Efficacy and Safety of Pediatric Critical Care Physician Telemedicine Involvement in Rapid Response Team and Code Response in a Satellite Facility

OBJECTIVES: Satellite inpatient facilities of larger children's hospitals often do not have on-site intensivist support. In-house rapid response teams and code teams may be difficult to operationalize in such facilities. We developed a system using telemedicine to provide pediatric intensivist involvement in rapid response team and code teams at the satellite facility of our children's hospital. Herein, we compare this model with our in-person model at our main campus. DESIGN: Cross-sectional. SETTING: A tertiary pediatric center and its satellite facility. PATIENTS: Patients admitted to the satellite facility. INTERVENTIONS: Implementation of a rapid response team and code team model at a satellite facility using telemedicine to provide intensivist support. MEASUREMENTS AND MAIN RESULTS: We evaluated the success of the telemedicine model through three a priori outcomes: 1) reliability: involvement of intensivist on telemedicine rapid response teams and codes, 2) efficiency: time from rapid response team and code call until intensivist response, and 3) outcomes: disposition of telemedicine rapid response team or code calls. We compared each metric from our telemedicine model with our established main campus model. MAIN RESULTS: Critical care was involved in satellite campus rapid response team activations reliably (94.6% of the time). The process was efficient (median response time 7 min; mean 8.44 min) and effective (54.5 % patients transferred to PICU, similar to the 45-55% monthly rate at main campus). For code activations, the critical care telemedicine response rate was 100% (6/6), with a fast response time (median 1.5 min). We found no additional risk to patients, with no patients transferred from the satellite campus requiring a rapid escalation of care defined as initiation of vasoactive support, greater than 60 mL/kg in fluid resuscitation, or endotracheal intubation. CONCLUSIONS: Telemedicine can provide reliable, timely, and effective critical care involvement in rapid response team and Code Teams at satellite facilities

Postpartum Depression: A Sociocultural Quantitative and Qualitative Analysis of Adolescent and Adult Hispanic Mothers

This dissertation is a mixed methods analysis investigating postpartum depression as it is experienced by self-reported depressed Mexican American adolescent and adult mothers. The qualitative portion of this study explores pregnancy and motherhood to better understand meanings attached to depression. Six adolescent and six adult mothers, were recruited from the Dallas/Fort-Worth area. Each was interviewed twice, using semi-structured interview guides. The quantitative phase utilizes a national sample of self-reported depressed Hispanic mothers to identify breastfeeding behavior and mothers' perceptions of the physical health of their babies. Specifically, a secondary analysis of the National Survey of Children's Health, 2003 was used to supplement the qualitative data. This study provides a theoretical framework of fragmented identity to explain socio-cultural factors contributing to postpartum depression among Mexican American adolescent and adult mothers. Common themes leading to a fragmented identify were indentified. Contributors to postpartum depression include: unplanned pregnancy, internal struggle between cultures, body image and family conflict. Stigma associated with teen motherhood also contributed to depression among adolescent mothers while the medicalization of childbirth was a contributing factor of depression among the adult mothers. Additionally, the duration of breastfeeding and mothers' perceptions of their babies' physical health were impacted by depression, but breastfeeding initiation was not

Developing a framework for arts in health programs targeting individuals with chronic pain: a mixed-methods study of practitioners

Objectives: Chronic pain is a leading cause of morbidity and disability across the world. Cultural engagement may be a valuable tool in addressing the social disconnection that often accompanies chronic pain. This study sought to develop a framework for arts in health programs targeting individuals with chronic pain. / Study design: Sequential explanatory mixed-methods study. / Methods: Web-based, cross-sectional survey sent to arts and cultural professionals to assess their experience with arts in health programming. Semi-structured interviews conducted with a sample of survey respondents to explore their perspectives on targeted arts in health programming for individuals with chronic pain. / Results: Between October 2019 and January 2020, 208 surveys were completed by arts and cultural professionals. One hundred and twenty (58%) of the respondents indicated that they currently run an arts in health or museums in health program. Among these 120 respondents, 52 (43%) targeted older adults, 50 (42%) targeted individuals with mental health concerns, and 18 (15%) targeted individuals living with pain. Improving well-being (101 [84%]) and reducing social isolation (90 [75%]) were the most common intended program outcomes, while improving pain was the least common outcome (26 [22%]). Fifteen survey respondents were interviewed. Interviewees identified four interdependent themes regarding best practices for arts in health programs pertaining to (1) program content and structure, (2) program facilitation, (3) partnerships, and (4) programs for individuals with chronic pain. / Conclusions: The cultural sector can support chronic pain prevention and treatment efforts through the development of specialized programs. This study provides a framework for developing arts in health programs that support individuals living with chronic pain

Fusion evaporation-residue cross sections for Si28+40Ca at E(28Si)=309, 397, and 452 MeV

Velocity distributions of mass-identified evaporation residues produced in the Si28+40Ca reaction have been measured at bombarding energies of 309, 397, and 452 MeV using time-of-flight techniques. These distributions were used to identify evaporation residues and to separate the complete-fusion and incomplete-fusion components. Angular distributions and upper limits for the total evaporation-residue and complete-fusion evaporation-residue cross sections were extracted at all three bombarding energies. The complete-fusion evaporation-residue cross sections and the deduced critical angular momenta are compared with earlier measurements and the predictions of existing models. The ratios of the complete-fusion evaporation-residue cross section to the total evaporation-residue cross section, along with those measured for the Si28+12C and Si28+28Si systems at the same energies, support the entrance-channel mass-asymmetry dependence of the incomplete-fusion evaporation-residue process reported earlier

Energy dependence of fusion evaporation-residue cross sections in the Si28+28Si reaction

Velocity distributions of mass-identified evaporation residues produced in the t28/rSi+28Si reaction have been measured at bombarding energies of 174, 215, 240, 309, 397, and 452 MeV using time-of-flight techniques. These distributions were used to identify evaporation residues and to separate the complete-fusion and incomplete-fusion components. Angular distributions and total cross sections were extracted at all six bombarding energies. The complete-fusion evaporation-residue cross sections and the deduced critical angular momenta are compared with lower energy data and the predictions of existing models

Correspondence from J. Gosdin

Correspondence from J. Gosdin regarding absent soldiers from Waldo Count

Perceptions of Postpartum Depression among Adolescent Mothers and the Social Construction of Related Stigma

Six serial focus groups were used to explore the perceptions of postpartum depression among nine adolescent mothers. The discussions were tape recorded, transcribed and analyzed using symbolic interaction theory, specifically Goffman's concept of stigma. Participants identified major stigma themes in relation to postpartum depression, teenage pregnancy and motherhood, all of which were portrayed negatively in the media. Several key causes of adolescent postpartum depression were also found including self esteem relating to poor body image and social support. The findings indicate a much needed change in the way adolescent mothers are identified and treated for postpartum depression. Additionally, the importance of social support in preventing and treating adolescent postpartum depression is highlighted and programs addressing such concerns must be implemented

Meteorological satellite photographs as indicators of cyclogenesis and the related cloud distribution and structure over the Gulf of Mexico: a case study.

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