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Background In the United States, post-cardiac arrest debriefing has increased, but historically it has occurred rarely in our pediatric intensive care unit (PICU). A fellow-led debriefing tool was developed as a tool for fellow development, as well as to enhance communication amongst a multidisciplinary team. Methods A curriculum and debriefing tool for fellow facilitators was developed and introduced in a 41-bed cardiac and medical PICU. Pre- and post-intervention surveys were sent to multidisciplinary PICU providers to assess effectiveness of debriefings using newly-trained leaders, as well as changes in team communication. Results Debriefing occurred after 84% (63/75) of cardiac arrests post-intervention. Providers in various team roles participated in pre-intervention (129 respondents/236 invitations) and post-intervention (96 respondents /232 invitations) surveys. Providers reported that frequently occurring debriefings increased from 9 to 58%, pre- and post-intervention respectively ( p  < .0001). Providers reported frequent identification and discussion of learning points increased from 32% pre- to 63% post-intervention. In the 12 months post-intervention, 62% of providers agreed that the overall quality of communication during arrests had improved, and 61% would be more likely to request a debriefing after cardiac arrest. Conclusion The introduction of a fellow-led debriefing tool resulted in regularly performed debriefings after arrests. Despite post-intervention debriefings being led by newly-trained facilitators, the majority of PICU staff expressed satisfaction with the quality of debriefing and improvement in communication during arrests, suggesting that fellow facilitators can be effective debrief leaders.

High-volume horizontal hydraulic fracturing (fracking) is a new technology that poses many threats to biodiversity. Species that have small geographic ranges and a large overlap with the extensively industrializing Marcellus and Utica shale-gas region are vulnerable to environmental impacts of fracking, including salinization and forest fragmentation. We reviewed the ranges and ecological requirements of 15 species (1 mammal, 8 salamanders, 2 fishes, 1 butterfly, and 3 vascular plants), with 36%–100% range overlaps with the Marcellus-Utica region to determine their susceptibility to shale-gas activities. Most of these species are sensitive to forest fragmentation and loss or to degradation of water quality, two notable impacts of fracking. Moreover, most are rare or poorly studied and should be targeted for research and management to prevent their reduction, extirpation, or extinction from human-caused impacts. Environmental Practice 14:1–12 (2012)

A 10-year-old male was referred with difficulties at school. He had particular difficulty with reading long words, following the sequence of text down a page, writing words in the correct order, writing words in line, and copying from the blackboard. He had a history of infective endocarditis complicated by intracerebral haemorrhage at the age of three years. Detailed history taking revealed symptoms typical of ‘dorsal stream’ pathology, namely a deficit of ‘vision for action’. This included a spatial disorder of attention (simultanagnosia), defective hand and foot movements under visual control (optic ataxia), and acquired oculomotor apraxia which are consistent with Balint's syndrome. Strategies were suggested for coping with the symptoms and one year later a distinct improvement in adapting to the disability was found.

We document the first confirmed cases of polygyny and double brooding in the Eastern Wood-Pewee (Contopus virens). During an intensive study of the effects of shelterwood harvesting on canopy-nesting songbirds in southeastern Ohio, 2007–2010, we color-banded 79 Eastern Wood-Pewees and monitored 237 pewee nests. In 2007, we confirmed a color-banded male provisioning at two concurrently active nests; the male was polygynous in at least two consecutive years. In 2009, we observed an unbanded female feeding fledglings and subsequently shaping a nest from which young had recently fledged; the female successfully fledged two broods from the same nest. In addition to confirmed observations, we identified several other probable cases of polygyny and double brooding. In our upland oak system, we estimated rates of polygyny from 6–22% with the greatest occurrence of polygyny during a dry spring in 2007; rates of double brooding may have been as high as 6–12%. Males appeared to benefit from polygyny, because males paired with two females fledged twice as many young compared to monogamous males, without any apparent negative effect on return rate. Overall, we did not find negative effects on reproductive success for females paired with polygynous males, although we were not able to consistently differentiate between primary and secondary females. Polygyny appeared to be related to either territory quality and/or male quality with nests of polygynous males located in preferred nest sites while provisioning rates were greater at polygynous compared to monogamous nests. In addition, we only found experienced males paired with two females. Both males and females benefited from double brooding, fledging twice as many young as single brooded pairs, but in our system double brooding appeared to be limited by high levels of nest predation early in the breeding season.

A 10‐year‐old male was referred with difficulties at school. He had particular difficulty with reading long words, following the sequence of text down a page, writing words in the correct order, writing words in line, and copying from the blackboard. He had a history of infective endocarditis complicated by intracerebral haemorrhage at the age of three years. Detailed history taking revealed symptoms typical of ‘dorsal stream’ pathology, namely a deficit of ‘vision for action’ . This included a spatial disorder of attention (simultanagnosia), defective hand and foot movements under visual control (optic ataxia), and acquired oculomotor apraxia which are consistent with Balint's syndrome. Strategies were suggested for coping with the symptoms and one year later a distinct improvement in adapting to the disability was found.

The Star Excursion Balance Test (SEBT) is a common assessment used across clinical and research settings to test dynamic standing balance. The primary measure of this test is maximal reaching distance performed by the non-stance limb. Response time (RT) is a critical cognitive component of dynamic balance control and the faster the RT, the better the postural control and recovery from a postural perturbation. However, the measure of RT has not been done in conjunction with SEBT, especially with musculoskeletal fatigue. The purpose of this study is to examine RT during a SEBT, creating a modified SEBT (mSEBT), with a secondary goal to examine the effects of muscular fatigue on RT during SEBT. Sixteen healthy young male and female adults [age: 20 ± 1 years; height: 169.48 ± 8.2 cm; weight: 67.93 ± 12.7 kg] performed the mSEBT in five directions for three trials, after which the same was repeated with a response time task using Blazepod™ with a random stimulus. Participants then performed a low-intensity musculoskeletal fatigue task and completed the above measures again. A 2 × 2 × 3 repeated measures ANOVA was performed to test for differences in mean response time across trials, fatigue states, and leg reach as within-subjects factors. All statistical analyses were conducted in JASP at an alpha level of 0.05. RT was significantly faster over the course of testing regardless of reach leg or fatigue state (p = 0.023). Trial 3 demonstrated significantly lower RT compared to Trial 1 (p = 0.021). No significant differences were found between fatigue states or leg reach. These results indicate that response times during the mSEBT with RT is a learned skill that can improve over time. Future research should include an extended familiarization period to remove learning effects and a greater fatigue state to test for differences in RT during the mSEBT.

Incorporating evidence-based practice (EBP) into occupational therapy (OT) program curricula is best practice and mandated by the Accreditation Council for Occupational Therapy Education (ACOTE). The Choosing Wisely[R] campaign, founded by the American Board of Internal Medicine (ABIM) and adopted by the American Occupational Therapy Association (AOTA), provides 10 recommendations for evidence-based OT. This project focused on the Choosing Wisely[R] campaign's incorporation into OT program curricula. A 40-min educational program focusing on the history of Choosing Wisely[R], its adoption by the AOTA as a specialty society partner, and strategies to bridge the campaign's evidence-based recommendations from classroom to clinical experience were provided to members of the Metropolitan Occupational Therapy Educational Council (MOTEC). Fifteen pre and post program surveys were collected. Pre and post responses were analyzed regarding the familiarity of the campaign, perceptions of the campaign, and the willingness of occupational therapists in academia to incorporate the recommendations into program curricula when referencing EBP. The data shows an increase in the participants' understanding of why the AOTA adopted the campaign, positive perceptions regarding the campaign, and a willingness to incorporate Choosing Wisely[R] as a reference to EBP in program curricula.

Background and objectivesNeuropsychiatric symptoms (NPS) are common in older people with cognitive impairment and Alzheimer’s disease (AD). No biomarkers to detect the related pathology or predict the clinical evolution of NPS are available yet. This study aimed to identify plasma proteins that may serve as biomarkers for NPS and NPS-related clinical disease progression.MethodsA panel of 190 plasma proteins was quantified using Luminex xMAP in the Alzheimer’s Disease Neuroimaging Initiative cohort. NPS and cognitive performance were assessed at baseline and after 1 and 2 years. Logistic regression, receiver operating characteristic analysis and cross-validation were used to address the relations of interest.ResultsA total of 507 participants with mild cognitive impairment (n=396) or mild AD dementia (n=111) were considered. Selected plasma proteins improved the prediction of NPS (area under the curve (AUC) from 0.61 to 0.76, p<0.001) and future NPS (AUC from 0.63 to 0.80, p<0.001) when added to a reference model. Distinct protein panels were identified for single symptoms. Among the selected proteins, ANGT, CCL1 and IL3 were associated with NPS at all three time points while CCL1, serum glutamic oxaloacetic transaminase and complement factor H were also associated with cognitive decline. The associations were independent of the presence of cerebral AD pathology as assessed using cerebrospinal fluid biomarkers.ConclusionsPlasma proteins are associated with NPS and improve prediction of future NPS.

Background Acute kidney injury (AKI) occurs in up to half of infants admitted to the neonatal intensive care unit (NICU) and is associated with increased risks of death and more days of mechanical ventilation, hospitalization, and vasopressor drug support. Our objective was to build a granular relational database to study the impact that AKI has on infants admitted to Level-IV NICUs. Methods A relational database was created by linking data from the Children’s Hospitals Neonatal Database with AKI-focused data from electronic health records from 9 centers. Results The current cohort consists of 24,870 infants with a median (IQR) gestational age of birth of 37 weeks (32 weeks, 39 weeks), and a median birth weight of 2.720 kg (1.750 kg, 3.310 kg). There was a male predominance with 14,214 (57%) males. In all, 2434 (9.8%) of the mothers were of Hispanic ethnicity. The maternal race breakdown of the cohort was as follows: 741 (3.0%) Asian, 5911 (24%) Black, and 14,945 (60%) White. Overall mortality was 5.8%. Conclusion The ADVANCE relational database is an innovative research tool to rigorously study the epidemiology of AKI in a large national cohort of infants admitted to Level-IV NICUs involved in the Children’s Hospital Neonatal Consortium. Impact We used a biomedical informatics approach to build a relational database to study acute kidney injury in infants. We highlight our methodology linking Children’s Hospital Neonatal Consortium and electronic health record data from nine neonatal intensive care units. The ADVANCE relational database is a granular and innovative research tool to study risk factors and in-hospital outcomes of acute kidney injury and mortality in a vulnerable patient population.

•Direct chemical screening of postal packages to detect fireworks.•Trace pyrotechnic residue detection with IRTD-DART-MS and CE with C4D.•Practical value demonstrated with swipes of seized parcels.•Differentiation of flash and black powder residues with IRTD-DART-MS. High volume screening of parcels with the aim to trace the illegal distribution and selling of fireworks using postal services is challenging. Inspection services have limited manpower and means to perform extensive visual inspection. In this study, the presence of solid pyrotechnic residues collected from cardboard shipping parcels containing fireworks was investigated for direct in-field chemical detection. Two emerging trace detection techniques, i.e., capillary electrophoresis (CE)-based inorganic oxidizer detector and infrared thermal desorption (IRTD) coupled with direct analysis in real time mass spectrometry (DART-MS), were investigated for their potential as screening tools. Detection of non-visible pyrotechnic trace residues from real-case seized parcels was demonstrated using both screening techniques. However, the high nitrate background in the commercial CE system complicated its screening for black powder traces. IRTD-DART-MS allowed differentiation between flash and black powder by identification of the molecular inorganic ions. Compared to the portable CE instrument, rapid screening using IRTD-DART-MS is currently limited to laboratory settings. The capabilities of these emerging techniques established solid particle and trace residue chemical detection as interesting options for parcel screening in a logistic setting.