Dyad rounding on inpatients admitted from Emergency Department: Rehumanizing the patient & clinician experience in a post pandemic world

Emergency departments (ED) across the country were stretched to the breaking point as a result of the COVID-19 pandemic. The chaos, fear, and uncertainty impacted the emotional, physical, and spiritual well-being of not only the patients and families but also nurses, providers, and the myriad of other clinical and non-clinical staff providing care in the ED. Compounding these challenges was the dehumanizing effects of providing care in personal protective equipment (PPE). The burnout ED teams experienced left them feeling defeated and unsure of how to reconnect with patients and families. The purpose of this narrative is to share the story of two clinical leaders, Christine M. Walden, Ph.D., R.N., NE-BC and Leigh A. Patterson, M.D., MAEd., who partnered to rehumanize the patient experience in the ED after the height of the COVID-19 pandemic and to share their learning and ultimate success in improving the patient experience. Equally as important was how feedback gathered through their conversations with patients personally reconnected them back to their passion and their practice, reassuring them that they could lead the way forward by listening to the voices of their patients. Experience Framework This article is associated with the Staff & Provider Engagement lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens

Transvaginal evisceration progressing to peritonitis in the emergency department: a case report

Background Abdominal pain is a common complaint among emergency department patients, making it essential to identify those with life-threatening etiologies. We report on the rare finding of atraumatic transvaginal bowel evisceration in a patient presenting to the emergency department with the primary complaint of abdominal pain. Case Description A 63-year-old female presented ambulatory to the emergency department with abdominal pain and foreign body sensation in her vagina after coughing. Physical exam demonstrated evisceration of her small bowel through her vagina. During her clinical course, she rapidly deteriorated from appearing well without abdominal tenderness to hypotensive with frank peritonitis. Conclusion This case demonstrates the need to perform a thorough physical exam on all patients with abdominal pain and details the management of vaginal evisceration. This case also highlights the difficulty of appropriate triage for patients with complaints not easily assessed in triage. In an era of emergency department crowding, emergency physicians should reevaluate nursing education on triaging abdominal pain to prevent delays in caring for well-appearing patients who have underlying life-threatening illnesses

Urban ecology of the Vervet Monkey Chlorocebus pygerythrus in KwaZulu-Natal, South Africa.

Doctor of Philosophy in Biological Sciences. University of KwaZulu-Natal, Pietermaritzburg 2017The spread of development globally is extensively modifying habitats and often results in competition for space and resources between humans and wildlife. For the last few decades a central goal of urban ecology research has been to deepen our understanding of how wildlife communities respond to urbanisation. In the KwaZulu-Natal Province of South Africa, urban and rural transformation has reduced and fragmented natural foraging grounds for vervet monkeys Chlorocebus pygerythrus. However, no data on vervet urban landscape use exist. They are regarded as successful urban exploiters, yet little data have been obtained prior to support this. This research investigated aspects of the urban ecology of vervet monkeys in three municipalities of KwaZulu-Natal (KZN), as well as factors that may predict human-monkey conflict. Firstly, through conducting an urban wildlife survey, we were able to assess residents’ attitudes towards, observations of and conflict with vervet monkeys, investigating the potential drivers of intragroup variation in spatial ecology, and identifying predators of birds’ nests. We analysed 602 surveys submitted online and, using ordinal regression models, we ascertained that respondents’ attitudes towards vervets were most influenced by whether or not they had had aggressive interactions with them, by the belief that vervet monkeys pose a health risk and by the presence of bird nests, refuse bins and house raiding on their properties. Secondly, to investigate the vervet monkeys perceived negative impact on urban nesting birds, 75 artificial nests were deployed, and monitored by camera traps. Overall, 17 were depredated, 15 by monkeys and two by domestic cats Felis catus. It was determined that future experiments on natural nest predation are essential for comparison. Thirdly, by collecting observational data on 20 vervet monkey troops living in a variety of developed landscapes within KZN, it was found that the key landscape features influencing vervet monkey troop-level visitation rates, durations and observed foraging in residences were the absence of dogs, presence of supplementary food provisioning, fruiting trees, trees taller than two meters, and a high percentage of tree coverage. Data analysis revealed higher visitation rates during winter, in gardens with higher tree density, and the highest foraging rates in gardens closer to main roads, where supplementary provisioning and bird feeders were present. Furthermore, gardens with greater canopy cover had higher rates of feeding, grooming and playing, which all decreased with increasing troop size, while resting rates decreased with increasing distance from indigenous forest patches and main roads. Gardens experiencing comparatively low levels of visitation experienced high levels of raiding. The combination of these variables appears to provide monkeys with predictable, accessible, indigenous, exotic and anthropogenic food sources in human-modified habitats within close proximity to suitable sleeping sites and safety. Lastly, we examined vervet monkey space use using GPS/UHF telemetry data from 10 vervet monkeys across six troops over nine months within a 420 ha eco-estate. We documented a mean home range of 0.99 km2 (95% MCP) and 1.07 km2 (95% FK) for females (n = 6), 1 km2 (95% MCP) and 1.50 km2 (95% FK) for males (n = 4) and 0.87 km2 (95% MCP) and 1.12 km2 (95% FK) for troops (n=6), respectively, indicating that males and larger troops had larger home ranges. These relatively small home ranges included shared territorial boundaries and high home range overlap. Vervet monkey movements indicated higher morning activity levels and habitat selection indicated significantly more use of golf course, urban residential and forest, thicket and woodland areas, and avoidance of wetland, grassland and shrub, and urban built-up areas. Our results suggest that modified-habitat use by vervet monkeys is a consequence of behavioural facilitation to access highly-available food resources, thereby facilitating their persistence in developing ecosystems in South Africa. Therefore, conflict management is dependent on the conservation of sufficient natural habitats and food resources, to minimize their dependence on manmade resources and consequently reduce human-monkey conflict. The results contributed to an understanding of the drivers of urban vervet monkey spatial ecology within a transformed landscape. This hopefully will assist in determining the most sustainable way to mitigate conflict and manage vervet monkeys in these municipalities. In a broader context, this study highlights the value of citizen science and wildlife spatial ecology studies in providing mechanisms for identifying priority management and conservation efforts at the highly complex human-wildlife interface

SCHOOL-BASED MINDFULNESS AND YOGA WITH YOUNG ADOLESCENTS AS AN ENHANCED HEALTH AND PHYSICAL EDUCATION CURRICULUM

Little is known about the effects of mindfulness-based intervention and yoga implemented with adolescents in school settings, especially regarding evaluation of specific outcomes compared to alternate Health and PE curriculums. The current study describes the effects of a mindfulness and yoga enhanced Health and PE curriculum compared to an active control Health and PE curriculum on stress, mechanisms of mindfulness, emotional self-regulation, and other psychological outcomes. Participants (N=80) were recruited from five, ninth grade classes in a rural, public high school. A mindfulness intervention was implemented with whole classrooms (N = 49) twice per week for 30 minutes, after delivery of a 30-minute yoga session, over six weeks during Health and PE class. The classes in the active control condition (N = 31) participated in a Stress Management and Coping Skills program (SM&C) delivered in the same format. Data was collected regarding feasibility, acceptability according to teachers, administration, and students, as well as efficacy of the programs at initial, end of treatment and follow up time points. There were not significant differences between treatment and active control groups in student reported stress, overall difficulties in emotional regulation, symptoms of depression, or disruptive behavior between groups at posttest or follow up. Participation in the SM&C program predicted significantly lower posttest SCARED GAD scores compared to the L2B condition. Participation in the L2B condition buffered decreases in academic efficacy scores on the PALS Academic Efficacy subtest at follow up compared to the active control condition. Participants in the mindfulness intervention did not show significant changes in stress, emotional regulation, or the development of mechanisms of mindfulness compared to the active control condition. This study highlights that mindfulness programs can be challenging to implement with adolescents in large groups in school settings and that considerable planning is needed to minimize disruption and facilitate effective delivery. Implications for future research and practice are provided including considerations for implementation within a Multi-Tiered System of Supports framework, ensuring effective classroom management is in place, further tailoring programming to developmental needs of adolescent students, and providing training and involvement of teachers and school staff

Novel application of synchrotron x-ray computed tomography for ex-vivo imaging of subcutaneously-injected polymeric microsphere suspension formulations

Purpose: Subcutaneously or intramuscularly administered biodegradable microsphere formulations have been successfully exploited in the management of chronic conditions for over two decades, yet mechanistic understanding of the impact of formulation attributes on in vivo absorption rate from such systems is still in its infancy. Methods: Suspension formulation physicochemical attributes may impact particulate deposition in subcutaneous (s.c.) tissue. Hence, the utility of synchrotron X-ray microcomputed tomography (μCT) for assessment of spatial distribution of suspension formulation components (PLG microspheres and vehicle) was evaluated in a porcine s.c. tissue model. Optical imaging of dyed vehicle and subsequent microscopic assessment of microsphere deposition was performed in parallel to compare the two approaches. Results: Our findings demonstrate that synchrotron μCT can be applied to the assessment of microsphere and vehicle distribution in s.c. tissue, and that microspheres can also be visualised in the absence of contrast agent using this approach. The technique was deemed superior to optical imaging of macrotomy for the characterisation of microsphere deposition owing to its non-invasive nature and relatively rapid data acquisition time. Conclusions: The μCT method outlined in this study provides a novel insight into the relative distribution of vehicle and suspended PLG microspheres following s.c. injection. A potential application for our findings is understanding the impact of injection, device and formulation variables on initial and temporal depot geometry in pre-clinical or ex-vivo models that can inform product design

MRL12: Robert E. Speer Papers, 1795-1947

Pamphlets, reports, correspondence, and minutes collected by prominent American church leader, author, and missionary statesman who served on the Board of Foreign Missions of the Presbyterian Church in the United States for 46 years and was a founding member of the Foreign Missions Conference of North America

Evaluation of Social Media Use by Emergency Medicine Residents and Faculty

Introduction Clinicians and residency programs are increasing their use of social media (SM) websites for educational and promotional uses, yet little is known about the use of these sites by residents and faculty. The objective of the study is to assess patterns of SM use for personal and professional purposes among emergency medicine (EM) residents and faculty. Methods In this multi-site study, an 18-question survey was sent by e-mail to the residents and faculty in 14 EM programs and to the Council of Emergency Medicine Residency Directors (CORD) listserv via the online tool SurveyMonkey™. We compiled descriptive statistics, including assessment with the chi-square test or Fisher’s exact test. StatsDirect software (v 2.8.0, StatsDirect, Cheshire, UK) was used for all analyses. Results We received 1,314 responses: 63% of respondents were male, 40% were <30 years of age, 39% were between the ages 31 and 40, and 21% were older than 40. The study group consisted of 772 residents and 542 faculty members (15% were program directors, 21% were assistant or associate PDs, 45% were core faculty, and 19% held other faculty positions. Forty-four percent of respondents completed residency more than 10 years ago. Residents used SM markedly more than faculty for social interactions with family and friends (83% vs 65% [p<0.0001]), entertainment (61% vs 47% [p<0.0001]), and videos (42% vs 23% [p=0.0006]). Residents used Facebook™ and YouTube™ more often than faculty (86% vs 67% [p<0.001]; 53% vs 46% [p=0.01]), whereas residents used Twitter™ (19% vs 26% [p=0.005]) and LinkedIn™ (15% vs 32% [p<0.0001]) less than faculty. Overall, residents used SM sites more than faculty, notably in daily use (30% vs 24% [p<0.001]). For professional use, residents were most interested in its use for open positions/hiring (30% vs 18% [p<0.0001]) and videos (33% vs 26% [p=0.005]) and less interested than faculty with award postings (22% vs 33% [p<0.0001]) or publications (30% vs 38% [p=0.0007]). Conclusion EM residents and faculty have different patterns and interests in the personal and professional uses of social media. Awareness of these utilization patterns could benefit future educational endeavors

Social media guidelines and best practices - Recommendations from the council of residency directors (cord) social media taskforce

Social media has become a staple of everyday life among over one billion people worldwide. A social networking presence has become a hallmark of vibrant and transparent communications. It has quickly become the preferred method of communication and information sharing. It offers the ability for various entities, especially residency programs, to create an attractive internet presence and “brand� the program. Social media, while having significant potential for communication and knowledge transfer, carries with it legal, ethical, personal, and professional risks. Implementation of a social networking presence must be deliberate, transparent, and optimize potential benefits while minimizing risks. This is especially true with residency programs. The power of social media as a communication, education, and recruiting tool is undeniable. Yet the pitfalls of misuse can be disastrous, including violations in patient confidentiality, violations of privacy, and recruiting misconduct. These guidelines were developed to provide emergency medicine residency programs leadership with guidance and best practices in the appropriate use and regulation of social media, but are applicable to all residency programs that wish to establish a social media presence

Broadly sampled multigene analyses yield a well-resolved eukaryotic tree of life

Author Posting. © The Authors, 2010. This is the author's version of the work. It is posted here by permission of Oxford University Press for personal use, not for redistribution. The definitive version was published in Systematic Biology 59 (2010): 518-533, doi:10.1093/sysbio/syq037.An accurate reconstruction of the eukaryotic tree of life is essential to identify the innovations underlying the diversity of microbial and macroscopic (e.g. plants and animals) eukaryotes. Previous work has divided eukaryotic diversity into a small number of high-level ‘supergroups’, many of which receive strong support in phylogenomic analyses. However, the abundance of data in phylogenomic analyses can lead to highly supported but incorrect relationships due to systematic phylogenetic error. Further, the paucity of major eukaryotic lineages (19 or fewer) included in these genomic studies may exaggerate systematic error and reduces power to evaluate hypotheses. Here, we use a taxon-rich strategy to assess eukaryotic relationships. We show that analyses emphasizing broad taxonomic sampling (up to 451 taxa representing 72 major lineages) combined with a moderate number of genes yield a well-resolved eukaryotic tree of life. The consistency across analyses with varying numbers of taxa (88-451) and levels of missing data (17-69%) supports the accuracy of the resulting topologies. The resulting stable topology emerges without the removal of rapidly evolving genes or taxa, a practice common to phylogenomic analyses. Several major groups are stable and strongly supported in these analyses (e.g. SAR, Rhizaria, Excavata), while the proposed supergroup ‘Chromalveolata’ is rejected. Further, extensive instability among photosynthetic lineages suggests the presence of systematic biases including endosymbiotic gene transfer from symbiont (nucleus or plastid) to host. Our analyses demonstrate that stable topologies of ancient evolutionary relationships can be achieved with broad taxonomic sampling and a moderate number of genes. Finally, taxonrich analyses such as presented here provide a method for testing the accuracy of relationships that receive high bootstrap support in phylogenomic analyses and enable placement of the multitude of lineages that lack genome scale data

The Saccadic and Neurological Deficits in Type 3 Gaucher Disease

Our objective was to characterize the saccadic eye movements in patients with type 3 Gaucher disease (chronic neuronopathic) in relationship to neurological and neurophysiological abnormalities. For approximately 4 years, we prospectively followed a cohort of 15 patients with Gaucher type 3, ages 8–28 years, by measuring saccadic eye movements using the scleral search coil method. We found that patients with type 3 Gaucher disease had a significantly higher regression slope of duration vs amplitude and peak duration vs amplitude compared to healthy controls for both horizontal and vertical saccades. Saccadic latency was significantly increased for horizontal saccades only. Downward saccades were more affected than upward saccades. Saccade abnormalities increased over time in some patients reflecting the slowly progressive nature of the disease. Phase plane plots showed individually characteristic patterns of abnormal saccade trajectories. Oculo-manual dexterity scores on the Purdue Pegboard test were low in virtually all patients, even in those with normal cognitive function. Vertical saccade peak duration vs amplitude slope significantly correlated with IQ and with the performance on the Purdue Pegboard but not with the brainstem and somatosensory evoked potentials. We conclude that, in patients with Gaucher disease type 3, saccadic eye movements and oculo-manual dexterity are representative neurological functions for longitudinal studies and can probably be used as endpoints for therapeutic clinical trials