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Background: Catheter-associated urinary tract infections (CAUTIs) are a leading cause of healthcare-associated infection. Catheter insertion and maintenance bundles have been developed to prevent CAUTIs, but they have not been extensively validated for use in pediatric populations. We report the CAUTI prevention efforts of a large network of children’s hospitals. Methods: Children’s hospitals joined the Solution for Patient Safety (SPS) safety engagement network from 2011 through 2017 and elected to participate in CAUTI prevention efforts, with 26 hospitals submitting data initially and 128 participating by the end. CAUTI prevention recommendations were first released in May 2012, and insertion and maintenance bundles were released in May 2014 (Table 1). Hospitals reported on CAUTIs, patient days, urinary catheter line days (CLD), and they tracked reliability to each bundle. For the network, control charts were used to plot CAUTI rates, urinary catheter utilization, and reliability to each bundle component. Results: Following the introduction of the pediatric CAUTI insertion and maintenance bundles, CAUTI rates across the network decreased 61.6%, from 2.55 to 0.98 infections per 1,000 CLD (Fig. 1). Centerline shifts occurred both before and after the 2015 CDC CAUTI definition change, which may also have contributed to a centerline shift. Urinary catheter utilization rates did not decline during the intervention period. Network reliability to the insertion and maintenance bundles increased to 95.4% and 86.9%, respectively. Conclusions: Insertion and maintenance bundles aimed at preventing CAUTIs were introduced across a large network of children’s hospitals. Across the network, the rate of urinary tract infections among hospitalized children with indwelling urinary catheters decreased 61.6%. Funding: None Disclosures: None

Citizen science is a growing method of scientific discovery and community engagement. To date, there is a paucity of data using citizen scientists to monitor community level physical activity, such as bicycling or walking; these data are critical to inform community level intervention. Volunteers were recruited from the local community to make observations at five local greenways. The volunteers picked their location, time to collect data and duration of data collection. Volunteer observations included recording estimated age, race or ethnicity and activity level of each individual they encountered walking, running or bicycling on the greenway. A total of 102 volunteers were recruited to participate in the study, of which 60% completed one or more observations. Average observational time lasted 81 minutes and resulted in recording the demographics and physical activity of a mean of 48 people per session. The majority of adult bicyclists observed were biking at a moderate pace (86%) and were white (72%) males (62%). Similar results were observed for those walking. We demonstrate the feasibility of using citizen scientists to address the current scarcity of data describing community-level physical activity behavior patterns. Future work should focus on refining the citizen science approach for the collection of physical activity data to inform community-specific interventions in order to increase greenway use.

BackgroundEmerging evidence has shown racial and ethnic disparities in rates of harm for hospitalised children. Previous work has also demonstrated how highly heterogeneous approaches to collection of race and ethnicity data pose challenges to population-level analyses. This work aims to both create an approach to aggregating safety data from multiple hospitals by race and ethnicity and apply the approach to the examination of potential disparities in high-frequency harm conditions.MethodsIn this cross-sectional, multicentre study, a cohort of hospitals from the Solutions for Patient Safety network with varying race and ethnicity data collection systems submitted validated central line-associated bloodstream infection (CLABSI) and unplanned extubation (UE) data stratified by patient race and ethnicity categories. Data were submitted using a crosswalk created by the study team that reconciled varying approaches to race and ethnicity data collection by participating hospitals. Harm rates for race and ethnicity categories were compared with reference values reflective of the cohort and broader children’s hospital population.ResultsRacial and ethnic disparities were identified in both harm types. Multiracial Hispanic, Combined Hispanic and Native Hawaiian or other Pacific Islander patients had CLABSI rates of 2.6–3.6 SD above reference values. For Black or African American patients, UE rates were 3.2–4.4 SD higher. Rates of both events in White patients were significantly lower than reference values.ConclusionsThe combination of harm data across hospitals with varying race and ethnicity collection systems was accomplished through iterative development of a race and ethnicity category framework. We identified racial and ethnic disparities in CLABSI and UE that can be addressed in future improvement work by identifying and modifying care delivery factors that contribute to safety disparities.

Purpose. This study investigated the relationship between organizational climate and academic achievement of students in elementary schools. The research was designed to determine: (a) if a relationship existed between teachers' perceptions of their school's organizational climate and academic achievement of their students from low socioeconomic backgrounds; and (b) if a particular dimension of the school's organizational climate (i.e., Esprit) related to academic achievement of students from low socioeconomic backgrounds. Procedures. The first phase of the study required the identification of: (a) schools with the most and least open climate, and (b) schools with the highest and lowest Esprit. The Organizational Climate Description Questionnaire (OCDQ) was administered to 508 teachers in 32 schools. The OCDQ was scored by the method prescribed by Halpin and Croft, and an openness score was determined for each school. Schools were ranked by openness score from most to least open; the two schools which received extreme scores were selected for study. Next, the schools were ranked by OCDQ Esprit subtest score from highest Esprit to lowest Esprit. The two schools receiving extreme scores were identified for study. The second phase of the study required the researcher to secure mathematics scores of all fourth grade low socioeconomic students from those schools having certain characteristics (i.e., most and least open climates and highest and lowest OCDQ Esprit subtest scores). The Science Research Associates Test (SRA) was the instrument utilized to measure students' achievement in the areas of total mathematics, mathematics computation, and mathematics concepts. A mean school score was computed for each mathematics subtest using individual students' scores from those schools identified as having the most and least open climate schools. The procedure was repeated for those two schools having the highest and lowest OCDQ Esprit subtest scores. A series of t tests was the statistical method used to identify differences between mathematics achievement of students in the two types of school climate, most and least open. The same statistical method was utilized to determine differences between mathematics achievement of students in schools having the highest and lowest OCDQ Esprit subtest scores. The critical probability associated with the testing of the hypotheses was .05. Results. Comparisons were made between SRA mathematics subtest scores of fourth grade low socioeconomic students in schools having the most and least open school organizational climates. Significant differences were determined to exist between student achievement on the mathematics subtest of total mathematics, mathematics computation, and mathematics concepts in the most open and the least open climate schools. In addition, comparisons were made between SRA mathematics subtests scores of fourth grade low socioeconomic students in schools having the highest and lowest OCDQ Esprit subtest scores. Significant differences were found to exist between student achievement on the mathematics subtest of total mathematics and mathematics concepts in schools having the highest Esprit and lowest Esprit. No significant difference was determined to exist between student achievement on the subtest of mathematics computation in schools having the highest Esprit and lowest Esprit. Conclusions. The following conclusions were generated as a result of this study: (1) A school whose organizational climate was classified as most open had fourth grade low socioeconomic students who scored significantly higher on the SRA subtests of total mathematics, mathematics computation, and mathematics concepts. (2) A school whose OCDQ Esprit subtest score was classified as highest had fourth grade low socioeconomic students who scored significantly higher on the SRA subtests of total mathematics and mathematics concepts.

Gulf War illness (GWI) is a disorder related to military service in the 1991 GW. Prominent symptoms include fatigue, pain and cognitive problems. These symptoms were reported by GW Veterans (GWV) immediately after the war and were eventually incorporated into case definitions of GWI. Neuropsychological function in GW veterans has been studied both among deployed GWV and in GWV diagnosed with GWI. Results have been inconsistent between and across GW populations. The purpose of the present investigation was to better characterize neuropsychological function in this veteran population. Meta-analysis techniques were applied to published studies on neuropsychological performance in GWV to identify domains of dysfunction in deployed vs. non-deployed GW-era veterans and symptomatic vs. non-symptomatic GWVs. Significantly decreased performance was found in three functional domains: attention and executive function, visuospatial skills and learning/memory. These findings document the cognitive decrements associated with GW service, validate current GWI case definitions using cognitive criteria, and identify test measures for use in GWI research assessing GWI treatment trial efficacy.

Abstract The median survival of patients with idiopathic pulmonary fibrosis (IPF) continues to be approximately 3 years from the time of diagnosis, underscoring the lack of effective medical therapies for this disease. In the United States alone, approximately 40,000 patients die of this disease annually. In November 2012, the NHLBI held a workshop aimed at coordinating research efforts and accelerating the development of IPF therapies. Basic, translational, and clinical researchers gathered with representatives from the NHLBI, patient advocacy groups, pharmaceutical companies, and the U.S. Food and Drug Administration to review the current state of IPF research and identify priority areas, opportunities for collaborations, and directions for future research. The workshop was organized into groups that were tasked with assessing and making recommendations to promote progress in one of the following six critical areas of research: (1) biology of alveolar epithelial injury and aberrant repair; (2) role of extracellular matrix; (3) preclinical modeling; (4) role of inflammation and immunity; (5) genetic, epigenetic, and environmental determinants; (6) translation of discoveries into diagnostics and therapeutics. The workshop recommendations provide a basis for directing future research and strategic planning by scientific, professional, and patient communities and the NHLBI.

Purpose>Concerns about psychological well-being (PWB) in doctoral students have grown in recent years. The purpose of this study was to explore qualitatively doctoral students’ perceptions of factors that promoted their PWB during the doctoral journey.Design/methodology/approach>Nine recent doctoral graduates at an English university participated in the study. Participants recalled their experience and PWB during the doctoral journey via a life grid and semi-structured interview. The life grids were visually inspected to identify high points in PWB whilst the interview data were analysed thematically.Findings>The analysis produced the following seven themes representing factors that participants described during periods of better PWB: accomplishments; intrinsic rewards; self-efficacy; comprehension and understanding; supervisor support; wider support network; and self-care and lifestyle.Originality/value>By adopting a positive psychology approach and exploring qualitatively factors that promoted PWB in doctoral students, this study offers an alternative perspective to research on doctoral student well-being, which has largely adopted a pathological focus. As such, the study demonstrates the utility of approaching research on doctoral students’ PWB from a positive psychology perspective. Findings are discussed in relation to the extant literature, and future directions for research are outlined.

Despite increased demand for new curricula in medical education, most academic medical centers have few faculty with training in curriculum development. To describe and evaluate a longitudinal mentored faculty development program in curriculum development. A 10-month curriculum development program operating one half-day per week of each academic year from 1987 through 2003. The program was designed to provide participants with the knowledge, attitudes, skills, and experience to design, implement, evaluate, and disseminate curricula in medical education using a 6-step model. One-hundred thirty-eight faculty and fellows from Johns Hopkins and other institutions and 63 matched nonparticipants. Pre- and post-surveys from participants and nonparticipants assessed skills in curriculum development, implementation, and evaluation, as well as enjoyment in curriculum development and evaluation. Participants rated program quality, educational methods, and facilitation in a post-program survey. Sixty-four curricula were produced addressing gaps in undergraduate, graduate, or postgraduate medical education. At least 54 curricula (84%) were implemented. Participant self-reported skills in curricular development, implementation, and evaluation improved from baseline (p < .0001), whereas no improvement occurred in the comparison group. In multivariable analyses, participants rated their skills and enjoyment at the end of the program significantly higher than nonparticipants (all p < .05). Eighty percent of participants felt that they would use the 6-step model again, and 80% would recommend the program highly to others. This model for training in curriculum development has long-term sustainability and is associated with participant satisfaction, improvement in self-rated skills, and implementation of curricula on important topics.

Exercise capacity (EC) is a critical outcome in chronic obstructive lung disease (chronic obstructive pulmonary disease (COPD)). It measures the impact of the disease and the effect of specific interventions like pulmonary rehabilitation (PR). EC determines COPD prognosis and is associated with health-care utilization and quality of life. Field walking tests and cardiopulmonary exercise test (CPET) are two ways to measure EC. The 6-minute walking test (6MWT) is the commonest and easiest field test. CPET has the advantage of assessing maximal aerobic capacity. Determinants of EC include age, gender, breathlessness, and lung function. Previous research suggests that socioeconomic status (SES), a meaningful factor in COPD, may also be associated with EC. However, those findings have not been replicated. We aimed to determine whether SES is an independent factor associated with EC in COPD. For this analysis, we used the National Emphysema Treatment Trial (NETT) database. NETT was a multicenter clinical trial where severe COPD patients were randomized to lung volume reduction surgery or medical therapy. Measures used were taken at baseline, postrehabilitation. Patients self-reported their income and were divided in two groups whether it was less or above US$30,000. Patients with a lower income had worse results in 6MWT (p < 0.0001). We found an independent association between income and the 6MWT in patients with severe COPD after adjusting for age, gender, lung function, dyspnea, and living conditions (p < 0.0007). One previous publication stated the relationship between income and EC. Our research confirms and extends previous publications associating EC with income by studying a large and well characterized cohort of severe COPD patients, also addressing EC by two different methods (maximal watts and 6MWT). Our results highlight the importance of addressing social determinants of health such as income when assessing COPD patients.

Therapeutic Residential Care for Children and Youth: A Consensus Statement of the International Work Group on Therapeutic Residential Care. In many developed countries around the world residential care interventions for children and adolescents have come under increasing scrutiny. Against this background an international summit was organised in England (spring 2016) with experts from 13 countries to reflect on therapeutic residential care (TRC). The following working definition of TRC was leading: \"Therapeutic residential care involves the planful use of a purposefully constructed, multi-dimensional living environment designed to enhance or provide treatment, education, socialization, support, and protection to children and youth with identified mental health or behavioral needs in partnership with their families and in collaboration with a full spectrum of community based formal and informal helping resources\". The meeting was characterised by exchange of information and evidence, and by preparing an international research agenda. In addition, the outlines of a consensus statement on TRC were discussed. This statement, originally published in English and now reproduced in a Spanish translation, comprises inter alia five basic principles of care that according to the Work Group on Therapeutic Residental Care should be guiding for residential youth care provided at any time.