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Background: Across international healthcare systems, healthcare assistant roles have proliferated, in part to decrease nursing costs and support workplace staffing. There is a lack of consensus about the professional title for healthcare assistants, and whether this group requires professional regulation. The variety of terms for healthcare assistants has resulted in confusion around their scope of practice and role within the healthcare team, which may influence patient care. Aim: We aimed to identify the terminology used for healthcare assistants across English speaking countries and determine the international status of professional regulation of healthcare assistants. Method: We conducted a deductive, structured search for healthcare assistant roles that were codified on English-language nursing regulator websites in each jurisdiction in Australia, New Zealand, USA, Canada, Ireland, and the United Kingdom. We assessed what terminology were used for healthcare assistant roles in each area, and whether they were regulated by a professional regulator, such as a college of nursing. Results: Across 77 jurisdictions, we identified 37 different terms for healthcare assistants. The most frequent term was Certified Nurse Aid with 24 uses, and Certified Nursing Assistant with 13 uses. The majority of healthcare assistants are not professionally regulated. Only 12 jurisdictions have professional regulation programs for healthcare assistants, all in the USA. Conclusion: There is an urgent need for international consensus about the nomenclature for healthcare assistants, so the healthcare assistant workforce can be supported, and their work evaluated via research studies. Regulators can consider how to engage with healthcare assistants and protect the public, as healthcare assistants provide an increasing proportion of patient care.

Background: The experience of cardiovascular diseases affects various physical, psychological, social and existential aspects of the patient. But, after studying the research background, it was found that Each of the conducted studies have studied only one of these dimensions. Therefore, the absence of a research that examines all the mentioned components in relation to each other is a sign of the existence of a scientific gap in this field. Aims: The present research was conducted with the aim of studying the "disease experience" in people suffering from cardiovascular diseases. Methods: In this qualitative research, interpretive phenomenological method was used. Sampling was done using the purposeful sampling method and in order to collect data, a semi-structured interview based on the axes proposed by Spradley (2016) was conducted individually with 16 cardiovascular patients. The data were analyzed based on the 6-step strategy of Smith, Larkin and Flowers (2021) and using MAXQDA-2020 software. Results: From the analysis of the findings, the central category of "Disease-caused Transformations" was identified, which includes five main categories of phenomenal body, agency barrier, communication interference, difficult emotional experiences, and existential challenges. Conclusion: According to the obtained results, it can be said that cardiovascular diseases cause profound changes in various aspects of the patients' personal and social life. Using the categories identified in the current research can be a guide for specialists to evaluate that In which of the categories of "pathological changes" does the cardiovascular patient have more serious problems and as a result, it can help specialists in designing and implementing interventions according to the same category.

Abstract Background The overdose crisis continues across Canada which calls for novel harm reduction strategies. Previous research indicates that a majority of eHealth solutions are cost-effective however current literature on the cost-benefit of eHealth for harm reduction is sparse. The National Overdose Response Service (NORS) is a Canada-wide telephone-based harm reduction service. Service users can call the phone number and connect to a peer who can virtually monitor the substance use session and dispatch appropriate interventions in the case of overdose. Objectives of the research/project We aim to assess the cost-benefit of NORS by comparing the estimated cost-savings from prevented overdose mortality to the operating costs of the program, alongside healthcare costs associated with its operation. Methods Data around systems costs and operational costs were gathered for our calculations. Our primary outcome was cost-benefit ratios, derived from estimates and models of mortality rates in current literature and value of life lost. We presented our main results across a range of values for costs and the probability of death following an unwitnessed overdose. These values were utilized to calculate cost-benefit ratios and value per dollar spent on service provision by NORS over the length of the program’s operation (December 2020–2022). Results Over the total funded lifespan of the program, and using a Monte Carlo estimate, the benefit-to-cost ratio of the NORS program was 8.59 (1.53–15.28) per dollar spent, depending on estimated mortality rates following unwitnessed overdose and program operation costs. Further, we conservatively estimate that early community-based naloxone intervention results in healthcare system savings of $4470.82 per overdose response. Conclusions We found the NORS program to have a positive benefit-to-cost ratio when the probability of death following an unwitnessed overdose was greater than 5%. NORS and potentially other virtual overdose monitoring services have the potential to be cost-effective solutions for managing the drug poisoning crisis.

Here, Rouet et al. present a strategy for the identification of broadly neutralising antibodies against SARS-CoV-2 receptor binding domain from peripheral blood mononuclear cells of convalescent patients, which enabled the identification of a new class 6 epitope.

Abstract Background Nurses are known to have negative health outcomes related to their work. While it is acknowledged that nursing work is associated with things like back injuries and burnout, there is limited evidence as to what factors in the work environment contribute to these issues. Purpose The aims of this study were to assess how Licensed Practical Nurses (LPNs) report their Health-related quality of life (HRQoL), and how nurses’ health is impacted by their work environment. Methods These data used for analysis comes from a cross-sectional survey administered online to all LPNs in Alberta (2018). The survey collected data on the following variables: participant’s demographics, the SF-36 HRQoL, Practice Environment Scale of the Nursing Work Index (PES-NW) and the CD-RISC measure of resilience. The beta distribution was used to model HRQoL outcomes. In instances where optimal health (score of ‘1’) was observed then an extended version of beta distribution (called one—inflated beta) was applied. Results 4,425 LPNs responded to the survey. LPNs (mean age: 40) report lower scores on each SF-36 subscale than the general Canadian population aged 35–44. LPNs who work ‘causal’ had better physical health, (OR 1.21, CI 1.11–1.32, p = 0.000), and mental health (OR 1.22, CI 1.12–1.30, p = 0.000) than LPNs who work full time, even after controlling for resilience. LPNs’ views on the adequacy of staffing and resources in their workplaces have an influence across all dimensions of health. Conclusion This study suggests that improvements in the work environment could positively impact health outcomes and that adequate resourcing could support the nursing workforce.

Abstract Background and aims We report on a cost analysis study, using population level data to determine the emergency service costs avoided from emergency overdose management at supervised consumption services (SCS). Design We completed a cost analysis from a payer’s perspective. In this setting, there is a single-payer model of service delivery. Setting In Calgary, Canada, ‘Safeworks Harm Reduction Program’ was established in late 2017 and offers 24/7 access to SCS. The facility is a nurse-led service, available for client drop-in. We conducted a cost analysis for the entire duration of the program from November 2017 to January 2020, a period of 2 years and 3 months. Methods We assessed costs using the following factors from government health databases: monthly operational costs of providing services for drug consumption, cost of providing ambulance pre-hospital care for clients with overdoses who could not be revived at the facility, cost of initial treatment in an emergency department, and benefit of costs averted from overdoses that were successfully managed at the SCS. Results The proportion of clients who have overdosed at the SCS has decreased steadily for the duration of the program. The number of overdoses that can be managed on site at the SCS has trended upward, currently 98%. Each overdose that is managed at the SCS produces approximately $1600 CAD in cost savings, with a savings of over $2.3 million for the lifetime of the program. Conclusion Overdose management at an SCS creates cost savings by offsetting costs required for managing overdoses using emergency department and pre-hospital ambulance services.

Abstract Background Guillain‐Barré syndrome (GBS) is a rare inflammatory peripheral nerve disorder with variable recovery. Evidence is lacking on experiences of people with GBS and measurement of these experiences. Objective We aimed to develop and validate an instrument to measure experiences of people with GBS. Design We used a cross‐sectional design and online self‐administered questionnaire survey. Question domains, based on a previous systematic review and qualitative study, covered experiences of GBS, symptom severity at each stage, healthcare and factors supporting or hindering recovery. Descriptive, exploratory factor and reliability analyses and multivariable regression analysis were used to investigate the relationships between variables of interest, explore questionnaire reliability and validity and identify factors predicting recovery. Setting and Participants People with a previous diagnosis of GBS were recruited through a social media advert. Results A total of 291 responders, of different sexes, and marital statuses, were included, with most diagnosed between 2015 and 2019. Factor analysis showed four scales: symptoms, information provided, factors affecting recovery and care received. Positive social interactions, physical activity including physiotherapy and movement, changes made at home and immunoglobulin treatment were important for recovery. Multivariable models showed that immunoglobulin and/or plasma exchange were significant predictors of recovery. Employment and recovery factors (positive interactions, work support and changes at work or home, physical activity and therapy), though associated with recovery, did not reach statistical significance. Conclusion The questionnaire demonstrated good internal reliability of scales and subscales and construct validity for people following GBS. Patient Contribution Patients were involved in developing and piloting the questionnaire.

Circulating cell-free tumor DNA (ctDNA) can serve as a real-time biomarker of tumor burden and provide unique insights into the evolving molecular landscape of cancers under the selective pressure of immunotherapy. Tracking the landscape of genomic alterations detected in ctDNA may reveal the clonal architecture of the metastatic cascade and thus improve our understanding of the molecular wiring of therapeutic responses. While liquid biopsies may provide a rapid and accurate evaluation of tumor burden dynamics during immunotherapy, the complexity of antitumor immune responses is not fully captured through single-feature ctDNA analyses. This underscores a need for integrative studies modeling the tumor and the immune compartment to understand the kinetics of tumor clearance in association with the quality of antitumor immune responses. Clinical applications of ctDNA testing in patients treated with immune checkpoint inhibitors have shown both predictive and prognostic value through the detection of genomic biomarkers, such as tumor mutational burden and microsatellite instability, as well as allowing for real-time monitoring of circulating tumor burden and the assessment of early on-therapy responses. These efforts highlight the emerging role of liquid biopsies in selecting patients for cancer immunotherapy, monitoring therapeutic efficacy, determining the optimal duration of treatment and ultimately guiding treatment selection and sequencing. The clinical translation of liquid biopsies is propelled by the increasing number of ctDNA-directed interventional clinical trials in the immuno-oncology space, signifying a critical step towards implementation of liquid biopsies in precision immuno-oncology.

Abstract Aims and objectives This study aimed to understand how licenced practical nurses perceive their work environments across different work settings and to analyse the association between these nurses’ perceptions of their work environments and their intentions to stay employed at their current nursing unit. Design A cross‐sectional descriptive survey was conducted with Licensed Practical Nurses in Alberta, Canada. Methods The study population consisted of 598 licenced practical nurses. Survey measures included demographic information, the Perceived Work Environment‐Nursing Work Index, and an intention to stay scale. Descriptive statistics were calculated and mean scores for perceptions about the work environment were compared by work setting. The associations between perceived work environment and intention to stay were analysed using linear regression. Results Overall, licenced practical nurses rated their work environment as mixed, with statistically significantly lower scores in acute care settings. Nurse manager ability and adequate staffing and resources were the highest contributing variables.

Abstract Taxanes are a leading cause of severe and often permanent chemotherapy‐induced alopecia. As the underlying pathobiology of taxane chemotherapy‐induced alopecia remains poorly understood, we investigated how paclitaxel and docetaxel damage human scalp hair follicles in a clinically relevant ex vivo organ culture model. Paclitaxel and docetaxel induced massive mitotic defects and apoptosis in transit amplifying hair matrix keratinocytes and within epithelial stem/progenitor cell‐rich outer root sheath compartments, including within Keratin 15+ cell populations, thus implicating direct damage to stem/progenitor cells as an explanation for the severity and permanence of taxane chemotherapy‐induced alopecia. Moreover, by administering the CDK4/6 inhibitor palbociclib, we show that transit amplifying and stem/progenitor cells can be protected from paclitaxel cytotoxicity through G1 arrest, without premature catagen induction and additional hair follicle damage. Thus, the current study elucidates the pathobiology of taxane chemotherapy‐induced alopecia, highlights the paramount importance of epithelial stem/progenitor cell‐protective therapy in taxane‐based oncotherapy, and provides preclinical proof‐of‐principle in a healthy human (mini‐) organ that G1 arrest therapy can limit taxane‐induced tissue damage.

BackgroundGuillain-Barré syndrome (GBS) is an immune-mediated polyradiculoneuropathy, with an incidence of 1-2/100,000 per year. Its severity is variable, ranging from very mild cases with brief weakness to severe paralysis, leading to inability to breathe independently, or even death. Currently there is limited evidence exploring the experiences of GBS patients. The aim of this study was to review patients' experiences and perceptions of GBS and its variants at diagnosis, discharge and during recovery, by conducting a systematic review and thematic meta-synthesis of qualitative studies of patients' experiences of GBS (and its variants).MethodsWe searched twelve electronic databases, supplemented with internet searches and forward and backward citation tracking from the included studies and review articles. Data were synthesised thematically following the Thomas and Harden approach. The CASP Qualitative Checklist was used to assess the quality of the included studies of this review.ResultsOur search strategy identified a total of 5,282 citations and after removing duplicates and excluding citations based on title and abstract, and full-text screening, five studies were included in the review and meta-synthesis; all included studies were considered of acceptable quality. Through constant discussions and an iterative approach, we developed six analytical themes following a patient's journey from suspecting that they had a health problem, through to being hospitalised, experiencing ongoing difficulties, slowly recovering from GBS, adjusting to their new circumstances, and re-evaluating their lives.ConclusionsDespite the variety of experiences, it was evident from all included studies that being diagnosed with and surviving GBS was a life-changing experience for all participants.Trial registrationProtocol was registered (CRD42019122199) on the International Prospective Register of Systematic Reviews (http://www.crd.york.ac.uk/PROSPERO).

Antibodies against coronavirus spike protein potently protect against infection and disease, but whether such protection can be extended to variant coronaviruses is unclear. This is exemplified by a set of iconic and well-characterized monoclonal antibodies developed after the 2003 SARS outbreak, including mAbs m396, CR3022, CR3014 and 80R, which potently neutralize SARS-CoV-1, but not SARS-CoV-2. Here, we explore antibody engineering strategies to change and broaden their specificity, enabling nanomolar binding and potent neutralization of SARS-CoV-2. Intriguingly, while many of the matured clones maintained specificity of the parental antibody, new specificities were also observed, which was further confirmed by X-ray crystallography and cryo-electron microscopy, indicating that a limited set of VH antibody domains can give rise to variants targeting diverse epitopes, when paired with a diverse VL repertoire. Our findings open up over 15 years of antibody development efforts against SARS-CoV-1 to the SARS-CoV-2 field and outline general principles for the maturation of antibody specificity against emerging viruses.

Background Immune checkpoint inhibitors (ICIs) have expanded treatment options for metastatic renal cell carcinoma (mRCC); however, there are limited predictive biomarkers for response to ICIs in this indication, with programmed death-ligand 1 (PD-L1) status demonstrating little predictive utility in mRCC. While predictive of ICI response in other tumor types, the utility of tumor mutation burden (TMB) in mRCC is unclear. Here, we assess TMB, loss of antigen presentation genes and PD-L1 status correlated with outcomes to ICI treatment in mRCC.Methods Tumor samples from 34 patients with mRCC treated with ICI therapy at Duke Cancer Institute were retrospectively evaluated using Personal Genome Diagnostics elio tissue complete (RUO version), a tumor genomic profiling assay for somatic variants, TMB, microsatellite status and genomic status of antigen presentation genes. Tumor samples were also analyzed with the Dako 28-8 PD-L1 immunohistochemistry assay. Deidentified clinical information was extracted from the medical record, and tumor response was evaluated based on the Response Evaluation Criteria In Solid Tumors (RECIST) V.1.1 criteria.Results Patients were stratified by overall response following ICI therapy and designated as progressive disease (PD; n=18) or disease control groups (DC; n=16). TMB scores ranged from 0.36 to 12.24 mutations/Mb (mean 2.83 mutations/Mb) with no significant difference between the PD and DC groups (3.01 vs 2.63 mutations/Mb, respectively; p=0.7682). Interestingly, 33% of PD patients displayed loss of heterozygosity of major histocompatibility complex class I genes (LOH-MHC) vs 6% of DC patients. Nine of 34 samples were PD-L1-positive (4 in the PD group; 5 in the DC group), suggesting no correlation between PD-L1 expression and response to ICI therapy. Notably, the DC group displayed an enrichment of mutations in DNA repair genes (p=0.04), with 68.8% exhibiting at least one mutated homologous recombination repair (HRR)-related gene compared with only 38.9% of the PD group (p=0.03).Conclusions Overall, neither TMB nor PD-L1 correlated with ICI response and TMB was not significantly associated with PD-L1 expression. The higher incidence of LOH-MHC in PD group suggests that loss of antigen presentation may restrict response to ICIs. Separately, enrichment of HRR gene mutations in the DC group suggests potential utility in predicting ICI response and a potential therapeutic target, warranting future studies.

Among rural families, rates of both child obesity and household food insecurity (FI) are higher compared to non-rural families. These disparities result from a complex interplay of social and environmental conditions that influence behavior. The Transtheoretical Model suggests individual readiness to change underlies success in modifying obesity-preventing behaviors; however, whether an association between readiness to change obesity-related behaviors and FI status among rural families exists is unknown. We examined the association between readiness to change family-level nutrition and physical activity (PA) behaviors that predict child obesity and family FI status within a sample of rural families to better understand these relationships. Families (n=144) were recruited from six rural Oregon communities in 2013. Families completed a FI screener and the Family Stage of Change Survey (FSOC), a measure of readiness to change family-level nutrition and PA behaviors associated with obesity. Demographic differences by FI status were explored, and regression was applied to examine relationships between FI and FSOC scores, adjusting for relevant covariates. Among FI families (40.2%), more were non-white (77.8% vs. 22.2%; p=0.036) and had lower adult education (30.4% vs. 11.8% with >high school degree; p=0.015) compared to non-FI families. After adjusting for education, race, ethnicity, and eligibility for federal meal programs, readiness to provide opportunities for PA was lower among FI families (p=0.002). These data highlight a need to further investigate how food insecurity and low readiness to provide PA opportunities, i.e. “physical activity insecurity” may be contributing to the higher obesity rates observed among rural children and families. Keywords: Food insecurity, Physical activity, Rural, Childhood obesity

Interleukin-2 (IL-2) is a T-cell proliferating factor used for cancer immunotherapy. Here, the authors develop a long-lived variant of IL-2 that, mutated in its binding domain, drives a much more potent tumour regression by depleting CD25+ CD4+regulatory T-cells via targeting them for phagocytosis.

The ocean knows no political borders. Ocean processes, like summertime wind-driven upwelling, stretch thousands of kilometers along the Northeast Pacific (NEP) coast. This upwelling drives marine ecosystem productivity and is modulated by weather systems and seasonal to interdecadal ocean-atmosphere variability. Major ocean currents in the NEP transport water properties such as heat, fresh water, nutrients, dissolved oxygen, pCO2, and pH close to the shore. The eastward North Pacific Current bifurcates offshore in the NEP, delivering open-ocean signals south into the California Current and north into the Gulf of Alaska. There is a large and growing number of NEP ocean observing elements operated by government agencies, Native American Tribes, First Nations groups, not-for-profit organizations, and private entities. Observing elements include moored and mobile platforms, shipboard repeat cruises, as well as land-based and estuarine stations. A wide range of multidisciplinary ocean sensors are deployed to track, for example, upwelling, downwelling, ocean productivity, harmful algal blooms, ocean acidification and hypoxia, seismic activity and tsunami wave propagation. Data delivery to shore and observatory controls are done through satellite and cell phone communication, and via seafloor cables. Remote sensing from satellites and land-based coastal radar provide broader spatial coverage, while numerical circulation and biogeochemical modeling complement ocean observing efforts. Models span from the deep ocean into the inland Salish Sea and estuaries. NEP ocean observing systems are used to understand regional processes and, together with numerical models, provide ocean forecasts. By sharing data, experiences and lessons learned, the regional ocean observatory is better than the sum of its parts.

Marine carbon dioxide (CO2) system data has been collected from December 2014 to June 2018 in the Northern Salish Sea (NSS; British Columbia, Canada) and consisted of continuous measurements at two sites as well as spatially- and seasonally distributed discrete seawater samples. The array of CO2 observing activities included high-resolution CO2 partial pressure (pCO2) and pHT (total scale) measurements made at the Hakai Institute’s Quadra Island Field Station (QIFS) and from an Environment Canada weather buoy, respectively, as well as discrete seawater measurements of pCO2 and total dissolved inorganic carbon (TCO2) obtained during a number of field campaigns. A relationship between NSS alkalinity and salinity was developed with the discrete datasets and used with the continuous measurements to highly resolve the marine CO2 system. Collectively, these datasets provided insights into the seasonality in this historically under-sampled region and detail the area’s tendency for aragonite saturation state (Ωarag) to be at non-corrosive levels (i.e., Ωarag > 1) only in the upper water column during spring and summer months. This depth zone and time period of reprieve can be periodically interrupted by strong northwesterly winds that drive short-lived (∼1 week) episodes of high-pCO2, low-pH, and low-Ωarag conditions throughout the region. Interannual variability in summertime conditions was evident and linked to reduced northwesterly winds and increased stratification. Anthropogenic CO2 in NSS surface water was estimated using data from 2017 combined with the global atmospheric CO2 forcing for the period 1765 to 2100, and projected a mean value of 49 ± 5 μmol kg-1 for 2018. The estimated trend in anthropogenic CO2 was further used to assess the evolution of Ωarag and pHT levels in NSS surface water, and revealed that wintertime corrosive Ωarag conditions were likely absent pre-1900. The percent of the year spent above Ωarag = 1 has dropped from ∼98% in 1900 to ∼60% by 2018. Over the coming decades, winter pHT and spring and summer Ωarag are projected to decline to conditions below identified biological thresholds for select vulnerable species.

Introduction Clinical reasoning is a complex cognitive process that involves multiple steps. Diagnosing and remediating clinical reasoning difficulties requires faculty to have an understanding of the cognitive theory behind clinical reasoning, familiarity with terminology, and a framework to identify different domains of struggle in their learners. Published resources on faculty development to diagnose and remediate clinical reasoning difficulties are limited. We created and implemented a workshop to assist faculty in developing these skills based on the five-domain framework described by Audétat, Laurin, and Sanche. This workshop provides all the materials needed to replicate this training with faculty at other institutions. Methods The workshop consists of a didactic component and case-based active learning in small groups. Each case focuses on different domains of clinical reasoning difficulties and targets different learner levels (preclinical medical students through residents). The workshop was given in multiple venues in 2016 and 2017. Results Participants reported the session was valuable (4.71/5.0), the facilitators were effective (4.5/5.0), and the objectives were met (4.28/5.0). They highlighted the strengths of the interactive format, the framework to diagnose and remediate clinical reasoning difficulties, and the excellent take-home resources. They suggested more time for the workshop, revision of cases to better highlight difficulties, and refinement of instructions to approach the cases. These suggestions were incorporated into the current iteration of the workshop. Discussion We successfully implemented a workshop for diagnosing and remediating clinical reasoning difficulties in multiple venues. The sessions were diverse in terms of faculty participants and learner groups addressed.

The High Commissioner on National Minorities' (HCNM) role as a normative actor is significant both for understanding the success of this specific instrument as well as the crucial importance of norms in diffusing and ultimately overcoming minority/majority tensions more generally. Security, like politics, is a fundamentally normative activity. Within this context, actors engage in a political process intended to secure a particular normative outcome. In the HCNM's case, that outcome is security for minorities and majorities understood as a plural democracy in which diversity is recognized and respected.

A qualitative intervention was used to explore how older adults living in a long-term care environment (nursing home) understand hope and experience being participants in a group in which a hope intervention was carried out. A group project in which each session focused intentionally on a hope strategy was carried out with a convenience sample of 10 women (ages 75–99) who were members of an existing group. Data were analyzed using thematic analysis of the interviews (conducted before the group intervention was carried out and again at the end), field notes, and collaborative conversations regarding emerging themes. Findings from this study suggest that hope is not static and that it can change over time in response to one’s situations and circumstances. Also evident in this study is the potential for using a group process in long-term care to foster hope in an intentional way to make it more visible in the lives of the residents and their environment suggesting that one is “never too old for hope.”

Abstract Given the rarity of pediatric cardiopulmonary arrests, pediatric residents' experience in participating in resuscitations is very limited, even in large tertiary care centers. In our experience, a significant obstacle to their resuscitation performance is residents' limited awareness of which emergency supplies are available to them, where they are located, or how to access them, resulting in disorganized and inefficient leadership performance during resuscitations. We developed this scavenger hunt activity to offer an interactive and practical method of orienting residents to the emergency management supplies and other resources available to them in the inpatient clinical setting. Having a working knowledge of their supplies will increase residents' ability to more efficiently and effectively lead and participate in resuscitations. In addition, this learning activity can facilitate residents' establishment of interprofessional relationships with ancillary staff throughout the medical center as they conduct their search. We have implemented this activity with multiple resident groups during this academic year. It was clear since the beginning of our implementation that our residents enjoyed this interactive learning activity, and they have remained very enthusiastic participants. The element of competition between teams is particularly appealing to some residents, who make the activity that much more engaging for the rest of the learner group. To assess knowledge retention related to resuscitation equipment and emergency systems of care for pediatric patients in our medical center, we conducted a 6-month follow-up assessment using a 48-item quiz with scavenger hunt participants. They scored higher on the question items assessing knowledge of emergency supply location compared to controls. Based on this data, we have concluded that the scavenger hunt activity can help improve residents' knowledge of available emergency equipment and resources in their medical center compared to traditional training experiences alone.

Abstract Introduction Although pediatric residents frequently encounter acutely ill children in the hospital, emergency room, and intensive care settings, most do not receive focused instruction on how to manage acute, life-threatening conditions in the outpatient setting where many of these children will present. Given that the emergency equipment, the staff's experience and skill levels, and other resources are entirely different in the outpatient office setting than in acute care settings, we have created a training curriculum with content focused on the unique needs of the outpatient setting in maintaining emergency readiness. The focus of this module is to give residents a strong foundation of knowledge and broader awareness of the issues involved in outpatient emergency preparedness, and teach residents how to effectively stabilize patients in the outpatient setting using available staff and on-site resources. Methods The materials in this resource are divided into three parts: (1) an introductory training session on outpatient pediatric emergencies, (2) a series of practice management workshops, and (3) a series of team-training sessions on patient stabilization in the outpatient setting. Competency-based goals and objectives, a detailed description of each curriculum segment, and recommendations for implementation are included in the instructor's guide. All didactic materials, small-group activity worksheets, facilitator's guides to group discussions and simulation-based resuscitation exercises, and other materials associated with this curriculum are also included with this submission. Results We gathered subjective data from participating residents before and after all three portions of this curriculum in the form of self-assessments of their skills related to outpatient emergency management and office preparedness. The results showed significant improvement in posttraining versus pretraining self-assessment scores for all skills assessed, for residents in all levels of training. Further, outpatient general pediatrics faculty noted that the residents are very effectively and efficiently able to manage patient emergencies which have arisen in their clinic since the curriculum implementation began. Discussion The overall design of this curriculum is founded upon the best evidence in adult learning principles, providing trainees with multiple interactive learning activities that require them to problem-solve, practice self-reflection, and participate in deliberate practice. Instructors may implement the training content in this resource in multiple ways, either as a series of separate training sessions or as a single, extended training session. Future studies should be undertaken to determine if this type of training results in improved patient outcomes. As pediatric emergencies occur in relatively small numbers, gathering data at the patient outcomes level will be challenging but no less important.

Background. Prescription drug misuse among young adults is increasingly viewed as a public health concern, yet most research has focused on student populations and excluded high-risk groups. Furthermore, research on populations who report recent prescription drug misuse is limited. This study examined patterns of prescription drug misuse among high-risk young adults in Los Angeles (LA) and New York (NY), which represent different local markets for illicit and prescription drugs. Design and Methods. Between 2009 and 2011, 596 young adults (16 to 25 years old) who had misused prescription drugs within the past 90 days were interviewed in Los Angeles and New York. Sampling was stratified to enroll three groups of high-risk young adults: injection drug users (IDUs); homeless persons; and polydrug users. Results. In both sites, lifetime history of receiving a prescription for an opioid, tranquilizer, or stimulant was high and commonly preceded misuse. Moreover, initiation of opioids occurred before heroin and initiation of prescription stimulants happened prior to illicit stimulants. NY participants more frequently misused oxycodone, heroin, and cocaine, and LA participants more frequently misused codeine, marijuana, and methamphetamine. Combining prescription and illicit drugs during drug using events was commonly reported in both sites. Opioids and tranquilizers were used as substitutes for other drugs, e.g., heroin, when these drugs were not available. Conclusion. Patterns of drug use among high-risk young adults in Los Angeles and New York appear to be linked to differences in local markets in each city for illicit drugs and diverted prescription drugs.

While digital tools are often recommended for researchers, there is a lack of evidence around effective social media strategies among researchers to optimise participant recruitment and data collection. However, an 'add Facebook and stir' approach could create extra burden for participants or foil researchers' efforts. Participant recruitment using digital tools requires a high degree of knowledge and strategy to be effective. Data collection with digital tools offers new avenues for social researchers to engage with different types of data. Online photos, databases, and social media posts offer opportunities to use data analysis techniques like thematic analysis or photovoice with broad data sets. There are specific ethical issues with digital recruitment and data collection, including relationship boundaries and informed consent. The insights in this article can support researchers to widen participation in their studies, sample from broader geographic areas and data sets, access different kinds of data, and increase the feasibility of social research.

Although in Canada, hearing screening and early intervention are presented as a health need, we question whether young deaf and hard of hearing children's access to language is adequately supported by public health and children's services. The Ontario Infant Hearing Program has the stated mandate of supporting the language development of deaf and hard of hearing infants and young children. However, this program presents parents with early intervention service options involving either spoken or signed language, but not both together. This policy effectively restricts access to sign language learning for a majority of Ontario's deaf children. Consequently, some deaf children suffer language deprivation and its deleterious effects on cognition and emotional development. In support of our arguments, we refer to Article 25 of the United Nations Convention on the Rights of Persons with Disabilities (CRPD), which Canada has signed and ratified. The CRPD supports recognition of deaf children's right to sign language as a health need because language deprivation occurs in many children who are not offered sign language, and this is a permanent impairment imposed on top of hearing loss. We conclude that in Canada, health services for deaf children do not align with accessibility and human rights legislation, thus creating a policy gap that leaves deaf children vulnerable to additional impairment., Author(s): Kristin Snoddon [sup.1] , Jennifer Jackson Paul [sup.2] Author Affiliations: (1) grid.68312.3e, 0000 0004 1936 9422, School of Early Childhood Studies, Ryerson University, , 350 Victoria St., M5B 2K3, [...]