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Providing care in a twenty-first century urban emergency department (ED) and trauma center is a complex high-pressure practice environment. The pressure is intensified during patient surge scenarios commonly seen during mass casualty incidents, such that response must be practiced regularly. Beyond clinical mastery of individual patient trauma care, a coordinated system-level response is essential to optimize patient care during these relatively infrequent events. This paper highlights the need to perform exercises in hospitals while providing practical advice on how to utilize in situ simulation for mass casualty testing. Eleven lessons are presented to assist other emergency management professionals, hospital administrators, or clinical staff to achieve success with in situ simulation. Based upon our experience designing and executing an in situ mass casualty simulation within an ED, we offer lessons applicable to any type of disaster exercise. Simulation offers a powerful tool for the conduct of disaster preparedness exercises for staff across multiple hospital departments and professions.

Objectives Disaster-preparedness and response are a commonly overlooked aspect of hospital policy and can frequently be outdated and undertested. Simulation-based education has become a core education modality within Canadian medical training programs. We hypothesized that integrating in situ simulation (ISS) into a hospital-wide, mass-casualty response exercise would enhance realism and our ability to identify latent safety threats (LSTs). Methods Using ISS we created a simulated mass shooting scenario with 20 patients, played by actors in full moulage, presenting to a large tertiary care hospital over a 50-minute period. Results Integrating ISS into our exercise created a realistic experience for the participants involved and improved participant education, while imparting enough systemic stress to expose LSTs associated within patient care and hospital policy. Conclusion Overall, ISS was successfully used and enhanced a large-scale test of our hospital's mass-casualty response plan.

Objective To explore pregnant women's views of participation in a clinical research trial while pregnant. Design Prospective nested qualitative cohort study embedded within a national, multi-site randomized controlled trial of a diagnostic test for preeclampsia: Placental Growth Factor. One-to-one in-depth semi-structured interviews were undertaken with 19 women who had recently participated in the trial at a single recruiting site. The interviews were conducted in private, recorded digitally and transcribed verbatim. Setting Single tertiary maternity hospital currently recruiting eligible women onto an on-going randomized controlled trial (NCT02881073). Participants Women who had participated in the PARROT Ireland randomized controlled trial during their recent pregnancy. Methods Thematic analysis was utilized. Each line of the transcribed interviews was coded into a category by two researchers. The resultant categories were reviewed, and those with similarities were pooled allowing the development of themes. Main outcome measures Women's opinions and experience of participation in a randomized controlled trial of an interventional diagnostic test during their pregnancy. Results Four major themes were identified as follows: (a) Understanding of preeclampsia, (b) Motivators for clinical trial participation, (c) Barriers to decision making and (d) Influence of PARROT Ireland on pregnancy experience. Conclusions Women are generally interested and positively inclined to participate in research during pregnancy. The potential of risk is an important consideration for eligible pregnant woman. Information and support by both researchers and clinicians are paramount in aiding women's understanding of a research trial.

The introduction of linear functions is the turning point where many students decide if mathematics is useful or not. This means the role of parameters and variables in linear functions could be considered to be ‘threshold concepts’. There is recognition that linear functions can be taught in context through the exploration of linear modelling examples, but this has its limitations. Currently, statistical data is easily attainable, and graphics or computer algebra system (CAS) calculators are common in many classrooms. The use of this technology provides ease of access to different representations of linear functions as well as the ability to fit a least-squares line for real-life data. This means these calculators could support a possible alternative approach to the introduction of linear functions. This study compares the results of an end-of-topic test for two classes of Australian middle secondary students at a regional school to determine if such an alternative approach is feasible. In this study, test questions were grouped by concept and subjected to concept by concept analysis of the means of test results of the two classes. This analysis revealed that the students following the alternative approach demonstrated greater competence with non-standard questions.

The rejection of King Saul seems somewhat unjust. After exterminating the Amalekite enemies and capturing their King, Agag, Saul is demoted from being King of Israel. A study of the background to the battle, the battle itself, and the aftermath of it, in the textual unit 1 Sam 15:1—9, with particular reference to the literary-critical problem in 1 Sam 15:8—9, can provide the key to understanding why Saul was rejected.

Ulceration of the lower extremities is one of the most important medicosocial problems (Skobelkin et al 1990). In this article, two case studies show that it is the length of time that laser therapy is used that can have a significant impact on ulcer size.

Introduction Screening for pre-eclampsia is a focus of prenatal care and is largely based on the use of clinical risk factors. However, current screening protocols are unfit to determine pre-eclampsia risk in 1st time pregnant women; biomarkers have the potential to address this unmet need. As single biomarkers have insufficient predictive accuracy, unbiased biomarker discoveries have been performed to identify panels of markers which when combined, have the potential pre-eclampsia prediction. Metabolite based solutions using mass spectrometry have gained significant interest as they have the potential to readily translate to clinical practice. Objectives To translate the discovery that blood-borne metabolite biomarkers stratify pregnant women early in pregnancy (∼15 weeks) to their risk of pre-eclampsia [1] into a commercial LC–MS based clinical assay. To pursue fit-for-purpose testing of the first version of the developed LC–MS pipeline followed by independent verification through a case:control study. Methods The analysis pipeline incorporated (1) a single step metabolite extraction, (2) multiplex LC-QqQ-MS assays for 40+ metabolites and (3) a dedicated data processing protocol. Case:control study testing utilised 15 weeks’ plasma samples of from 50 pregnant women who subsequently developed pre-eclampsia and 500 random control pregnancies. All participants are part of the SCOPE study [2] and were recruited in Cork, Ireland. Results For the 40+ metabolite assays: 62% had a %CV £ 15% and 82% had a %CV £ 25%. Univariate analyses using the ROC statistic showed that 7 of the metabolites tested had significant predictive power (lower limit 95% CI ROC-AUC [3] 0.5). Multivariate logistic regression analysis revealed particular combinations of metabolites which identified groups of women either at increased risk or at decreased risk for pre-eclampsia. Conclusion These findings underpin the potential of metabolite-centric multimarker panels to encapsulate a complex syndrome such as pre-eclampsia considerably in advance of any clinical manifestation. Further development steps will include performing additional case:control studies and subsequent clinical validation of this metabolite based test in the large scale European, multicentre phase IIa clinical study IMproved Pregnancy Outcomes by Early Detection (IMPROvED) which is currently recruiting 1st time pregnant women in 5 European countries [3] . Acknowledgment The authors gratefully acknowledge funding from the EU-HEALTH Project IMPROvED (305169) of the Seventh Framework Programme (FP7).

This paper outlines the work of a community nursing development unit in relation to their role in health promotion and those patients suffering incontinence. The role of the nurse in health promotion has become fundamental in the new NHS in achieving the government health targets. It is well documented that incontinence is a huge problem that affects both men and women and unless a comprehensive package of care is made available many sufferers will go untreated. The underlying principles of many health promotion strategies involves changing behaviour, it is with this particular focus that district nurses at Yardley Green Nursing Development unit have attempted to understand why some patients’ progress with treatment better than others in terms of behaviour change. Patients attending a continence clinic demonstrated considerable improvement in their condition, however, the process of change is multifactoral and an increasingly complex problem providing a challenge for those involved.

This report draws from ongoing Student Privacy Initiative research as well as participant inputs from an April 2013 exploratory workshop, "Student Privacy in the Cloud Computing Ecosystem," to begin to map the current landscape and connect the often-siloed perspectives of educational institutions, students, parents, and administrators as well as cloud service providers and policy makers. Following the workshop, the Berkman Center distilled a number of high-level observations that may be particularly critical in informing and catalyzing both future research and action. Some of the key points include the following: Expanding educational and knowledge sharing efforts will be integral to engage parents, students, and teachers alongside representatives from a variety of disciplines. These diverse stakeholders may have vastly different baseline knowledge of relevant issues — from cloud computing to privacy concerns to regulatory considerations — and addressing these differences may require a multi-pronged approach. In particular, it will be important to share up-to-date information about rapidly developing educational technologies so that potential users can better understand what data vendors might access and collect as well as what the vendor might do with this data. Developing a shared vocabulary and understanding of privacy and technological termswill be central to future research, outreach, policy, and educational efforts. Taxonomies and guides can help to cultivate a shared language and bolster communication and collaboration across educational, commercial, and regulatory settings. Good practices and draft standards, especially around contractual practices and terms of service, represent a fruitful area for attention. Stakeholders should enter this space in close communication with vendors and industry representatives. Ongoing normative analysis and discussion will be critical in grappling with the many dimensions of the topic and considering how core technologies, opportunities, and behaviors may evolve. In particular, the rapid emergence of data analytics technologies raise important questions about how existing legal frameworks should be interpreted or evolve. This dialogue should be grounded in real-world examples and data, and address open questions such as whether and how cloud technologies support broader educational values and if so, what specific value trade-offs may be involved. This report offers many more concrete details regarding research, policymaking, outreach, and engagement around student privacy and cloud computing.

This research update presents an aggregation and summary of recent academic literature on youth bullying. The purpose of this document is to “translate” scholarly research for a concerned public audience, which may include but is not limited to parents, caregivers, educators, and practitioners. This translation highlights recent findings and developments in the literature and makes them accessible to the informed but non-expert reader. The document’s two guiding questions are “What is bullying?” (Section I) and “What can be done about bullying?” (Section II). Section I begins with a brief overview of key definitions and related research conversations and then addresses bullying’s prevalence, the types of individuals involved in bullying, the characteristics of individuals involved and the consequences of their involvement, and community-level dynamics related to bullying. Section II covers four areas where action has been taken to address problems associated with bullying – school policy, curricula, school climate, and parents – and ends on a note about approaches that mix or cut across these areas. The purpose is to render lessons learned from research and assessment accessible to those interested in deepening or expanding their knowledge of bullying-related issues.

Objectives Unbiased metabolite biomarker discovery has revealed that combinations of blood-borne metabolites have the potential to predict preeclampsia accurately at ca. 15 weeks of gestation (Kenny et al., 2010). Our aim is to deploy a dedicated translational effort bringing the merits of de-novo biomarker research to health care providers and patients. Methods To exploit the widespread availability of quadrupole mass spectrometers (QqQ-MS) in clinical laboratories world-wide, a platform migration to QqQ-MS was performed. To support the further refinement of the metabolites-based pre-eclampsia prediction algorithm, and the technical and clinical validation of the test, access to appropriate patient samples from prospective cohorts is warranted. A public-private partnership involving supranational government funding, clinicians and dedicated small and medium sized companies collaborated to establish a pregnancy biobank. Results Thus far, a simple metabolite extraction and a targeted LC-QqQ-MS approach using stable isotope labelled metabolites for relative quantification has been developed. The (semi-)quantitative analysis of circa 40 metabolites with very disparate physicochemical characteristics is achievable in a single 10 min run. The company is engaged in 2 dedicated public-private initiatives, i.e. SCreening fOr Pregnancy Endpoints (SCOPE) (North et al., 2011) and IMproved Pregnancy Outcomes by Early Detection (IMPROvED) (Navaratnam et al., 2013). These collaborations are instrumental for the further clinical and technical validation of the test under development. Conclusions Development of a dedicated translational effort to further exploit newly discovered biomarkers relevant to the prediction of preeclampsia has already resulted in an analytical method ready for testing in clinically relevant patient cohorts. Public–private biobanking efforts have proved to be a cost-efficient means enabling both additional basic biomarker research and progression of biomarkers to market. Disclosures: L. Bond: employee Metabolomic Diagnostics. C. Nolan: employee Metabolomic Diagnostics. K. Hyland: employee Metabolomic Diagnostics. C. Lenaerts: None. P.N. Baker: Commercial Interest: Metabolomic Diagnostics. L.C. Kenny: Commercial Interest: Metabolomic Diagnostics. R. Tuytten: employee Metabolomic Diagnostics.

Even in multicultural nations interracial relationships and marriages are quite rare, one reflection of assortative mating. A relatively unexplored factor that could explain part of this effect is that people may find members of their own racial group more attractive than members of other groups. We tested whether there is an own-race preference in attractiveness judgments, and also examined the effect of familiarity by comparing the attractiveness ratings given by participants of different ancestral and geographic origins to faces of European, East Asian and African origin. We did not find a strong own-race bias in attractiveness judgments, but neither were the data consistent with familiarity, suggesting an important role for other factors determining the patterns of assortative mating observed.

Background Apical Membrane Antigen 1 (AMA1), a polymorphic merozoite surface protein, is a leading blood-stage malaria vaccine candidate. This is the first reported use in humans of an investigational vaccine, AMA1-C1/Alhydrogel, with the novel adjuvant CPG 7909. Methods A phase 1 trial was conducted at the University of Rochester with 75 malaria-naive volunteers to assess the safety and immunogenicity of the AMA1-C1/Alhydrogel+CPG 7909 malaria vaccine. Participants were sequentially enrolled and randomized within dose escalating cohorts to receive three vaccinations on days 0, 28 and 56 of either 20 microg of AMA1-C1/Alhydrogel+564 microg CPG 7909 (n = 15), 80 microg of AMA1-C1/Alhydrogel (n = 30), or 80 microg of AMA1-C1/Alhydrogel+564 microg CPG 7909 (n = 30). Results Local and systemic adverse events were significantly more likely to be of higher severity with the addition of CPG 7909. Anti-AMA1 immunoglobulin G (IgG) were detected by enzyme-linked immunosorbent assay (ELISA), and the immune sera of volunteers that received 20 microg or 80 microg of AMA1-C1/Alhydrogel+CPG 7909 had up to 14 fold significant increases in anti-AMA1 antibody concentration compared to 80 microg of AMA1-C1/Alhydrogel alone. The addition of CPG 7909 to the AMA1-C1/Alhydrogel vaccine in humans also elicited AMA1 specific immune IgG that significantly and dramatically increased the in vitro growth inhibition of homologous parasites to levels as high as 96% inhibition. Conclusion/significance The safety profile of the AMA1-C1/Alhydrogel+CPG 7909 malaria vaccine is acceptable, given the significant increase in immunogenicity observed. Further clinical development is ongoing. Trial registration ClinicalTrials.gov NCT00344539.