Emergencies within hospital wards: An observational study of the non-technical skills of medical emergency teams

Background Medical emergency teams are essential in responding to acute deterioration of patients in hospitals, requiring both clinical and non-technical skills. This study aims to assess the non-technical skills of medical emergency teams during hospital ward emergencies and explore team members perceptions and experiences of the use non-technical skills during medical emergencies. Methods A multi-methods study was conducted in two phases. During phase one observation and assessment of non-technical skills used in medical emergencies using the Team Emergency Assessment Measure (TEAM™) was conducted; and in the phase two in-depth interviews were undertaken with medical emergency team members. Results Based on 20 observations, mean TEAM™ ratings for non-technical skill domains were: ‘leadership’ 5.0 out of 8 (±2.0); ‘teamwork’ 21.6 out of 28 (±3.6); and ‘task management’ 6.5 out of 8 (±1.4). The mean ‘global’ score was 7.5 out of 10 (±1.5). The qualitative findings identified three areas, ‘individual’, ‘team’ and ‘other’ contributing factors, which impacted upon the non-technical skills of medical emergency teams. Conclusion Non-technical skills of hospital medical emergency teams differ, and the impact of the skill mix on resuscitation outcomes was recognised by team members. These findings emphasize the importance non-technical skills in resuscitation training and well-developed processes for medical emergency teams

Exploring orthopaedic patients’ experiences of hospital discharge: Implications for nursing care

Background Nurses play a key role in providing discharge education. With the increased demand for orthopaedic surgery and subsequent fast‐track surgical programmes resulting in reduction in hospital length of stay, obtaining patient feedback about discharge is important to inform nursing practice of discharge. Aim To explore patients’ experiences of discharge from hospital following orthopaedic surgery. Methods A descriptive qualitative study was undertaken with a sample of 34 patients discharged following orthopaedic surgery at a private acute Australian hospital. Individual semistructured telephone interviews were conducted and analysed using inductive thematic analysis. Findings From the analysis, patient experiences have been described in three themes: (1) experiences of hospital discharge, (2) perceptions of discharge information, and (3) limitations of discharge information. Although participants reported being informed when discharged from hospital, more information about medication management, constipation, and wound care would have better supported their recovery to assist in their self-care. Discussion Discharge experiences and perceptions varied between participants, highlighting the importance of nurses and other health professionals, in providing discharge information to meet individual patient needs. This included improved communication, information about the discharge process, management of medication, wound, and prevention of constipation as part of recovery. Conclusion Patient feedback has highlighted that nurses need to provide more tailored discharge information for orthopaedic patients to support recovery to prevent postdischarge problems and hospital readmission

Working Together: Building K-12/College Mentor Partnerships to Support Students with Learning Differences

In an interactive discussion with audience members, presenters will share ideas for developing positive mentor-mentee partnerships between K-12 schools and colleges; discuss the impact of two recently established mentor partnerships, as well as perspectives from college student mentors and K-12 teachers of student mentees with learning differences; collaboratively examine data to discuss potential program adaptations; and provide mentoring activities that audience members can utilize

Lean economies and innovation in mental health systems

Poor access to mental health care is widely reported, although it differs according to sociopolitical and economic contexts. In emerging economies, including Brazil, Russia, India, China, and South Africa (BRICS), there has been increased public investment in recent years, but rapid economic growth in these countries has now slowed. Precarious global transitions affect both the burden of mental health problems and demand for services. Innovations prompted by these transitions, in both high-income and low-income countries, could help meet population needs during times of economic shock, whether scarcity or affluence

Multiplexed immunofluorescence identifies high stromal CD68+PD‑L1+ macrophages as a predictor of improved survival in triple negative breast cancer

Triple negative breast cancer (TNBC) comprises 10–15% of all breast cancers and has a poor prognosis with a high risk of recurrence within 5 years. PD-L1 is an important biomarker for patient selection for immunotherapy but its cellular expression and co-localization within the tumour immune microenvironment and associated prognostic value is not well defined. We aimed to characterise the phenotypes of immune cells expressing PD-L1 and determine their association with overall survival (OS) and breast cancer-specific survival (BCSS). Using tissue microarrays from a retrospective cohort of TNBC patients from St George Hospital, Sydney (n = 244), multiplexed immunofluorescence (mIF) was used to assess staining for CD3, CD8, CD20, CD68, PD-1, PD-L1, FOXP3 and pan-cytokeratin on the Vectra Polaris™ platform and analysed using QuPath. Cox multivariate analyses showed high CD68+PD-L1+ stromal cell counts were associated with improved prognosis for OS (HR 0.56, 95% CI 0.33–0.95, p = 0.030) and BCSS (HR 0.47, 95% CI 0.25–0.88, p = 0.018) in the whole cohort and in patients receiving chemotherapy, improving incrementally upon the predictive value of PD-L1+ alone for BCSS. These data suggest that CD68+PD-L1+ status can provide clinically useful prognostic information to identify sub-groups of patients with good or poor prognosis and guide treatment decisions in TNBC

A framework for incorporating evolutionary genomics into biodiversity conservation and management

Evolutionary adaptation drives biodiversity. So far, however, evolutionary thinking has had limited impact on plans to counter the effects of climate change on biodiversity and associated ecosystem services. This is despite habitat fragmentation diminishing the ability of populations to mount evolutionary responses, via reductions in population size, reductions in gene flow and reductions in the heterogeneity of environments that populations occupy. Research on evolutionary adaptation to other challenges has benefitted enormously in recent years from genomic tools, but these have so far only been applied to the climate change issue in a piecemeal manner. Here, we explore how new genomic knowledge might be combined with evolutionary thinking in a decision framework aimed at reducing the long-term impacts of climate change on biodiversity and ecosystem services. This framework highlights the need to rethink local conservation and management efforts in biodiversity conservation. We take a dynamic view of biodiversity based on the recognition of continuously evolving lineages, and we highlight when and where new genomic approaches are justified. In general, and despite challenges in developing genomic tools for non-model organisms, genomics can help management decide when resources should be redirected to increasing gene flow and hybridisation across climate zones and facilitating in situ evolutionary change in large heterogeneous areas. It can also help inform when conservation priorities need to shift from maintaining genetically distinct populations and species to supporting processes of evolutionary change. We illustrate our argument with particular reference to Australia’s biodiversity.This paper arose out of a workshop funded through the Office of the Chief Executive Science Team at CSIRO and the Science Industry Endowment Fund

The Right to Water for Food and Agriculture

The right to water emerged in the Nineties primarily as the right to domestic water for drinking, washing and cooking, and was closely related to the right to sanitation, both of which are seen as a component of the right to an adequate standard of living. This study examines the question of the right to water for food and agriculture and asks whether such a right can be found in the right to water, or whether it is more appropriate to examine the right to adequate food for that purpose. Seeking inspiration from the right to adequate food and from other fields of international law, the study explores the content of the right to water for food and agriculture and then considers its implications for water law. Recognizing a human right to water – for drinking and household needs as well as for growing food – has implications for water allocation and sets limits to the extent that water can be allocated for other uses. In addition, it entails the respect for procedural rights and attention to important principles, such as the principle of non-discrimination and the rights of indigenous peoples

TILs immunophenotype in breast cancer predicts local failure and overall survival : analysis in a large radiotherapy trial with long-term follow-up

Aim: To determine the prognostic significance of the immunophenotype of tumour-infiltrating lymphocytes (TILs) within a cohort of breast cancer patients with long-term follow-up. Methods: Multiplexed immunofluorescence and automated image analysis were used to assess the expression of CD3, CD8, CD20, CD68, Fox P3, PD-1 and PD-L1 in a clinical trial of local excision and radiotherapy randomised to a cavity boost or not (n = 485, median follow-up 16 years). Kaplan–Meier and Cox multivariate analysis (MVA) methodology were used to ascertain relationships with local recurrence (LR), overall survival (OS) and disease-free survival (DFS). NanoString BC360 gene expression panel was applied to a subset of luminal patients to identify pathways associated with LR. Results: LR was predicted by low CD8 in MVA in the whole cohort (HR 2.34, CI 1.4–4.02, p = 0.002) and luminal tumours (HR 2.19, CI 1.23–3.92, p = 0.008) with associations with increased stromal components, decreased Tregs (FoxP3), inflammatory chemokines and SOX2. Poor OS was associated with low CD20 in the whole cohort (HR 1.73, CI 1.2–2.4, p = 0.002) and luminal tumours on MVA and low PD-L1 in triple-negative cancer (HR 3.44, CI 1.5–7, p = 0.003). Conclusions: Immunophenotype adds further prognostic data to help further stratify risk of LR and OS even in TILs low-luminal tumours

The intertidal hydraulics of tide-dominated reef platforms

A 2 week field experiment investigated the hydrodynamics of a strongly tidally forced tropical intertidal reef platform in the Kimberley region of northwestern Australia, where the spring tidal range exceeds 8 m. At this site, the flat and wide (∼1.4 km) reef platform is located slightly above mean sea level, such that during low tide the offshore water level can fall 4 m below the platform. While the reef always remained submerged over each tidal cycle, there were dramatic asymmetries in both the water levels and velocities on the reef, i.e., the flood duration lasted only ∼2 h versus ∼10 h for the ebb. These dynamics were investigated using a one-dimensional numerical model (SWASH) to solve the nonlinear shallow water equations with rapid (sub to supercritical) flow transitions. The numerical model revealed that as water drains off the reef, a critical flow point was established near the reef edge prior to the water discharging down the steep forereef. Despite this hydraulic control, bottom friction on the reef was still found to make a far greater contribution to elevating water levels on the reef platform and keeping it submerged over each tidal cycle. Finally, a simple analytical model more broadly shows how water levels on intertidal reef platforms functionally depend on properties of reef morphology, bottom roughness, and tidal conditions, revealing a set of parameters (a reef draining time-scale and friction parameter) that can be used to quantify how the water depth will fall on a reef during ebb tide.This is the publisher’s final pdf. The article is copyrighted by American Geophysical Union and published by John Wiley & Sons, Inc.. It can be found at: http://agupubs.onlinelibrary.wiley.com/agu/jgr/journal/10.1002/%28ISSN%292169-9291