Beyond the clinical team: evaluating the human factors-oriented training of non-clinical professionals working in healthcare contexts

Background: As clinical simulation has evolved, it is increasingly used to educate staff who work in healthcare contexts (e.g. hospital administrators) or frequently encounter clinical populations as part of their work (e.g. police officers) but are not healthcare professionals. This is in recognition of the important role such individuals play in the patients’ experience of healthcare, frequently being a patients’ first point of contact with health services. The aim of the training is to improve the ability of the team to communicate and co-ordinate their actions, but there is no validated instrument to evaluate the human factors learning of non-clinical staff. Our aim was to develop, pilot and evaluate an adapted version of the Human Factors Skills for Healthcare Instrument, for non-clinical professionals. Method: The 18-item instrument was developed reflecting the human factors skills of situation awareness, decision making, communication, teamwork, leadership, care and compassion and stress and fatigue management. The instrument was piloted pre- and post-training with non-healthcare professionals (n = 188) attending mental health simulation training within an 11-month period (June 2017–April 2018). Trainees were hospital/primary care administrators (n = 53, 28%), police officers (n = 112, 59%), probation officers (n = 13, 7%) and social workers (n = 10, 5%). Most participants were female (n = 110, 59%) and from White ethnic backgrounds (n = 144, 77%). Results: Six items were removed, five were not sufficiently sensitive to change (d  .7). Cluster analysis revealed that participants with lower pre-training scores showed the greatest improvement. Discussion: The Human Factors Skills for Healthcare Instrument-Auxiliary version (HuFSHI-A) provides a reliable and valid instrument for the evaluation of human factors skills learning following training of non-clinical populations working in healthcare contexts. Although this instrument has been developed and evaluated with training courses specifically focusing on mental health topics, HuFSHI-A is applicable for any training where teamwork and co-ordination between clinical and non-clinical professionals is considered

Interprofessional teamwork for managing medical deterioration in pregnancy: What contributes to good clinical performance in simulated practice?

Objectives: To identify the patterns of teamwork displayed by interprofessional teams during simulated management of medical deterioration in pregnancy and examine whether and how they are related to clinical performance in simulated practice. Design: Exploratory observational cohort study. Setting: Interprofessional clinical simulation training with scenarios involving the management of medical deterioration in pregnant women. Participants: Seventeen simulated scenarios involving 62 qualified healthcare staff working within the National Health Service attending clinical simulation training (midwives (n=18), obstetricians (n=24) and medical physicians (n=20)). Main outcome measure(s): Teamwork behaviours over time, obtained through detailed observational analysis of recorded scenarios, using the Temporal Observational Analysis of Teamwork (TOAsT) framework. Clinician rated measures of simulated clinical performance. Results: Scenarios with better simulated clinical performance were characterised by shared leadership between obstetricians and midwives at the start of the scenario, with obstetricians delegating less and midwives disseminating rationale, while both engaged in more information gathering behaviour. Towards the end of the scenario, better simulated clinical performance was associated with dissemination of rationale to the team. More delegation at the start of a scenario was associated with less spontaneous sharing of information and rationale later in the scenario. Teams that shared their thinking at the start of a scenario continued to do so over time. Conclusions: Teamwork during the opening moments of a clinical situation is critical for simulated clinical performance in the interprofessional management of medical deterioration in pregnancy. Shared leadership and the early development of the shared mental model are associated with better outcomes

Prevention Of Xerophthalmia By Oral Massive Dose Vitamin A: (A Preliminary Report)

Untuk menilai efektivitas pemberian vitamin A dosis tinggi (200.000 IU vitamin A dan 40 IU vitamin E) secara masai dalam USAha pencegahan xerophthalmia, dilakukan penelitian terhadap seluruh anak umur 1-5 tahun di tujuh RK kotamadya Salatiga dan lima desa kabupaten Semarang, oleh suatu team ophthalmologi. Pada pemeriksaan awal ditemukan 132 penderita xerophthalmia diantara 2812 anak (4,7 persen). Kepada 2680 anak yang tidak menderita xerophthalmia sebagian diberi kapsul vitamin A dosis tinggi dan sebagian lain diberi kapsul placebo yang identik, secara "double-blind" diperiksa ulang sesudah enam bulan. Ternyata bahwa 7 diantara 1286 anak penerima vitamin A yang diperiksa (0,5 persen) menunjukkan tanda-tanda xerophthalmia. Sedang diantara 1183 anak penerima placebo yang diperiksa ternyata terdapat 43 penderita xerophthalmia (3,6 persen). Secara statistik bedanya amat bermakna. Tanda-tanda utama yang ditemukan adalah kombinasi dari buta-senja, xerosis conjunctiva, dan bercak Bitot. Kedua tanda yang terakhir ini terdapat pada 90 persen dari penderita, sedang buta-senja hanya 15 persen. Pada pemeriksaan ulang 132 anak penderita xerophthalmia yang telah diberi kapsul vitamin A dosis tinggi ternyata bahwa 91 persen dari yang diperiksa tidak lagi memperlihatkan tanda-tanda xerophthalmia. Jumlah anak yang tidak dapat diperiksa kembali jauh dibawah angka perkiraan. Sebagian besar karena telah pindah alamat, sebagian kecil meninggal. Antara golongan placebo dan vitamin, jumlah anak yang tidak dapat diperiksa kembali ini sama besar. Penelitian ini membuktikan bahwa kapsul vitamin A dosis tinggi efektip sekali untuk mencegah timbulnya xerophthalmia dan menyembuhkan gejala-gejala xerophthalmia ringan

Holding time study of volatile organic compounds in SUMMA canisters

According to this work, the headspace concentration of VOC`s is not changing measurably with time. That is, no appreciable uncertainty is added to the analysis of VOC`s in the headspace of storage drums by storage of the samples in SUMMA canisters for greater than 28 days

The Framework for Assessing Changes To Sea-level (FACTS) v1.0: a platform for characterizing parametric and structural uncertainty in future global, relative, and extreme sea-level change

Future sea-level rise projections are characterized by both quantifiable uncertainty and unquantifiable structural uncertainty. Thorough scientific assessment of sea-level rise projections requires analysis of both dimensions of uncertainty. Probabilistic sea-level rise projections evaluate the quantifiable dimension of uncertainty; comparison of alternative probabilistic methods provides an indication of structural uncertainty. Here we describe the Framework for Assessing Changes To Sea-level (FACTS), a modular platform for characterizing different probability distributions for the drivers of sea-level change and their consequences for global mean, regional, and extreme sea-level change. We demonstrate its application by generating seven alternative probability distributions under multiple emissions scenarios for both future global mean sea-level change and future relative and extreme sea-level change at New York City. These distributions, closely aligned with those presented in the Intergovernmental Panel on Climate Change Sixth Assessment Report, emphasize the role of the Antarctic and Greenland ice sheets as drivers of structural uncertainty in sea-level change projections.</p

Cosmogenic Samarium-150 and Calcium-41 in Norton County

Though brecciated, the Norton County (NC) aubrite contains little or no trapped noble gas and has been widely assumed to have a simple if unusually long cosmic ray exposure (CRE), 115 Ma. One goal of this ongoing study of NC has been to search for signs of pre-irradiation as proposed. One may test for multiple stages of CRE by comparing thermal neutron fluences inferred from Ca-41 (t(sub 1/2)=0.1 Ma) activities, which reflect irradiation conditions over the last approximately 0.3 Ma, with those inferred from (stable) Sm isotope abundances, which integrate over the entire CRE history. In the case of a one-stage exposure the fluences should agree. We focus on these particular comparisons because the properties of NC - its long CRE exposure, relatively large size, and low iron concentration - all promised high production rates and ease of measurement. Previously, we reported on several cosmogenic nuclides in NC. Here we present new Ca-41 data, Sm isotope measurements, and comparisons with model calculations of cosmic ray production

Magnetic flaring in the pre-main sequence Sun and implications for the early solar system

To address the role of energetic processes in the solar nebula, we provide a detailed characterization of magnetic flaring in stellar analogs of the pre-main sequence Sun based on 23 hours observations of 43 analogs of the young Sun in the Orion Nebula Cluster obtained with the Chandra X-ray Observatory. We find the X-ray luminosities are strongly elevated over main sequence levels with average = 30.3 erg/s and = -3.9 (0.5-8 keV), and dozens of flares are present. Analogs of the <= 1 My old pre-main sequence Sun exhibit X-ray flares 10^{1.5} times more powerful and 10^{2.5} times more frequent than the most powerful flares seen on the contemporary Sun. Extrapolating the solar relationship between X-ray luminosity and proton fluence, we infer that the young Sun exhibited a 10^5-fold enhancement in energetic protons compared to contemporary levels. Unless the flare geometries are unfavorable, this inferred proton flux on the disk is sufficient to produce the observed meteoritic abundances of several important short-lived radioactive isotopes. Our study thus strengthens the astronomical foundation for local proton spallation models of isotopic anomalies in carbonaceous chondritic meteorites. The radiation, particles and shocks produced by the magnetic reconnection flares seen with Chandra may also have flash melted meteoritic chondrules and produced excess 21-Ne seen in meteoritic grains.Comment: 36 pages, 3 figures. Accepted for publication in the Astrophysical Journa

CF2 Represses Actin 88F Gene Expression and Maintains Filament Balance during Indirect Flight Muscle Development in Drosophila

The zinc finger protein CF2 is a characterized activator of muscle structural genes in the body wall muscles of the Drosophila larva. To investigate the function of CF2 in the indirect flight muscle (IFM), we examined the phenotypes of flies bearing five homozygous viable mutations. The gross structure of the IFM was not affected, but the stronger hypomorphic alleles caused an increase of up to 1.5X in the diameter of the myofibrils. This size increase did not cause any disruption of the hexameric arrangement of thick and thin filaments. RT-PCR analysis revealed an increase in the transcription of several structural genes. Ectopic overexpression of CF2 in the developing IFM disrupts muscle formation. While our results indicate a role for CF2 as a direct negative regulator of the thin filament protein gene Actin 88F (Act88F), effects on levels of transcripts of myosin heavy chain (mhc) appear to be indirect. This role is in direct contrast to that described in the larval muscles, where CF2 activates structural gene expression. The variation in myofibril phenotypes of CF2 mutants suggest the CF2 may have separate functions in fine-tuning expression of structural genes to insure proper filament stoichiometry, and monitoring and/or controlling the final myofibril size

Estimating the frequency of extremely energetic solar events, based on solar, stellar, lunar, and terrestrial records

The most powerful explosions on the Sun [...] drive the most severe space-weather storms. Proxy records of flare energies based on SEPs in principle may offer the longest time base to study infrequent large events. We conclude that one suggested proxy, nitrate concentrations in polar ice cores, does not map reliably to SEP events. Concentrations of select radionuclides measured in natural archives may prove useful in extending the time interval of direct observations up to ten millennia, but as their calibration to solar flare fluences depends on multiple poorly known properties and processes, these proxies cannot presently be used to help determine the flare energy frequency distribution. Being thus limited to the use of direct flare observations, we evaluate the probabilities of large-energy solar explosions by combining solar flare observations with an ensemble of stellar flare observations. We conclude that solar flare energies form a relatively smooth distribution from small events to large flares, while flares on magnetically-active, young Sun-like stars have energies and frequencies markedly in excess of strong solar flares, even after an empirical scaling with the mean activity level of these stars. In order to empirically quantify the frequency of uncommonly large solar flares extensive surveys of stars of near-solar age need to be obtained, such as is feasible with the Kepler satellite. Because the likelihood of flares larger than approximately X30 remains empirically unconstrained, we present indirect arguments, based on records of sunspots and on statistical arguments, that solar flares in the past four centuries have likely not substantially exceeded the level of the largest flares observed in the space era, and that there is at most about a 10% chance of a flare larger than about X30 in the next 30 years.Comment: 14 pages, 3 figures (in press as of 2012/06/18); Journal of Geophysical Research (Space Physics), 201

Spallation reactions. A successful interplay between modeling and applications

The spallation reactions are a type of nuclear reaction which occur in space by interaction of the cosmic rays with interstellar bodies. The first spallation reactions induced with an accelerator took place in 1947 at the Berkeley cyclotron (University of California) with 200 MeV deuterons and 400 MeV alpha beams. They highlighted the multiple emission of neutrons and charged particles and the production of a large number of residual nuclei far different from the target nuclei. The same year R. Serber describes the reaction in two steps: a first and fast one with high-energy particle emission leading to an excited remnant nucleus, and a second one, much slower, the de-excitation of the remnant. In 2010 IAEA organized a worskhop to present the results of the most widely used spallation codes within a benchmark of spallation models. If one of the goals was to understand the deficiencies, if any, in each code, one remarkable outcome points out the overall high-quality level of some models and so the great improvements achieved since Serber. Particle transport codes can then rely on such spallation models to treat the reactions between a light particle and an atomic nucleus with energies spanning from few tens of MeV up to some GeV. An overview of the spallation reactions modeling is presented in order to point out the incomparable contribution of models based on basic physics to numerous applications where such reactions occur. Validations or benchmarks, which are necessary steps in the improvement process, are also addressed, as well as the potential future domains of development. Spallation reactions modeling is a representative case of continuous studies aiming at understanding a reaction mechanism and which end up in a powerful tool.Comment: 59 pages, 54 figures, Revie