have an additive effect on liver injury, resulting in accelerated elevations in liver aminotransferases

Risk Recognition Policies for the Long-Term Care Workforce during the First Year of the COVID-19 Pandemic: A Multi-Country Study

Context: The precarious work arrangements experienced by many long-term care workers have led to the creation of a “shared” workforce across residential, home, and community aging care sectors. This shared workforce was identified as a contributor to the spread of COVID-19 early in the pandemic. Objective: This analysis sought to review policy measures targeting the long-term care workforce across seven high income jurisdictions during the first year of the COVID-19 pandemic. The focus was on financial supports introduced to recognize long-term care workers for the increased risks they faced, including both (1) health risks posed by direct care provision during the pandemic and (2) economic risks associated with restrictions to multi-site work. Method: Environmental scan of publicly available policy documents and government news releases published between March 1, 2020 and March 31, 2021, across seven high income jurisdictions. Findings: While there was limited use of financial measures in the United States to compensate long-term care workers for the increased health risks they faced, these measures were widely used across Canada, as well as in Wales, Scotland, and Australia. Moreover, there was a corresponding use of financial measures to protect workers from income loss in parts of Canada, Australia and the UK. Limitations: Our analysis did not include additional policy measures such as sick pay or recruitment incentives. We also relied primarily on publicly available policy documentation. In some cases, documents had been archived or revised, making it difficult to ascertain and clarify original information and amendments. Implications: While these financial measures are temporary, they brought to light long-standing issues related to the supply of and support for workers providing care to older adults in long-term care homes

A review of the trade in orchids and its implications for conservation

Orchids are one of the largest plant families and are commercially traded for a variety of purposes, including as ornamental plants, medicinal products and food. These markets involve thousands of species, which may be traded legally or illegally, sustainably or unsustainably, and take place at local, national or international scales. In this review, we provide the first overview of commercial orchid trade globally and highlight the main types that involve wild-collected plants. Much of this trade is the result of illegal harvest meaning that it is little documented and is absent from official statistics, at the same time as being of growing conservation concern. We discuss the associated legal–regulatory context, identify key conservation challenges and highlight four key priorities for addressing these challenges. These are to (1) research trade dynamics and the impacts of harvest; (2) strengthen the legal trade of orchids; (3) adopt measures to reduce illegal trade; and (4) raise the profile of orchid trade among policy makers, conservationists and the public