Healing Our Own: A Randomized Trial to Assess Benefits of Peer Support.

OBJECTIVES: This study aimed to develop and evaluate a structured peer support program to address the needs of providers involved in obstetric adverse outcomes. METHODS: In this pilot randomized controlled trial, participants were providers who experienced an obstetric-related adverse outcome. Providers were randomly assigned to routine support (no further follow-up) or enhanced support (follow-up with a trained peer supporter). Participants completed surveys at baseline, 3 months, and 6 months. The primary outcome was the use of resources and the perception of their helpfulness. Secondary outcomes were the effect on the recovery stages and the duration of use of peer support. RESULTS: Fifty participants were enrolled and randomly assigned 1:1 to each group; 42 completed the program (enhanced, 23; routine, 19). The 2 groups were not significantly different with respect to event type, demographics, or baseline stage; in both groups, most participants started at the stage 6 thriving path. Most participants required less than 3 months of support: 65.2% did not need follow-up after the first contact, and 91.3% did not need follow-up after the second contact. Participants who transitioned from an early stage of recovery (stages 1-3) to the stage 6 thriving path reported that they most often sought support from peers (P = 0.02) and departmental leadership (P = 0.07). Those in the enhanced support group were significantly more likely to consider departmental leadership as one of the most helpful resources (P = 0.02). CONCLUSIONS: For supporting health care providers involved in adverse outcomes, structured peer support is a practicable intervention that can be initiated with limited resources.

An examination of the effect of aerosolized Permanone insecticide on zebra finch susceptibility to West Nile virus.

West Nile virus (WNV) is maintained cryptically primarily in avian (passerine) populations, where it is transmitted by Culex spp. mosquitoes. Mosquito-control measures currently include physical activities to reduce mosquito-breeding sites and the application of mosquito larvicides or aerosolized insecticides to kill adults (adulticides) when arboviral diseases such as WNV or Zika virus are detected in mosquito populations. Organochlorine, organophosphorus, carbamate, and pyrethroid insecticides are often used. Previous work suggests an effect of pyrethroids on the immune system in a variety of vertebrates. We examined the effects of exposure to aerosolized Permanone® 30:30 insecticide (permethrin and piperonyl butoxide in soy oil vehicle) at approximately 103 to 106 times potential environmental concentrations on the response of captive zebra finches (Taeniopygia guttata) to experimental challenge with WNV. Compared to vehicle control birds, WNV outcome was unchanged (65% of birds produced a viremia) in the "low" exposure (9.52 ± 3.13 mg/m3 standard deviation [SD] permethrin) group but reduced in the "high" exposure (mean 376.5 ± 27.9 mg/m3 SD permethrin) group (30% were viremic; p < 0.05). After clearing WNV infection, birds treated with Permanone regained less body mass than vehicle-treated birds (p < 0.001). The present study suggests that exposure to aerosolized Permanone insecticide at levels exceeding typical application rates has the potential to not change or to mildly enhance a bird's resistance to WNV. Environ Toxicol Chem 2017;36:3376-3386. Published 2017 Wiley Periodicals Inc. on behalf of SETAC. This article is a US government work and, as such, is in the public domain in the United States of America.

Dynamic Radioactive Source for Evaluating and Demonstrating Time-dependent Performance of Continuous Air Monitors.

Evaluation of continuous air monitors in the presence of a plutonium aerosol is time intensive, expensive, and requires a specialized facility. The Radiation Protection Services Group at Los Alamos National Laboratory has designed a Dynamic Radioactive Source, intended to replace plutonium aerosol challenge testing. The Dynamic Radioactive Source is small enough to be inserted into the sampler filter chamber of a typical continuous air monitor. Time-dependent radioactivity is introduced from electroplated sources for real-time testing of a continuous air monitor where a mechanical wristwatch motor rotates a mask above an alpha-emitting electroplated disk source. The mask is attached to the watch's minute hand, and as it rotates, more of the underlying source is revealed. The measured alpha activity increases with time, simulating the arrival of airborne radioactive particulates at the air sampler inlet. The Dynamic Radioactive Source allows the temporal behavior of puff and chronic release conditions to be mimicked without the need for radioactive aerosols. The new system is configurable to different continuous air monitor designs and provides an in-house testing capability (benchtop compatible). It is a repeatable and reusable system and does not contaminate the tested air monitor. Test benefits include direct user control, realistic (plutonium) aerosol spectra, and iterative development of continuous air monitor alarm algorithms. Data obtained using the Dynamic Radioactive Source has been used to elucidate alarm algorithms and to compare the response time of two commercial continuous air monitors.

Validating Obstetric Emergency Checklists using Simulation: A Randomized Controlled Trial.

Background The World Health Organization's Surgical Safety Checklist has demonstrated significant reduction in surgical morbidity. The American Congress of Obstetricians and Gynecologists District II Safe Motherhood Initiative (SMI) safety bundles include eclampsia and postpartum hemorrhage (PPH) checklists. Objective To determine whether use of the SMI checklists during simulated obstetric emergencies improved completion of critical actions and to elicit feedback to facilitate checklist revision. Study Design During this randomized controlled trial, teams were assigned to use a checklist during one of two emergencies: eclampsia and PPH. Raters scored teams on critical step completion. Feedback was elicited through structured debriefing. Results In total, 30 teams completed 60 scenarios. For eclampsia, trends toward higher completion were noted for blood pressure and airway management. For PPH, trends toward higher completion rates were noted for PPH stage assessment and fundal massage. Feedback resulted in substantial checklist revision. Participants were enthusiastic about using checklists in a clinical emergency. Conclusion Despite trends toward higher rates of completion of critical tasks, teams using checklists did not approach 100% task completion. Teams were interested in the application of checklists and provided feedback necessary to substantially revise the checklists. Intensive implementation planning and training in use of the revised checklists will result in improved patient outcomes.

In-Place Filter Tester Instrument for Nuclear Material Containers.

A portable instrument was developed to determine filter clogging and container leakage of in-place nuclear material storage canisters. This paper describes the development of an in-place filter tester for determining the "as found" condition of unopened canisters. The U.S. Department of Energy uses several thousand canisters for nuclear material storage, and air filters in the canister lids allow gases to escape while maintaining an equilibrated pressure without release of radioactive contamination. Diagnosing the filter condition and canister integrity is important for ensuring worker and public safety. Customized canister interfaces were developed for suction clamping (during tests) to two of the canister types in use at Los Alamos National Laboratory. Experimental leakage scenarios included: O-rings fouled with dust, cracked O-rings, and loose canister lids. The prototype tester has a measurement range for air leakage rates from 8.2 × 10 mL s up to 3.0 × 10 mL s. This is sufficient to measure a leak rate of 3.4 × 10 mL s, which is the Los Alamos helium leak criterion for post-drop tested canisters. The In-Place-Filter-Tester cannot measure to the lower value of the helium leak criterion for pre-drop tested canisters (1.0 × 10 mL s). However, helium leak testing requires canister disassembly, while the new in-place filter tester is able to assess the assembled condition of as-found and in-situ canisters.

Determination of the internal exposure hazard from plutonium work in an open front hood.

The particle size and quantity of a plutonium dioxide surrogate escaping an open front hood during routine work was measured. Aerosols were collected using a cascade impactor, and the amount of surrogate on each stage of the impactor was measured using neutron activation analysis. The aerodynamic mass median diameter of particles in the breathing zone of a worker was found to be 0.35 ± 5.1 µm. During a 2-h period when normal work activities were mimicked, an average of 3% of the material or 11.13 ± 0.54 µg escaped the hood. This was calculated to be equivalent to 10,000 ± 487 Bq (²³9Pu). The activity in the breathing zone of the worker is estimated, based on other research, to be 36 times less than this, or approximately 280 Bq. Worker occupancy factors were considered and a committed effective dose equivalent of 5 mSv was calculated. The cost-benefit analysis showed the use of the open front hood as a reasonable protective measure. Although worker exposure may approach the International Commission on Radiological Protection limit, the cost of the ergonomic injuries caused by work in a glove box is 5,000 times greater than the dose received by the worker. Protective measures such as respiratory protection should be evaluated on a case by case basis to keep worker exposure as low as reasonably achievable.

Aerosol collection of the (Bladewerx Corporation) breathing zone monitor and portable workplace monitor.

The Radiation Protection Group at the Los Alamos National Laboratory has a wind tunnel capable of measuring the aerosol collection efficiencies of air sampling devices. In the fall of 2005, the group received an internal Los Alamos request to perform aerosol collection efficiency tests on two air samplers manufactured by the Bladewerx Corporation (Rio Rancho, NM). This paper presents the results from tests performed in the wind tunnel facility at a test velocity of 0.5 m s. The SabreAlert (Portable Workplace Monitor) and the SabreBZM (Breathing Zone Monitor) are both designed to detect and measure the presence of alpha emitting isotopes in atmospheres. The SabreAlert was operated at two test air flow rates of 6 and 45 liters per minute (LPM), and the SabreBZM was operated at two test air flow rates of 3 and 19 LPM. The aerosol collection efficiencies of both samplers were evaluated with oleic acid (monodisperse) liquid droplet aerosols tagged with sodium fluorescein tracer. These test aerosols varied in size from about 2.3 to 17.2 microns (aerodynamic equivalent diameter). The SabreAlert was roughly 100% efficient in aerosol collection at a flow rate of 6 LPM, and had an aerodynamic cutpoint diameter of 11.3 microns at the 45 LPM flow rate. The SabreBZM had an aerodynamic cutpoint diameter of 6.7 microns at the 3 LPM flow rate, but the SabreBZM aerosol collection efficiency never exceeded 13.6% at the 19 LPM test flow rate condition.