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Research facilities such as spallation sources and synchrotrons generate radiation for use in atomic-level or molecular-scale experiments. These facilities can be viewed as complex safety-critical systems. An important aspect of the safety management of such systems is the short safety education and training programme the users are required to undergo in order to gain facility access. As research on the topic is limited, this study aimed to increase the knowledge about current education design and practice using the perspectives of safety science and pedagogy. Study objectives were to identify preconditions that impact the safety education design, to describe current design and practice of the safety education, and to identify weaknesses and possibilities for improvement. Site visits with a total of 20 interviews were performed at three research facilities. The results show the need for sufficient resources to maintain learning activities for users, provide pedagogical continuing education for educators, and maintain safety culture-enhancing activities to meet the challenges of having large numbers of short-term facility users. Increased focus should be placed on safety-related competence needs and the mapping of these to match the competence of individual users. New thinking and innovation can benefit the design and provision of such education activities, based on both socio-technical system and system safety perspectives.

Abstract Background There is growing evidence that Internet-based cognitive behavioral therapy (ICBT) is as effective as a stand-alone treatment and helps facilitating access to treatment. Given the complexity of the treatment, we argue that the effect of ICBT could be even greater if guided by a therapist, as this could increase treatment adherence. We modified an established and well-evaluated treatment approach and developed a mobile application for treating social anxiety disorder (SAD). In the present study, we compare the efficacy of app use alone (APP) with video-based, therapist-guided app use (TG-APP) and with a wait-list control group (WLC) in terms of symptom reduction, and various secondary outcomes such as increase in quality of life or decrease of general psychological distress. Methods/design A within-between interaction design with randomization to one of three conditions will be used. In the APP condition, patients receive only the app without any additional contact with therapists, while in the TG-APP condition, therapists provide 8 sessions of video-based treatment in addition to using the app. The study will be conducted in two university outpatient treatment centers with reliably diagnosed SAD patients. The primary outcome will be defined as change in SAD symptoms, as measured by the Liebowitz Social Anxiety Scale (expert rating). Furthermore, a wide range of self-reports and clinician ratings for other symptoms (depression, general psychopathology) or quality of life will be used. A simulation-based power analysis for a 3 × 2 interaction effect (group × time) on the primary outcome in a linear mixed model resulted in a total sample size of N = 165. Discussion The present study will be one of the first to examine the additional benefit of therapist-guided video sessions regarding the use of an app treating SAD. Study results are pivotal to future treatment application in SAD.

Background/aims An effective workflow at the endoscopy unit is important for optimal production. We conducted a time-and-motion study to identify the amount of time that patients spend during the different steps of a regular endoscopy procedure and compared propofol with midazolam sedation. Methods Data from 376 patients were prospectively collected. Durations of the different procedure steps were measured. Correlations between recovery times, age, and dose of sedative were calculated. Multiple regression analysis was performed to evaluate how various factors affect recovery time. Results The use of midazolam resulted in significantly shorter procedure duration for gastroscopy (5.1 vs 8.3 min), shorter endoscopist delay duration for either types of endoscopy (5.9 vs 8.3 min for gastroscopy and 6.7 vs 11.4 min for colonoscopy), shorter endoscopy room duration for gastroscopy (22.2 vs 30.0 min), shorter recovery time for colonoscopy (23.4 vs 27.4 min) and shorter Endoscopy Unit Duration for either type of endoscopy (77.1 vs 101.4 min for gastroscopy and 99.6 vs 123.2 min for colonoscopy). There was a weak correlation between dose of midazolam and recovery time. Conclusions In contrast to other studies, propofol administration leads to more time spent at different steps in the workflow at our unit. Implementing propofol sedation will not improve efficacy if other steps in the workflow are not taken into account.

Abstract Background Management and monitoring of pain and sedation to reduce discomfort as well as side effects, such as over- and under-sedation, withdrawal syndrome and delirium, is an integral part of pediatric intensive care practice. However, the current state of management and monitoring of analgosedation across European pediatric intensive care units (PICUs) remains unknown. The aim of this survey was to describe current practices across European PICUs regarding the management and monitoring of pain and sedation. Methods An online survey was distributed among 357 European PICUs assessing demographic features, drug choices and dosing, as well as usage of instruments for monitoring pain and sedation. We also compared low- and high-volume PICUs practices. Responses were collected from January to April 2021. Results A total of 215 (60% response rate) PICUs from 27 European countries responded. Seventy-one percent of PICUs stated to use protocols for analgosedation management, more frequently in high-volume PICUs (77% vs 63%, p = 0.028). First-choice drug combination was an opioid with a benzodiazepine, namely fentanyl (51%) and midazolam (71%) being the preferred drugs. The starting doses differed between PICUs from 0.1 to 5 mcg/kg/h for fentanyl, and 0.01 to 0.5 mg/kg/h for midazolam. Daily assessment and documentation for pain (81%) and sedation (87%) was reported by most of the PICUs, using the preferred validated FLACC scale (54%) and the COMFORT Behavioural scale (48%), respectively. Both analgesia and sedation were mainly monitored by nurses (92% and 84%, respectively). Eighty-six percent of the responding PICUs stated to use neuromuscular blocking agents in some scenarios. Monitoring of paralysed patients was preferably done by observation of vital signs with electronic devices support. Conclusions This survey provides an overview of current analgosedation practices among European PICUs. Drugs of choice, dosing and assessment strategies were shown to differ widely. Further research and development of evidence-based guidelines for optimal drug dosing and analgosedation assessment are needed.

In wide-ranging attacks on academic freedom in Turkey in recent years, thousands of academics have lost their university positions. At the end of 2016 oppositional academics, many of whom were dismissed from their positions for having signed a peace petition, established a Street Academy as an alternative way to reach out to both students and the public in Ankara. In this study we analyse the experiences of these street academy lecturers from the perspective of Social Representation Theory. Our main aims were to explore teaching experience perceptions and representations and, in addition, also the opportunities and challenges generated by this alternative academy. Data consisted of semi-structured interviews with five female and five male street academy lecturers. The results of a qualitative thematic analysis revealed that the way participants explained their experiences could be organised into three major themes and several subordinate themes. One of the most salient results was that participating in the street Academy had become a way to defend academic freedom. More generally suggested results demonstrated that teaching in this new setting, outside of the universities and away from customised learning environments, was quite a novel experience. The possible implications of street academy lecturers' experiences are discussed.

Attacks on academic freedom in Turkey have become increasingly systematic in recent years and thousands of academics have been dismissed. This study reflects on the effects of this worsening repression through interviews with academics in the social sciences, both those dismissed and those still active in their profession. Although the dismissed academics are socially in a very precarious position, they are continuing their scholarly activities in alternative, underground forms. This resistance stands in contrast to the accommodation and self-censorship that seem, according to the interviewees, to prevail in university departments.

Feather pecking and cannibalism are 2 major problems in laying hens' husbandry. Although additional environmental enrichment material (EM) supply is thought to lessen these problems, consistent evidences are lacking. This study examined the effects of EM supply (pecking stones and alfalfa bales) on biological performance, carcass composition, and animal losses in a littered housing system. 2,000 brown-egg and 2,000 white-egg layer hen pullets of the genetic strains Lohmann Brown classic and Lohmann Selected Leghorn classic, respectively, were reared separately in a 16-compartment aviary system until week 18. 1,320 remaining laying hens were then transferred to a 44-compartment laying stable (weeks 19–48). Both strains were tested under 4 treatment variants (n = 150–180 per strain and per variant): V1—no EM over the entire study period; V2—the rearing period with and the laying period without EM; V3—the rearing period without and the laying period with EM; V4—EM over the entire study period. Data on development, performance, egg quality, feed intake, EM consumption, animal losses, carcass composition, and economic traits were collected. Enrichment material supply during rearing (V2 and V4, both strains) was found to globally increase not only hens' relative gizzard mass (P = 0.036) but also the cracked eggs' percentage (compared with V3; P = 0.008) and to decrease the body mass in weeks 6 (P = 0.023) and 8 (P = 0.023) and the uniformity in week 16 (P = 0.011). Enrichment material provision during the laying period (V3 and V4, both strains) increased egg weights (P = 0.028) and the mean body mass (P = 0.036); however, continuous provision of EM (V4, both strains) increased the floor eggs' percentage (P = 0.019). The EM supply did not affect mortality, loss of production days, losses due to skin and toe cannibalism, or the income over feed costs. However, the income over feed and enrichment costs of V1 hens was higher by 0.55 €/hen than that of V4 hens (P = 0.022). Therefore, EM supply cannot be recommended as a measure to increase laying performance and reduce animal losses, but its positive effects on animal welfare should be considered.

Background and SignificanceAdvances in pediatric intensive care have led to markedly improved survival rates in critically ill children. Approximately 70% of those children survive with varying forms of complex chronic diseases or impairment/disabilities. Length of stay, length of mechanical ventilation and number of interventions per patient are increasing with rising complexity of underlying diseases, leading to increasing pain, agitation, withdrawal symptoms, delirium, immobility, and sleep disruption. The ICU-Liberation Collaborative of the Society of Critical Care Medicine has developed a number of preventative measures for prevention, early detection, or treatment of physical and psychiatric/psychological sequelae of oftentimes traumatic intensive care medicine. These so called ABCDEF-Bundles consist of elements for (A) assessment, prevention and management of pain, (B) spontaneous awakening and breathing trials (SAT/SBT), (C) choice of analgesia and sedation, (D) assessment, prevention and management of delirium, (E) early mobility and exercise and (F) family engagement and empowerment. For adult patients in critical care medicine, research shows significant effects of bundle-implementation on survival, mechanical ventilation, coma, delirium and post-ICU discharge disposition. Research regarding PICS in children and possible preventative or therapeutic intervention is insufficient as yet. This narrative review provides available information for modification and further research on the ABCDEF-Bundles for use in critically ill children.Material and MethodsA narrative review of existing literature was used.ResultsOne obvious distinction to adult patients is the wide range of different developmental stages of children and the even closer relationship between patient and family. Evidence for pediatric ABCDEF-Bundles is insufficient and input can only be collected from literature regarding different subsections and topics.ConclusionIn addition to efforts to improve analgesia, sedation and weaning protocols with the aim of prevention, early detection and effective treatment of withdrawal symptoms or delirium, efforts are focused on adjusting ABCDEF bundle for the entire pediatric age group and on strengthening families' decision-making power, understanding parents as a resource for their child and involving them early in the care of their children.

BackgroundThe Post Intensive Care Syndrome (PICS) describes new impairments of physical, cognitive, social, or mental health after critical illness. In recent years, prevention and therapy concepts have been developed. However, it is unclear whether and to what extent these concepts are known and implemented in hospitals in German-speaking countries.MethodsWe conducted an anonymous online survey in German-speaking pediatric intensive care units on the current state of knowledge about the long-term consequences of intensive care treatment as well as about already established prevention and therapy measures. The request to participate in the survey was sent to the heads of the PICUs of 98 hospitals.ResultsWe received 98 responses, 54% of the responses came from nurses, 43% from physicians and 3% from psychologist, all working in intensive care. As a main finding, our survey showed that for only 31% of the respondents PICS has an importance in their daily clinical practice. On average, respondents estimated that about 42% of children receiving intensive care were affected by long-term consequences after intensive care. The existence of a follow-up outpatient clinic was mentioned by 14% of the respondents. Frequent reported barriers to providing follow-up clinics were lack of time and staff. Most frequent mentioned core outcome parameters were normal developmental trajectory (59%) and good quality of life (52%).ConclusionOverall, the concept of PICS seems to be underrepresented in German-speaking pediatric intensive care units. It is crucial to expand knowledge on long-term complications after pediatric critical care and to strive for further research through follow-up programs and therewith ultimately improve long-term outcomes.

Severe feather pecking is a damaging allopecking behavior in pullets and laying hens which was found to be associated with multiple factors. The aim of this study was to investigate whether the occurrence of feather pecking could be reduced by additional environmental enrichment materials (EM; pecking stones and hard-pressed alfalfa bales) in a littered housing system. In total 4,000 pullets (2000 Lohmann Brown classic [LB] and 2000 Lohmann Selected Leghorn classic [LSL]) were reared in an aviary system until week 18, and 1,320 remaining laying hens were kept thereafter, from week 19 to 48. During rearing, half of the compartments were permanently supplied with enrichment materials, while the other half did not receive any EM. After transferring to the laying hens’ stable, we examined the hens under four treatment variants: V1 - no EM over the entire study period; V2 - rearing period with and laying period without EM; V3 - rearing period without and laying period with EM; V4 - EM over the entire study period. The integument condition (i.e. beak protrusion, beak fissures, plumage condition, skin and toe injuries, and foot pad dermatitis) was scored in weeks 2, 4, 6, 10, 14, 18 (rearing) and 25, 30, 40, and 48 (laying period). At the end of the study (week 48), lower plumage damage was observed in the variants provided with EM during rearing (V2 and V4) compared to the other two variants (V1 and V3; P < 0.001). Skin injuries were less prevalent in week 40 in hens with access to EM during rearing (V2 and V4) than the other variants (V1 and V3) within LSL (P < 0.001), and in week 48 in the both strains (P < 0.001). The variants with access to EM during the laying period (V3 and V4) showed lesser protrusion of the beak tip in week 48 (P < 0.001). The observed beneficial effects of EM could be attributed to its impact on foraging behavior and beak-tip abrasion.

Mandana Fallahpour, 1, 2 Lena Borell, 1 Linda Sandberg, 1 Anne-Marie Boström 3–5 1Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden; 2Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden; 3Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet Stockholm, Solna, Sweden; 4Theme Aging, Karolinska University Hospital, Stockholm, Sweden; 5Department of Nursing, Western Norway University of Applied Science, Haugesund, NorwayCorrespondence: Mandana FallahpourDepartment of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Fack 23200, Huddinge SE-141 83, Stockholm, SwedenTel +46 8 524 838 56Fax +46 8 34 50 14Email Mandana.Fallahpour@ki.seIntroduction: An increasing number of older persons live at home with various limitations, such as dementia, requiring well-educated and trained home care staff to meet their complex care needs. Dementia care specialists working in home care service have reported high levels of job strain in comparison with home care staff in general.Aim: This pilot study aims to evaluate the effects of a dementia care education model targeting self-reported job strain and organizational climate, among dementia care specialists in home care service.Methods: A quasi-experimental, one-group pretest–posttest design was applied, with 12 months’ follow-up. Participants were dementia care specialists who worked in home care service (n=34 baseline; n=30 follow-up). The data were collected using the Strain in Dementia Care Scale and Creative Climate Questionnaires, administered pre- and post-intervention. The intervention applied an educational model based on previous research in dementia care and a person-centered approach.Results: The educational model was implemented in the context of home care services. Of 34 participants at baseline, only 21 responded to the questionnaires, due to a drop off of 13 participants and recruitment of 9 new participants (follow-up=30). A significantly reduced perceived job strain among the participants was detected, indicating perceiving less difficulty in “Balancing competing needs” when caring for the older persons. No significant difference was found in the self-reported creative organizational climate between the two occasions.Conclusion: The educational model could be integrated into dementia home care and it seemed to reduce job strain among dementia care specialists. Future studies are needed to evaluate the effects of the intervention using a stronger study design and a larger sample.Keywords: creative climate questionnaire, dementia, home care services, interventions, job strain, national guidelines, strain in dementia care scale