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ObjectivesTo make recommendations on improving understanding of bleeding and thrombosis with pediatric extracorporeal life support including future research directions.Data sourcesEvaluation of literature and consensus conferences of pediatric critical care and extracorporeal life support experts.Study selectionA team of 10 experts with pediatric cardiac and extracorporeal membrane oxygenation experience and expertise met through the Pediatric Cardiac Intensive Care Society to review current knowledge and make recommendations for future research to establish "best practice" for anticoagulation management related to extracorporeal life support.Data extraction/data synthesisThis white paper focuses on clinical understanding and limitations of current strategies to monitor anticoagulation. For each test of anticoagulation, limitations of current knowledge are addressed and future research directions suggested.ConclusionsNo consensus on best practice for anticoagulation monitoring exists. Structured scientific evaluation to answer questions regarding anticoagulation monitoring and bleeding and thrombotic events should occur in multicenter studies using standardized approaches and well-defined endpoints. Outcomes related to need for component change, blood product administration, healthcare outcome, and economic assessment should be incorporated into studies. All centers should report data on patient receiving extracorporeal life support to a registry.

Context: Determining and quantifying habitat selection of endangered species in peri-urban environments assists planners and managers to develop strategies and alternative conservation measures in the face of urban expansion and development. Sloane's Froglet (Crinia sloanei), listed nationally as endangered in Australia, is a little-known species distributed within peri-urban environments, where foundational ecological information and the development of adequate conservation responses has been lacking. Aims: (a) To determine a core calling period for Sloane's Froglet and detection probabilities for occupancy surveys. (b) To understand and characterise the habitat that Sloane's Froglet uses at the wetland and microhabitat scale. Methods: We used generalised linear modelling and the information-theoretic approach to model habitat preferences for this species at two scales: the waterbody scale, and the microhabitat scale. We quantified the habitat characteristics of waterbodies occupied by Sloane's Froglet in winter, its peak breeding period, by measuring the biophysical characteristics of 54 occupied and 40 unoccupied waterbodies. The microhabitat and relative spatial positioning of Sloane's Froglet within waterbodies was examined at 54 calling sites in an area of one m squared around individual male Sloane's Froglets and 57 randomly selected unused sites. Wetlands were surveyed multiple times to determine detection probabilities. Key results: Model selection indicated that Sloane's Froglet is 450 times more likely to occupy a waterbody when an adjacent ephemeral shallow overflow is present; and are more likely to be present when there is greater cover of small stem-diameter emergent vegetation and less bare ground on the bank. The microhabitat investigation of one m squared sites showed that Sloane's Froglet's calling sites are predominantly inundated, and at significantly shallower water depths, than unused sites. Sloane's Froglet was found to always call from within the waterbody, distinguishing them from other sympatric Crinia species. Conclusions: The habitat characteristics detailed provide information necessary for the management of Sloane's Froglet and its habitat. Implications: Housing and industrial development is occurring rapidly in Sloane's Froglet habitat. The information provided here can be used to refine local and state government planning and better design appropriate responses. Indeed, results from this study are currently being used by agencies and environmental consultants when developing conservation plans and in the design of stormwater retention ponds in rapidly urbanising environments. Managing habitat for threatened species in peri-urban environments is increasingly difficult as rapid urban expansion occurs. This study modelled habitat for Sloane's Froglet, a little-known endangered Australian amphibian, at waterbody and microhabitat scales, showing that wetlands with adjacent shallow overflows and small stem-diameter reeds are essential for the species' survival. Habitat needs should be considered in assessing development proposals and designing constructed wetlands, including stormwater retention ponds. Photograph by Alexandra Knight. [ABSTRACT FROM AUTHOR]

Objectives: To develop an objective, structured observational tool to enable identification and measurement of hazards in the built environment when applied to audiovisual recordings of simulations by trained raters. Background: Simulation-based facility design testing is increasingly used to optimize safety of healthcare environments, often relying on participant debriefing or direct observation by human factors experts. Methods: Hazard categories were defined through participant debriefing and detailed review of pediatric intensive care unit in situ simulation videos. Categories were refined and operational definitions developed through iterative coding and review. Hazard detection was optimized through the use of structured coding protocols and optimized camera angles. Results: Six hazard categories were defined: (1) slip/trip/fall/injury risk, impaired access to (2) patient or (3) equipment, (4) obstructed path, (5) poor visibility, and (6) infection risk. Analysis of paired and individual coding demonstrated strong overall reliability (0.89 and 0.85, Gwet's AC1). Reliability coefficients for each hazard category were >0.8 for all except obstructed path (0.76) for paired raters. Among individual raters, reliability coefficients were >0.8, except for slip/trip/fall/injury risk (0.68) and impaired access to equipment (0.77). Conclusions: Hazard Assessment and Remediation Tool (HART) provides a framework to identify and quantify hazards in the built environment. The tool is highly reliable when applied to direct video review of simulations by either paired raters or trained single clinical raters. Subsequent work will (1) assess the tool's ability to discriminate between rooms with different physical attributes, (2) develop strategies to apply HART to improve facility design, and (3) assess transferability to non-ICU acute care environments. [ABSTRACT FROM AUTHOR]