Improving clinician agreement and comfort through the development of a pediatric behavioral health huddle tool.

Background: Hospitalized pediatric patients with behavioral health (BH) diagnoses awaiting transfer can exhibit behaviors that may lead to workplace violence such as aggression. Workplace violence can lead to discomfort in caring for these patients. Huddles can be used as a tool to identify potential for violence, to help address workplace violence, and improve clinician situational awareness.

Biparental incubation behaviour under temperature extremes in sandbank nesting black skimmers.

Birds nesting on riverine beaches are exposed to large temperature fluctuations, while changing water levels pose flooding risks. We used miniature temperature loggers (Buttons®) placed in nests and on the beach surface combined with time-lapse photography to study incubation behaviour in the black skimmer () on the Manu River, Peru. Since the species exhibits sexual size dimorphism, we could identify partner switches in images and the contribution to incubation effort by each pair member.

Lung Protection After Severe Thermal Burns With Adenosine, Lidocaine, and Magnesium (ALM) Resuscitation and Importance of Shams in a Rat Model.

The management of severe burns remains a complex challenge. Adenosine, lidocaine, and magnesium (ALM) resuscitation therapy has been shown to protect against hemorrhagic shock and traumatic injury. The aim of the present study was to investigate the early protective effects of small-volume ALM fluid resuscitation in a rat model of 30% total body surface area (TBSA) thermal injury.

Major surgery leads to a proinflammatory phenotype: Differential gene expression following a laparotomy.

Background: The trauma of surgery is a neglected area of research. Our aim was to examine the differential expression of genes of stress, metabolism and inflammation in the major organs of a rat following a laparotomy.

Materials And Methods: Anaesthetised Sprague-Dawley rats were randomised into baseline, 6-hr and 3-day groups (n = 6 each), catheterised and laparotomy performed.

The role of matrix metalloproteinase-9 and its inhibitor TIMP-1 in burn injury: a systematic review.

Matrix metalloproteinase-9 (MMP-9) and its endogenous inhibitor, tissue inhibitor of metalloproteinase-1 (TIMP-1), are key mediators of acute inflammation and regulators of the wound healing process. The aim of this systematic review was to determine the local and systemic involvement of the MMP-9/TIMP-1 system following burn injury. Two databases (Scopus and MEDLINE) were searched for all studies reporting MMP-9 and/or TIMP-1 after burn injury.

The morbidity associated with paediatric burn wound escharotomies.

Introduction: An escharotomy is an effective surgical procedure for the rapid decompression of a constricting and unyielding eschar, to permit restoration of blood flow. However, an escharotomy is also a full-thickness incision, which adds additional scarring to the burn injury area. The cosmetic and functional morbidity of escharotomy scarring in children is poorly characterised.

Community-based conservation with formal protection provides large collateral benefits to Amazonian migratory waterbirds.

Populations of migratory waterbirds are facing dramatic declines worldwide due to illegal hunting, habitat loss and climate change. Conservation strategies to reverse these trends are imperative, especially in tropical developing countries, which almost invariably allocate insufficient levels of investment for environmental protection. Here, we compared the effectiveness of sustainable-use Protected Areas (PAs) and Community-based Conservation (CBC) arrangements for the conservation of migratory waterbirds that breed on seasonal riverine sandy beaches in Brazilian Amazonia.

The lethal heat dose for 50% primary human fibroblast cell death is 48 °C.

Understanding the effect of heat on skin cells is important for the prevention of burn injury. Knowledge of the heat dose required to kill cells can be used to study the cellular mechanisms involved in thermal injury cell death, to assist with the development of novel burn treatments. In this study, primary human skin dermal fibroblasts were exposed to temperatures from 37 to 54 °C for 1 h and the relative cell viability of heat-treated and control cells was assessed.

Seeking Care at Free Episodic Health Care Clinics in Appalachia.

Background: People who live in rural Appalachia experience a wide variety of problems when seeking access to health care. Health care disparities continue to be one of the most complex and prevalent problems, and many barriers exist for impoverished men and women such as a lack of education, complications with health insurance, and personal distrust of healthcare providers.

Purpose: A critical gap in the literature is the unheard voice of persons in rural underserved areas.

Traumatic-Induced Coagulopathy as a Systems Failure: A New Window into Hemostasis.

Traumatic-induced coagulopathy (TIC) is often associated with significant bleeding, transfusion requirements, inflammation, morbidity, and mortality. This review considers TIC as a systems failure, not as a single-event manifestation of trauma. After briefly reviewing the meaning of TIC and the bewildering array of fibrinolysis phenotypes, we will discuss the role of platelets and fibrinogen in coagulopathy.

A new model for standardising and treating thermal injury in the rat.

Thermal burn injury methodologies are inconsistently described within the current literature. To permit the advancement of new treatments there is an urgent need for the development and standardisation of an acute rat model. We describe a rat thermal burn model that involves: anaesthesia, chronic catheterisation, skin preparation, baseline hemodynamic and physiological monitoring, and a quantifiable method to reproduce a severe full-thickness burns injury affecting ∼30% percent of the total body surface area (%TBSA).

The role of invasive monitoring in the resuscitation of major burns: a systematic review and meta-analysis.

Increasingly, in major hospitals invasive monitoring endpoints are utilised to guide the acute resuscitation of burns. The aim of this review is to evaluate effects of invasive monitoring for major burns patients (>20% total body surface area) to prevent early organ dysfunction. Five databases were searched for randomised controlled trials and cohort studies that evaluated invasive monitoring within the acute phase (first 24 hours).

Third stage of labour management practices: A secondary analysis of a prospective cohort study of Australian women and their associated outcomes.

Objective: This study aimed to describe practices used during the third stage of labour in a cohort of Australian women and explore clinical outcomes such as postpartum hemorrhage and clinical decision making associated with these practices.

Design: This study employed a prospective cohort design and reports a secondary analysis of a primary study that examined factors associated with PPH; specifically relating to third stage management practices.

Setting: It was conducted in three linked sites, in Queensland, Australia: a regional hospital, rural hospital and a private-practising midwifery service.

Nursing considerations and interdisciplinary coordination in the care of conjoined twins.

Traditional nursing care strategies may require modification to meet the unique needs of conjoined twins. Here we discuss the strategies found to be useful in planning for and responding to distinctive circumstances encountered throughout hospitalization, as well as lessons learned. Areas of focus include ensuring privacy, designing adequate unit accommodations to meet space and equipment needs, staffing considerations and adaptations to typical neonatal intensive care nursing interventions.

Identifying the risk: a prospective cohort study examining postpartum haemorrhage in a regional Australian health service.

Background: In industrialised countries the incidence of postpartum haemorrhage (PPH) is increasing, for which exact etiology is not well understood. Studies have relied upon retrospective data with estimated blood loss as the primary outcome, known to be underestimated by clinicians. This study aimed to explore variables associated with PPH in a cohort of women birthing vaginally in coastal Queensland, Australia, using the gravimetric method to measure blood loss.

Barriers to Health Care Access for Low Income Families: A Review of Literature.

Having a low-income presents a variety of problems for families and children, with access to health care being the most complex and prevalent. Although there are many challenges for low-income families to access adequate health care in the United States, the key barriers identified in this review of literature are a lack of education, complications with health insurance, and a distrust of health care providers. Each obstacle is influenced by a myriad of factors that affect vulnerable sub-groups of low-income families.

Immune-inflammatory activation after a single laparotomy in a rat model: effect of adenosine, lidocaine and Mg infusion to dampen the stress response.

Our aim was to examine the effect of low-volume 0.9% NaCl adenosine, lidocaine and Mg (ALM) 'drip' on early immune-inflammatory activation after a single laparotomy with no further manipulation. Male Sprague-Dawley rats were anesthetized and randomly assigned to one of the groups, baseline, 1 h infusion 0.

Living with the Choice: A Grounded Theory of Iraqi Refugee Resettlement to the U.S.

Though the United States has become a place of increasing resettlement for refugees, particularly Iraqi refugees who have been forced to flee their homeland due to violence, persecution and civil unrest, little is known about Iraqi refugee resettlement in the United States, or the way in which resettlement impacts health and adjustment. A grounded theory study was conducted to develop a substantive theory of Iraqi refugee resettlement. Participants in the qualitative study included 29 Iraqi refugees and 2 community partners who participated in face-to face interviews.

Disaster Impact on Impoverished Area of US: An Inter-Professional Mixed Method Study.

Unlabelled: Introduction In the foothills of the Cumberland Mountains, in central Appalachia (a region that spans 13 states in the US), sits an economically distressed and rural community of the United States. Once a thriving coal-mining area, this region now is reported as one of the hardest places to live in the US. Southeastern Kentucky, located in a remote, rocky, mountainous area surrounded by rivers and valleys and prone to flooding, experienced a major flood in Spring 2013 causing significant damage to homes and critical infrastructure.

Birds of Two Oceans? Trans-Andean and Divergent Migration of Black Skimmers (Rynchops niger cinerascens) from the Peruvian Amazon.

Seasonal flooding compels some birds that breed in aquatic habitats in Amazonia to undertake annual migrations, yet we know little about how the complex landscape of the Amazon region is used seasonally by these species. The possibility of trans-Andes migration for Amazonian breeding birds has largely been discounted given the high geographic barrier posed by the Andean Cordillera and the desert habitat along much of the Pacific Coast. Here we demonstrate a trans-Andes route for Black Skimmers (Rynchops niger cinerascens) breeding on the Manu River (in the lowlands of Manu National Park, Perú), as well as divergent movement patterns both regionally and across the continent.

When communication fails: resolving end-of-life impasses.

Various protocols and advance directives can prepare physician assistants for difficult conversations with patients about end-of-life care. This case scenario explores the roles and influences that complicated one patient's care and how the situation was resolved.

East with the night: longitudinal migration of the Orinoco goose (Neochen jubata) between Manú National Park, Peru and the Llanos de Moxos, Bolivia.

We report on the intra-Amazonian migration of a pair of Orinoco Geese (Neochen jubata) from Manú National Park, Peru. The species is Critically Endangered in Peru, so a major aim of the study was to aid conservation planning by learning the wet season location of the country's last known breeding population. We captured a breeding pair on October 27, 2010, and fitted the birds with Microwave Telemetry, Inc.

Underreporting of complementary and alternative medicine use among arthritis patients in an orthopedic clinic.

Underreporting of complementary and alternative medicine (CAM) use can negatively affect patient care. The degree of such underreporting in a clinical orthopedic setting was assessed in a cross-sectional study of 50 patients with osteoarthritis by administering a standard medical history and then a specific CAM-use questionnaire. Of these patients, 70% were using CAM, and 64% underreported CAM use on the standard medical history.

To cry or not to cry: analyzing the dimensions of professional vulnerability.

In this article, the authors analyze the concept of professional vulnerability, as it relates to crying and the nursing profession. The span of potential professional vulnerability extends through all the nursing clinical, academic, and research environments. A dimensional analysis is the method used to analyze systematically how the concept of professional vulnerability is socially constructed and contextually situated in nursing.