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To quantify staff burnout and wellbeing in emergency departments (EDs) throughout New Zealand (NZ).A national cross sectional electronic survey of New Zealand clinical and non-clinical ED staff was conducted between 9 March and 3 April 2020. Burnout and wellbeing were assessed using the Copenhagen Burnout Inventory (CBI) and a variety of quantitative measures. Differences between measures were assessed by demography and work role using univariate analyses. Multivariate analyses assessed associations between burnout and wellbeing.1,372 staff responded from 22 EDs around New Zealand (response rate 43%). Most were female (n=678, 63%), NZ European (n=799, 59%), aged 20-39 years (n=743, 54%) and nurses (n=711, 52%). The overall prevalence of personal burnout was 60%, work-related burnout 55% and patient-related burnout 19%. There was a wide variation of burnout across all EDs. Females and nurses showed the highest degree of burnout by gender and role, respectively. Measures of wellbeing with significant negative correlations with burnout were work-related happiness, work-life balance, job satisfaction and perceived workplace excellence. Work stress had significant positive correlation with burnout.New Zealand ED staff have a high degree of burnout. Safety, financial sustainability and quality of care are likely being adversely affected. Stakeholders can be informed by findings from this study to inspire meaningful interventions in EDs and throughout the New Zealand healthcare system.

Introduction Emergency department (ED) staff face daily exposure to the illness, injury, intoxication, violence and distress of others. Rates of clinician burnout are high and associated with poor patient outcomes. This study sought to measure the prevalence of burnout in ED personnel as well as determine the important facilitators of and barriers to workplace wellbeing. Method An anonymous online survey including six open-ended questions on workplace wellbeing was completed by 1372 volunteer participants employed as nurses, doctors, allied health or nonclinical roles at 22 EDs in Aotearoa, New Zealand in 2020. Responses to the questions were analysed using a general inductive approach. Results The three key themes that characterise what matters most to participants' workplace wellbeing are: (1) Supportive team culture (2) Delivering excellent patient-centred care and (3) Professional development opportunities. Opportunities to improve wellbeing also focused on enhancements in these three areas. Conclusion In order to optimise workplace wellbeing, emergency departments staff value adequate resourcing for high-quality patient care, supportive and cohesive teams and professional development opportunities. Initiatives in these areas may facilitate staff wellbeing as well as improving safety and quality of patient care.

This dissertation explores the intersection of childhood and wildness within the literary movement of German realism. The latter half of the nineteenth century saw the introduction of mandatory education and the consolidation of the middle-class family, both of which established childhood as a distinct phase. The literary movement of German realism emerged at the same time, with a focus on representing ordinary life and experiences with a particular concentration on bourgeois values and norms.. But many children in the works of this movement prove more fantastical than realistic, more extraordinary than ordinary, and more deviant than safely bourgeois. This study therefore examines how representations of wild children interact with the aesthetics of the average within German realism. Ultimately, this dissertation has two main points: First, depictions of wild children should not be read solely as a means of celebrating the average, middle class reality of the nineteenth-century through a strategy of the literary containment of wild children. Rather, the wild child initiates a redemptive transformation of reality and is a means for introducing that which would otherwise escape representation in realist prose fiction. Second, the frequent appearance of wild children within the literary movement of German realism serves as a rhetorical strategy to depict a changing nineteenth-century reality with regard to education, family, gender, nation and art, as well as a means to question the success of these structures. In order to make these arguments, this dissertation engages with four types of wild children: literary descendants of Goethe’s Mignon, fairytale children, differently-abled children associated with the figure of Kaspar Hauser, and criminal children. It also considers the intersection of gender and wildness and the ways in which the language of wildness, culture and civilization have been used in Western literary traditions, particularly in a late-nineteenth-century German context.

Purpose: The aim was to validate a food frequency questionnaire (FFQ) against a 3-day food record (3DFR) for pregnant women with a focus on nutrients important for bone health from food and supplements. Methods: The FFQ and 3DFR were administered to pregnant women (n = 42) aged 18–45 years in their third trimester of pregnancy in Hamilton, Ontario. Nutrient analysis of intakes was conducted using an FFQ calculator and Nutritionist-Pro software. The average daily serving consumption of Milk and alternatives group and Vegetable subgroup from Canada’s Food Guide were also compared. Results: There was a high positive correlation between methods for total dietary vitamin D (r = 0.83). Low positive associations were observed for total protein (r = 0.37), calcium (r = 0.36), vitamin K (r = 0.41), and servings of Milk and alternatives (r = 0.36). A cross-classification analysis using participants’ intake quartiles revealed no major misclassifications. Bland–Altman analysis showed that the FFQ mildly underestimated the intake for protein, whereas it grossly overestimated the intake of vitamin K, and daily servings of Milk and alternatives and Vegetable. Conclusions: This FFQ can serve as a useful tool in clinical and research settings to assess key bone nutrients from foods and supplement sources in pregnant women.

Objective To evaluate the relationship between maternal self-reported race/ethnicity and persistent wheezing illness in former high-risk, extremely low gestational age newborns, and to quantify the contribution of socioeconomic, environmental, and biological factors on this relationship. Study design We assessed persistent wheezing illness determined at 18-24 months corrected (for prematurity) age in survivors of a randomized trial. Parents/caregivers were surveyed for wheeze and inhaled asthma medication use quarterly to 12 months, and at 18 and 24 months. We used multivariable analysis to evaluate the relationship of maternal race to persistent wheezing illness, and identified mediators for this relationship via formal mediation analysis. Results Of 420 infants (25.2 ± 1.2 weeks of gestation and 714 ± 166 g at birth, 57% male, 34% maternal black race), 189 (45%) had persistent wheezing illness. After adjustment for gestational age, birth weight, and sex, infants of black mothers had increased odds of persistent wheeze compared with infants of nonblack mothers (OR = 2.9, 95% CI 1.9, 4.5). Only bronchopulmonary dysplasia, breast milk diet, and public insurance status were identified as mediators. In this model, the direct effect of race accounted for 69% of the relationship between maternal race and persistent wheeze, whereas breast milk diet, public insurance status, and bronchopulmonary dysplasia accounted for 8%, 12%, and 10%, respectively. Conclusions Among former high-risk extremely low gestational age newborns, infants of black mothers have increased odds of developing persistent wheeze. A substantial proportion of this effect is directly accounted for by race, which may reflect unmeasured environmental influences, and acquired and innate biological differences. Trial registration ClinicalTrials.gov : NCT01022580 .

The majority of patients who present to the Emergency Department (ED) with chest pain, do not have Acute Coronary Syndrome (ACS). Rapid, safe discharge home for this large group is hampered by clinical uncertainty. A pragmatic Accelerated Diagnostic Pathway (ADP) used in our ED achieves this goal. AiIM: To demonstrate the safety and utility of a locally developed ADP. The primary outcome for patients who were identified as non-high risk by our ADP was death or acute myocardial infarction (AMI) at 30 days. Secondary outcomes were ED length of stay, discharge rates, provocative testing and revascularisation rates.This is a prospective observational convenience cohort study of chest pain patients presenting to a regional ED excluding ST-elevation myocardial infarction (STEMI). Using a locally derived ADP, patients were classified as high risk or non-high risk for 30-day death or AMI. Patients could be classified as high risk on the basis of ECG change, troponin elevation, or senior clinician "gestalt" irrespective of negative serial ECGs and troponins. All others were classified non-high risk and were followed up at 30 days.There were 452 patient events with the ADP identifying 75% as non-high-risk (93% of these patients were actually discharged). All patients were successfully followed up for 30-day outcomes. The sensitivity and negative predictive value of the ADP was 100% (95% CI: 99-100%). Specificity was 83% (95% CI: 79-87%). The average ED length of stay was 4 hours 5 minutes. There were low rates of revascularisation (1.5%) and provocative testing (6.2%) in the non-high risk group.This ED ADP for chest pain rapidly and safely identified patients who were not at high risk of a short-term AMI or death.

Over the past three years there have been many positive changes to the quality of services (for example, the colorectal department) and to the number of services offered by Hinchingbrooke (provision of in-house urology; ear, nose, and throat; and plastic and hand surgery). Recent data on mortality show that it is significantly lower than in other hospitals and the overall trend for mortality is reducing.1 We have had no …

The MNT1 gene of the human fungal pathogen Candida albicans is involved in O-glycosylation of cell wall and secreted proteins and is important for adherence of C. albicans to host surfaces and for virulence. Here we describe the molecular analysis of CaMNT2, a second member of the MNT1-like gene family in C. albicans. Mnt2p also functions in O-glycosylation. Mnt1p and Mnt2p encode partially redundant alpha-1,2-mannosyltransferases that catalyze the addition of the second and third mannose residues in an O-linked mannose pentamer. Deletion of both copies of MNT1 and MNT2 resulted in reduction in the level of in vitro mannosyltransferase activity and truncation of O-mannan. Both the mnt2Delta and mnt1Delta single mutants were significantly reduced in adherence to human buccal epithelial cells and Matrigel-coated surfaces, indicating a role for O-glycosylated cell wall proteins or O-mannan itself in adhesion to host surfaces. The double mnt1Deltamnt2Delta mutant formed aggregates of cells that appeared to be the result of abnormal cell separation. The double mutant was attenuated in virulence, underlining the importance of O-glycosylation in pathogenesis of C. albicans infections.

With routine prenatal diagnosis offered to pregnant women, cases of anencephaly are diagnosed and managed in the early stages of pregnancy. As cases of anencephaly have a lethal outcome, termination of pregnancy is offered. This has led to a lack of familiarity for clinicians on how to manage on-going anencephalic pregnancies from the obstetrics point of view. We present a case of late diagnosis of anencephalic pregnancy where the mother has opted to continue with the pregnancy.

(2003). Spontaneous oesophageal rupture in the second stage of labour. Journal of Obstetrics and Gynaecology: Vol. 23, No. 6, pp. 668-669.