Back to the Basics with Environmental Hygiene

Environmental hygiene is fundamental in preventing the transmission of pathogens that can cause health care-associated infections (HAIs). Inanimate surfaces within the patient’s environment are defined as high-touch surfaces and include areas such as bedrails, tray tables, call lights, telephones, any equipment that is attached to the patient, and the computer on wheels. HAIs develop during hospitalization and occur within 48 to 72 hours of admission or within 10 days after hospital discharge (CDC, 2014; Collins, 2008). HAIs increase the morbidity, mortality, and hospital expenditures; and critically ill patients are at greater risk for HAIs because of their compromised immune systems, prolonged indwelling medical devices, multiple invasive procedures, and antibiotic use (CDC, 2014; Collins, 2008). A 26-bed cardiac intensive care unit implemented a high-touch surface cleaning protocol in order to decrease HAI rates and improve overall environmental hygiene within the patient’s immediate surroundings. The pre- and post-survey results determined that the protocol was easily implemented into daily practice and the intervention improved environmental hygiene within the patient’s immediate environment

Coming in Warm: Qualitative Study and Concept Map to Cultivate Patient‐Centered Empathy in Emergency Care

Background Increased empathy may improve patient perceptions and outcomes. No training tool has been derived to teach empathy to emergency care providers. Accordingly, we engaged patients to assist in creating a concept map to teach empathy to emergency care providers. Methods We recruited patients, patient caretakers and patient advocates with emergency department experience to participate in three separate focus groups (n = 18 participants). Facilitators guided discussion about behaviors that physicians should demonstrate in order to rapidly create trust, enhance patient perception that the physician understood the patient's point of view, needs, concerns, fears, and optimize patient/caregiver understanding of their experience. Verbatim transcripts from the three focus groups were read by the authors and by consensus, 5 major themes with 10 minor themes were identified. After creating a codebook with thematic definitions, one author reviewed all transcripts to a library of verbatim excerpts coded by theme. To test for inter‐rater reliability, two other authors similarly coded a random sample of 40% of the transcripts. Authors independently chose excerpts that represented consensus and strong emotional responses from participants. Results Approximately 90% of opinions and preferences fell within 15 themes, with five central themes: Provider transparency, Acknowledgement of patient's emotions, Provider disposition, Trust in physician, and Listening. Participants also highlighted the need for authenticity, context and individuality to enhance empathic communication. For empathy map content, patients offered example behaviors that promote perceptions of physician warmth, respect, physical touch, knowledge of medical history, explanation of tests, transparency, and treating patients as partners. The resulting concept map was named the “Empathy Circle”. Conclusions Focus group participants emphasized themes and tangible behaviors to improve empathy in emergency care. These were incorporated into the “Empathy Circle”, a novel concept map that can serve as the framework to teach empathy to emergency care providers

Do children unintentionally report maltreatment? Comparison of disclosures of neglect versus sexual abuse

Background and aimsChildren's initial reports often play a key role in the identification of maltreatment, and a sizeable amount of scientific research has examined how children disclose sexual and physical abuse. Although neglect constitutes a large proportion of maltreatment experiences, relatively little attention has been directed toward understanding whether and how children disclose neglect. The overarching aim of the present study was to document this process by comparing disclosure patterns in cases of neglect to those in cases of sexual abuse.MethodRedacted jurisdiction reports (N = 136) of substantiated dependency cases of neglect (n = 71) and sexual abuse (n = 65) in 4- to 17-year-olds were coded for why maltreatment was suspected, and for children's perceived awareness and disclosure of the maltreatment.ResultsNeglect was most often initially suspected via contact with emergency services (e.g., police, emergency medical services), whereas sexual abuse was most often initially suspected as a result of children's statements. Children evidenced greater perceived awareness of sexual abuse than neglect and were more likely to disclose the former in their first investigative interview. Perceived awareness was further associated with a higher likelihood of children's statements initiating discovery of maltreatment and disclosing in the first investigative interview.ConclusionsChildren may benefit from greater knowledge about their needs for safety, supervision, and provision in the home, which could increase the likelihood they would disclose neglect. Such, in turn, could lead to earlier interventions for children and families

The Multitude of Unresolved Continuum Sources at 1.6 microns in Hubble Space Telescope images of Seyfert Galaxies

We examine 112 Seyfert galaxies observed by the Hubble Space Telescope (HST) at 1.6 microns. We find that ~50% of the Seyfert 2.0 galaxies which are part of the Revised Shapeley-Ames (RSA) Catalog or the CfA redshift sample contain unresolved continuum sources at 1.6 microns. All but a couple of the Seyfert 1.0-1.9 galaxies display unresolved continuum sources. The unresolved sources have fluxes of order a mJy, near-infrared luminosities of order 10^41 erg/s and absolute magnitudes M_H ~-16. Comparison non-Seyfert galaxies from the RSA Catalog display significantly fewer (~20%), somewhat lower luminosity nuclear sources, which could be due to compact star clusters. We find that the luminosities of the unresolved Seyfert 1.0-1.9 sources at 1.6 microns are correlated with [OIII] 5007A and hard X-ray luminosities, implying that these sources are non-stellar. Assuming a spectral energy distribution similar to that of a Seyfert 2 galaxy, we estimate that a few percent of local spiral galaxies contain black holes emitting as Seyferts at a moderate fraction, 10^-1 to 10^-4, of their Eddington luminosities. With increasing Seyfert type the fraction of unresolved sources detected at 1.6 microns and the ratio of 1.6 microns to [OIII] fluxes tend to decrease. These trends are consistent with the unification model for Seyfert 1 and 2 galaxies.Comment: accepted by Ap

The Variability of Seyfert 1.8 and 1.9 Galaxies at 1.6 microns

We present a study of Seyfert 1.5-2.0 galaxies observed at two epochs with the Hubble Space Telescope (HST) at 1.6 microns. We find that unresolved nuclear emission from 9 of 14 nuclei varies at the level of 10-40% on timescales of 0.7-14 months, depending upon the galaxy. A control sample of Seyfert galaxies lacking unresolved sources and galaxies lacking Seyfert nuclei show less than 3% instrumental variation in equivalent aperture measurements. This proves that the unresolved sources are non-stellar and associated with the central pc of active galactic nuclei. Unresolved sources in Seyfert 1.8 and 1.9 galaxies are not usually detected in HST optical surveys, however high angular resolution infrared observations will provide a way to measure time delays in these galaxies.Comment: accepted by ApJLetters (emulateapj latex

Report from the National Society of Genetic Counselors Service Delivery Model Task Force: A Proposal to Define Models, Components, and Modes of Referral

The Service Delivery Model Task Force (SDMTF) was appointed in 2009 by the leadership of the National Society of Genetic Counselors (NSGC) with a charge to research and assess the capacity of all existing service delivery models to improve access to genetic counseling services in the context of increasing demand for genetic testing and counseling. In approaching this charge, the SDMTF found that there were varying interpretations of what was meant by “service delivery models” and the group held extensive discussions about current practices to arrive at consensus of proposed definitions for current genetic service delivery models, modes of referral and components of service delivery. The major goal of these proposed definitions is to allow for conversations to begin to address the charge to the committee. We propose that current models of service delivery can be defined by: 1) the methods in which genetic counseling services are delivered (In‐person, Telephone, Group and Telegenetics), 2) the way they are accessed by patients (Traditional referral, Tandem, Triage, Rescue and Self‐referral) and 3) the variable components that depend upon multiple factors unique to each service setting. This report by the SDMTF provides a starting point whereby standardized terminology can be used in future studies that assess the effectiveness of these described models to overcome barriers to access to genetic counseling services.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146876/1/jgc40645.pd

Bringing Developmental Education to Scale: Lessons from the Developmental Education Initiative

While over half of all community college students are judged to need developmental (or remedial) reading, composition, and/or mathematics classes, these courses — which students are often required to complete before they can enroll in courses that confer credit toward a degree — typically present major roadblocks to student progress. To address this issue, the Developmental Education Initiative (DEI) was created in 2009. Fifteen highly diverse community colleges that had been early participants in Achieving the Dream, a national community college reform network, each received a three-year grant of $743,000 to scale up existing interventions or establish new ones that would help students progress through developmental courses more quickly and successfully. The colleges typically identified two or three “focal strategies” — most often, student support services and new instructional strategies — for achieving these goals. This second and final report from the evaluation relies on both qualitative and quantitative data to examine the implementation of these focal strategies

Pseudotemporal invitations: 6- to 9-year-old maltreated children’s tendency to misinterpret invitations referencing “time” as solely requesting conventional temporal information

Forensic interviewers ask children broad input-free recall questions about individual episodes in order to elicit complete narratives, often asking about “the first time,” “the last time,” and “one time.” An overlooked problem is that the word “time” is potentially ambiguous, referring both to a particular episode and to conventional temporal information. We examined 191 6-9-year-old maltreated children’s responses to questions about recent events varying the wording of the invitations, either asking children to “tell me about” or “tell me what happened” one time/the first time/the last time the child experienced recent recurrent events. Additionally, half of the children were asked a series of “when” questions about recurrent events before the invitations. Children were several times more likely to provide exclusively conventional temporal information to “tell me about” invitations compared to “tell me what happened” invitations, and asking “when” questions before the invitations increased children’s tendency to give exclusively conventional temporal information. Children who answered a higher proportion of “when” questions with conventional temporal information were also more likely to do so in response to the invitations. The results suggest that children may often fail to provide narrative information because they misinterpret invitations using the word “time.