Ebola Preparedness Planning and Collaboration by Two Health Systems in Wisconsin, September to December 2014

We describe the collaborative approach used by 2 health systems in Wisconsin to plan and prepare for the threat of Ebola virus disease. This was a descriptive study of the preparedness planning, infection prevention, and collaboration with public health agencies undertaken by 2 health systems in Wisconsin between September and December 2014. The preparedness approach used by the 2 health systems relied successfully on their robust infrastructure for planning and infection prevention. In the setting of rapidly evolving guidance and unprecedented fear regarding Ebola, the 2 health systems enhanced their response through collaboration and coordination with each other and government public health agencies. Key lessons learned included the importance of a rigorous planning process, robust infection prevention practices, and coalitions between public and private health sectors. The potential threat of Ebola virus disease stimulated emergency preparedness in which acute care facilities played a leading role in the public health response. Leveraging the existing expertise of health systems is essential when faced with emerging infectious diseases. (Disaster Med Public Health Preparedness. 2015;0:1-7)

Utilizing resident council leaders to improve the culture of patient care through systematic design of our clinical learning environment

Background: The health care landscape continues to evolve, with hospital and resident/fellowship accrediting bodies calling for a culture shift. There have been previous attempts to change this culture, but these have all failed. Alliance for Independent Academic Medical Center’s (AIAMC) National Initiative IV focuses on activating residents as leaders and participants in creating a patient safety and quality culture. Purpose: This study seeks to evaluate resident involvement as leaders and contributors to our institution’s quality and safety culture at two levels: individual residency programs and across residency programs. Methods: AIAMC National Initiative IV focuses on activating residents in creating a patient safety and quality culture. Three residency programs were selected to participate in National Initiative IV and required to design a project aimed at improving patient safety/care quality specific to their specialty. Our institution is required to have a Residency Council (RC) comprised of representatives from our resident/fellowship programs. The RC members were charged to serve as culture change leaders for quality/ safety across our institution’s graduate medical education programs. Results: Each of the three residencies has established an interprofessional program team with project timelines, tasks and roles. Each program team selected a project and finalized our institution’s established and created EPIC-based metrics to monitor improvement: Family Medicine (ambulatory medication reconciliation); Internal Medicine (30-hospital readmission rates); and OB/GYN (labor and delivery patient safety/quality checklists). RC received approval for all incoming residents and fellows to complete five Institute for Healthcare Improvement quality and safety modules as required activities. RC also received Graduate Medical Education Committee (GMEC) approval that a “Synergy Committee” be created to explicitly link quality and safety projects between hospital, clinic and GMEC leadership. RC members now co-present quality and safety curriculum using the GMEC shared noon conference slot. Conclusion: Bending the culture curve to address quality/ safety through engagement of residents/fellows at individual cross program levels through RC and GMEC can be done. Utilization of National Initiative IV as one of the triggers to spur engagement provides clear deadlines to spur action at program and RC/GMEC levels. Sustaining the program and RC role as culture change leaders and advocates will require additional accountability and leaders to facilitate a change in clinical culture

Beauty is skin deep : the skin tones of Vermeer's Girl with a Pearl Earring

The soft modelling of the skin tones in Vermeer’s Girl with a Pearl Earring (Mauritshuis) has been remarked upon by art historians, and is their main argument to date this painting to c. 1665. This paper describes the materials and techniques Vermeer used to accomplish the smooth flesh tones and facial features of the Girl, which were investigated as part of the 2018 Girl in the Spotlight research project. It combines macroscopic X-ray fluorescence imaging (MA-XRF), reflectance imaging spectroscopy (RIS), and 3D digital microscopy. Vermeer built up the face, beginning with distinct areas of light and dark. He then smoothly blended the final layers to create almost seamless transitions. The combination of advanced imaging techniques highlighted that Vermeer built the soft contour around her face by leaving a ‘gap’ between the background and the skin. It also revealed details that were otherwise not visible with the naked eye, such as the eyelashes. Macroscopic imaging was complemented by the study of paint cross-sections using: light microscopy, SEM–EDX, FIB-STEM, synchrotron radiation µ-XRPD and FTIR–ATR. Vermeer intentionally used different qualities or grades of lead white in the flesh paints, showing different hydrocerussite/cerussite ratios and particle sizes. Lead isotope analysis showed that the geographic source of lead, from which the different types of lead white were manufactured, was the same: the region of Peak District of Derbyshire, UK. Finally, cross-section analysis identified the formation of new lead species in the paints: lead soaps and palmierite (K2Pb(SO4)2), associated with the red lake