Bullying In Schools

Bullying is defined as aggressive acts being inflicted by one or more individuals to another individual who appears weaker. In the United States alone one in four children falls victim to bullying. Several different types of bullying are discussed including verbal, reactive, relational, racial, sexual, and cyberbullying. Characteristics of bullies and victims are provided to help readers gain an understanding of who might be a bully or a victim. The detrimental effects that bullies and victims face are described. Bully prevention programs are extremely effective in preventing bullying and changing the effects that victims and bullies experience

Reducing CLABSI Rates Through Education on Maintaining CVC Dressing Integrity: A Quality Improvement Initiative

BACKGROUND: Central line-associated bloodstream infections (CLABSIs) are a type of hospital-acquired infection (HAI). They arise as a complication from patients having a central venous catheter (CVC) placed. CVCs can provide numerous benefits for patients who require long-term venous access or hemodynamic monitoring. Acquiring a CLABSI can place patients at higher risk for complications, increased length of stay, and mortality. Reducing the risk of infection is imperative for all patients, but especially those who are more vulnerable to opportunistic infections, such as those in critical care units. LOCAL PROBLEM: This quality improvement project took place at a 234-bed, level II trauma center hospital in the Seacoast region of New Hampshire. The aim of this quality improvement project was to improve CVC dressing integrity through re-education of the application protocol and subsequently decrease the risk for CLABSIs. METHODS: The Plan, Do, Study, Act (PDSA) framework was utilized to design and carry out this quality improvement project. Based on auditing conducted by the infection prevention team, it was concluded that there was a lack of understanding of the dressing application protocol which may have been contributing to the decreased integrity of the CVC dressings. INTERVENTION: The intervention was centered around re-education for the staff nurses on the unit. Both a pamphlet and an instructional video were developed highlighting key points about the benefits of the CHG dressings in preventing CLABSIs as well as demonstrating the proper steps for dressing application to optimize integrity. The educational materials were disseminated to all nurses on the unit via email. RESULTS: Data was collected via weekly auditing sessions with the infection prevention team utilizing an updated CVC maintenance checklist that was altered to address the needs of this project. The data collection revealed that only a 54% adherence rate for the application protocol was achieved. There were no reported CLABSIs during this period. There was no statistically significant difference between dressings from pre-intervention to post-intervention for either category (“clean/dry”; p = 0.278, “intact”; p = 0.442). CONCLUSIONS: Although the intervention did not meet the specific aim or yield statistically significant results, there are several limitations that may have contributed. Limitations included a lack of acknowledgment and engagement with the educational materials by the nurse, assessment of dressings not placed by nurses on the unit, infrequent auditing sessions, as well as differing sample sizes between pre-intervention and post-intervention. Whilst the specific aim was not met, the infection prevention team and nurses on the unit expressed their encouragement for the project and the hopes to implement in more capacities throughout the hospital. Keywords: Central line-associated bloodstream infections (CLABSIs), CHG Tegaderm dressings, infection prevention, dressing integrit

The privilege of induction avoidance and calcineurin inhibitors withdrawal in 2 haplotype HLA matched white kidney transplantation

BACKGROUND: White recipients of 2-haplotype HLA-matched living kidney transplants are perceived to be of low immunologic risk. Little is known about the safety of induction avoidance and calcineurin inhibitor withdrawal in these patients. METHODS: We reviewed our experience at a single center and compared it to Organ Procurement and Transplantation Network (OPTN) registry data and only included 2-haplotype HLA-matched white living kidney transplants recipients between 2000 and 2013. RESULTS: There were 56 recipients in a single center (where no induction was given) and 2976 recipients in the OPTN. Among the OPTN recipients, 1285 received no induction, 903 basiliximab, 608 thymoglobulin, and 180 alemtuzumab. First-year acute rejection rates were similar after induction-free transplantation among the center and induced groups nationally. Compared with induction-free transplantation in the national data, there was no decrease in graft failure risk over 13 years with use of basiliximab (adjusted hazard ratio [aHR], 0.86; confidence interval [CI], 0.68-1.08), Thymoglobulin (aHR, 0.92; CI, 0.7-1.21) or alemtuzumab (aHR, 1.18; CI, 0.72-1.93). Among induction-free recipients at the center, calcineurin inhibitor withdrawal at 1 year (n = 27) did not significantly impact graft failure risk (HR,1.62; CI, 0.38-6.89). CONCLUSIONS: This study may serve as a foundation for further studies to provide personalized, tailored, immunosuppression for this very low-risk population of kidney transplant patients

Long-term safety and efficacy of antithymocyte globulin induction: Use of integrated national registry data to achieve ten-year follow-up of 10-10 Study participants

BACKGROUND: Rabbit antithymocyte globulin (rATG, Thymoglobulin®) is the most common induction immunosuppression therapy in kidney transplantation. We applied a database integration strategy to capture and compare long-term (10-year) outcome data for US participants in a clinical trial of rATG versus FDA-approved basiliximab. METHODS: Records for US participants in an international, 1-year, randomized clinical trial comparing rATG and basiliximab induction in deceased donor kidney transplantation were integrated with records from the US national Organ Procurement and Transplantation (OPTN) registry using center, transplant dates, recipient sex, and birthdates. The OPTN captures center-reported acute rejection, graft failure, death, and cancer events, and incorporates comprehensive death records from the Social Security Death Master File. Ten-year outcomes according to randomized induction regimen were compared by Kaplan–Meier analysis (two-sided P). Non-inferiority of rATG was assessed using a one-tailed equivalence test (a-priori equivalence margins of 0–10 %). RESULTS: Of 183 US trial participants, 89 % (n = 163) matched OPTN records exactly; the remainder were matched by extending agreement windows for transplant and birthdates. Matches were validated by donor and recipient blood types. By Kaplan–Meier analysis, 10 years post-transplant, freedom from acute rejection, graft failure, or death was 32.6 % and 24.0 % in the rATG and basiliximab arms, respectively (P = 0.09). The incidence of acute rejection with rATG versus basiliximab induction was 21.0 % versus 32.8 % (P = 0.07). Patient survival (52.5 % versus 52.2 %, P = 0.92) and graft survival (34.3 % versus 30.9 %, P = 0.56) rates were numerically and statistically similar for both arms. Comparison of the composite outcome meets non-inferiority criteria even with a 0 % equivalence margin (one-sided P = 0.04). With a 10 % equivalence margin, the odds that rATG is no worse than basiliximab for 10-year risk of the composite endpoint are >99 %. CONCLUSIONS: Ten years post-transplant, rATG induction has comparable efficacy and safety to FDA-approved basiliximab. Integration of clinical trial records with national registry data can enable long-term monitoring of trial participants in transplantation, circumventing logistical and cost barriers of extended follow-up. TRIAL REGISTRATION: ClinicalTrials.gov NCT00235300 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13063-015-0891-y) contains supplementary material, which is available to authorized users

Deceased donor procurement biopsy practices, interpretation, and histology-based decision-making: A survey of US kidney transplant centers

INTRODUCTION: The utility of kidney procurement biopsies is controversial. Understanding the current landscape of how clinicians obtain and use biopsies in organ evaluation may help inform consensus-building efforts. METHODS: An electronic survey was distributed to clinicians at US kidney transplant programs (April 22, 2021-June 30, 2021) to evaluate donor biopsy indications, frequency, processing and interpretation, and impact of findings on practices. RESULTS: Responses from staff involved in organ acceptance (73% surgeons, 20% nephrologists, 6% coordinators) at 95 transplant centers were analyzed, representing 40% of US transplant centers and 50% of recent deceased donor kidney transplant volume. More than a third of centers (35%) reported obtaining procurement biopsies on most-to-all kidneys. Most clinicians decided when to biopsy jointly with the Organ Procurement Organization (OPO) (82%) based on formal criteria for the decision (72%), although 41% reported having requested a biopsy outside of the criteria. Most respondents used a semiquantitative scoring system for interpretation (57%). Many respondents reported rarely or never having access to renal specialty pathologists (37%) or to telepathology (59%). Most respondents reported that a favorable biopsy result would encourage them to accept a marginal donor kidney (72%); nearly half (46%) indicated that an unfavorable biopsy result would lead to decline of a standard criteria kidney. CONCLUSION: Procurement biopsies are commonly used in organ acceptance decisions despite inconsistent access to experienced renal pathologists and heterogeneous approaches to criteria, scoring, and interpretation. Ongoing study and consensus building are needed to direct procurement biopsy practice toward increasing organ utilization and reducing allocation inefficiency

Multi-stage high order semi-Lagrangian schemes for incompressible flows in Cartesian geometries

Efficient transport algorithms are essential to the numerical resolution of incompressible fluid flow problems. Semi-Lagrangian methods are widely used in grid based methods to achieve this aim. The accuracy of the interpolation strategy then determines the properties of the scheme. We introduce a simple multi-stage procedure which can easily be used to increase the order of accuracy of a code based on multi-linear interpolations. This approach is an extension of a corrective algorithm introduced by Dupont \& Liu (2003, 2007). This multi-stage procedure can be easily implemented in existing parallel codes using a domain decomposition strategy, as the communications pattern is identical to that of the multi-linear scheme. We show how a combination of a forward and backward error correction can provide a third-order accurate scheme, thus significantly reducing diffusive effects while retaining a non-dispersive leading error term.Comment: 14 pages, 10 figure

Immune-complex deposits in “pauci-immune” glomerulonephritis: a case report and brief review of recent literature

Anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis is considered a “pauci-immune” disease, characterized by absent or mild glomerular tuft staining for immunoglobulin and/or complement. We describe a 72-year-old man with progressive renal failure over five months who was found to have P-ANCA associated crescentic glomerulonephritis. Renal biopsy also revealed immunofluorescence staining for Immunoglobulin G and C3. Treatment comprised corticosteroids, cyclophosphamide, and plasmapheresis but unfortunately kidney function did not recover, likely due to substantial interstitial fibrosis at diagnosis. This case illustrates that serologic evaluation for ANCAs should not be discounted when immune deposits are present. Prompt diagnosis is warranted