Search results for: Melissa James Maceachern

Authors: Alene Toulany, Elizabeth Dettmer, Seena Grewal, Kaley Roosen, Andrea Regina, Cathleen Steinegger, Kate Stadelman, Melissa Chambers, Lindsay Lochhead, Kelsey Gallagher, Alissa Steinberg, Andrea Leyser, Allison Lougheed, Jill Hamilton

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Obesity and psychiatric disorders occur together so frequently that the combination has been coined an epidemic within an epidemic. Youth living with obesity are at increased risk for trauma, depression, anxiety and disordered eating. Although symptoms of binge eating disorder are common in paediatric obesity management programs, they are often not identified or addressed within treatment. At The Hospital for Sick Children (SickKids), a tertiary care paediatric hospital in Toronto, Canada, adolescents with obesity are treated in an interdisciplinary outpatient clinic (1-2 hours/week). This intensity of care is simply not enough to help these extremely complex patients. Existing day treatment programs for eating, and psychiatric disorders are not well suited for patients with obesity. In order to address this identified care gap, a unique collaboration was formed between the obesity, psychiatry, and eating disorder programs at SickKids in 2015. The aim of this collaboration was to provide an enhanced treatment arm to our general psychiatry day hospital program that addresses both the mental health issues and the lifestyle challenges common to youth with obesity and binge eating. The program is currently in year-one of a two-year pilot project and is designed for a length of stay of approximately 6 months. All youth participate in daily group therapy, academics, and structured mealtimes. The groups are primarily skills-based and are informed by cognitive/dialectical behavioural therapies. Weekly family therapy and individual therapy, as well as weekly medical appointments with a psychiatrist and a nurse, are provided. Youth in the enhanced treatment arm also receive regular sessions with a dietitian to establish normalized eating behaviours and monthly multifamily meal sessions to address challenges related to behaviour change and mealtimes in the home. Outcomes that will be evaluated include measures of mental health, anthropometrics, metabolic status, and healthcare satisfaction. At the end of the two years, it is expected that we will have had about 16 youth participants. This model of care delivery will be the first of its kind in Canada and is expected to inform future paediatric treatment practices.

Keywords: adolescent, binge eating, mental illness, obesity

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Authors: James Ponniah

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Christianity is the largest religious tradition of the world. What makes Christianity a world religion is its characteristics of universality and particularity. Its universality and particularity are closely interrelated. Its university is realized and embodied in its particularities and its particularity is recognized and legitimized through its universality. This paper focuses on the dimension of the particularity of Christianity in that it looks at the particularized ideas and discourses of Christian thinking in India in the 20th century and pays attention to the differing shifts and new shades of meaning in Indian Christian notion of God. Drawing upon the writings of select Indian theologians such as Brahmabandhab Upadhyaya, Sundar Sing, A.J Appasamy, Raymond Panikkar, Amalorpavadass and George Soares Prabhhu, this paper delves into how the contexts—be it personal, political, historical or ecclesial—bear upon the way Indian theologians have conceived and constructed the notion of God in their work. Focusing upon how they responded to the signs of their time through their theological narratives, the paper argues that the religion of Christianity can sustain its universality only when it translates its key notions such as God into indigenous categories and local idioms and thus makes itself relevant to the people among whom it is spread. Monotheistic God of Christianity has to accommodate plurality of expressions if Christian idea God has to capture and convey everyone’s experience of God. The case of Indian Christianity then reveals that a monolithic world religion will be experienced and recognised as truly universal only when it sheds its homogeneity and assumes a heterogeneous portrait through the acquisition of local idioms. Allowing culturally diverse idioms to influence theological categories is not inconsequential to—‘accommodating differences and accepting diversities,’ an issue we encounter within and beyond religious domains in our contemporary times.

Keywords: concept of God, heterogeneity, Indian Christianity, indigenous categories

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Authors: Andile Mkhohlakali, Tien-Chien Jen, James Tshilongo, Happy Mabowa

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Among different parameters, oxygen is one of the most important analytes of interest, dissolved oxygen (DO) concentration is very crucial and significant for various areas of physical, chemical, and environmental monitoring. Herein we report oxygen-sensitive luminophores -based lanthanum(III) trifluoromethanesulfonate), [La]³⁺ was encapsulated into SiO₂-based xerogel matrix. The nanosensor is composed of organically modified silica nanoparticles, doped with the luminescent oxygen–sensitive lanthanum(III) trifluoromethanesulfonate complex. The precursor materials used for sensing film were triethyl ethoxy silane (TEOS) and (3-Mercaptopropyltriethoxysilane) (MPTMS- TEOS) used for SiO2-baed matrices. Brunauer–Emmett–Teller (BET), and BJH indicate that the SiO₂ transformed from microporous to mesoporous upon the addition of La³⁺ luminophore with increased surface area (SBET). The typical amorphous SiO₂ based xerogels were revealed with X-Ray diffraction (XRD) and Selected Area Electron Diffraction (SAED) analysis. Scanning electron microscope- (SEM) and transmission electron microscope (TEM) showed the porous morphology and reduced particle for SiO₂ and La-SiO₂ xerogels respectively. The existence of elements, siloxane networks, and thermal stability of xerogel was confirmed by energy dispersive spectroscopy (EDS), Fourier-transform infrared spectroscopy (FTIR), and Thermographic analysis (TGA). UV-Vis spectroscopy and photoluminescence (PL) have been used to characterize the optical properties of xerogels. La-SiO₂ demonstrates promising characteristic features of an active sensing film for dissolved oxygen in the water. Keywords: Sol-gel, ORMOSILs, encapsulation, Luminophores quenching, O₂-sensing

Keywords: sol-gel, ORMOSILs, luminophores quenching, O₂-sensing

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Authors: Ange Weinrabe, James Tran, Ian B. Hickie

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Risk-taking behaviour is common during youth. In the time between adolescence and early adulthood, young people (aged 15-25 years) are more vulnerable to mood disorders, such as anxiety and depression. What impact does an emerging mood disorder have on decision-making in youth at critical decision points in their lives? In this article, we explore the impact of risk and ambiguity on youth decision-making in a clinical setting using a well-known economic experiment. At two time points, separated by six to eight weeks, we measured risky and ambiguous choices concurrently with findings from three psychological questionnaires, the 10-item Kessler Psychological Distress Scale (K10), the 17-item Quick Inventory of Depressive Symptomatology Adolescent Version (QIDS-A17), and the 12-item Somatic and Psychological Health Report (SPHERE-12), for young help seekers aged 16-25 (n=30, mean age 19.22 years, 19 males). When first arriving for care, we found that 50% (n=15) of participants experienced severe anxiety (K10 ≥ 30) and were severely depressed (QIDS-A17 ≥ 16). In Session 2, taking attrition rates into account (n=5), we found that 44% (n=11) remained severe across the full battery of questionnaires. When applying multiple regression analyses of the pooled sample of observations (N=55), across both sessions, we found that participants who rated severely anxious avoided making risky decisions. We suggest there is some statistically significant (although weak) (p=0.09) relation between risk and severe anxiety scores as measured by K10. Our findings may support working with novel tools with which to evaluate youth experiencing an emerging mood disorder and their cognitive capacities influencing decision-making.

Keywords: anxiety, decision-making, risk, adolescence

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Authors: Nisha James, Shubha Ranganathan

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One of the most poignant forms of organized crime against women, which has rarely made it to the world of Indian cinema, is that of sex trafficking, i.e. the forcible involvement of women in the sex trade through fraud or coercion (Hughes, 2005). In the space of Indian cinema, much of the spotlight has been on the sensational drug trafficking and gang mafia of Bombay. During our research on sex trafficking, the rehabilitated women interviewed often expressed strong criticism about mass media’s naive portrayal of prostitutes as money-minting, happy and sexually driven women. They argued that this unrealistic portrayal ignored the fact that this was not a reality for the majority of trafficked women. Given the gravity of sex trafficking as a human rights issue, it is, therefore, refreshing to see three recent films on sex trafficking in Indian Languages – Naa Bangaaru Talli (2014, Telugu), Mardaani (2014, Hindi) and Lakshmi (2014, Hindi). This paper reviews these three films to explore the portrayal of the everyday reality of trafficking for women. Film analysis was used to understand the representation of psychological issues in the media. The strength of these movies starts with their inspirations which are of true stories and that they are all aimed at bringing awareness about the issue of sex trafficking, which is a rising social evil in Indian society though none of the three films move to portray the next phase of rehabilitation and reintegration of victims, which is a very complex and important process in the life of a survivor. According to findings, survivors of sex trafficking find the rehabilitation and reintegration into society to be a slow and tough part of their life as they continuously face stigma and social exclusion and have to strive to live against all odds of non-acceptance starting from their family.

Keywords: film review, Indian films, sex trafficking, survivors

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Authors: Khaled Al-Badani, James Ren, Lisa Li, David Allanson

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Droplet formation is an important process in many engineering systems and manufacturing procedures, which includes welding, biotechnologies, 3D printing, biochemical, biomedical fields and many more. The volume and the characteristics of droplet formation are generally depended on various material properties, microfluidics and fluid mechanics considerations. Hence, a detailed investigation of this process, with the aid of numerical computational tools, are essential for future design optimization and process controls of many engineering systems. This will also improve the understanding of changes in the properties and the structures of materials, during the formation of the droplet, which is important for new material developments to achieve different functions, pending the requirements of the application. For example, the shape of the formed droplet is critical for the function of some final products, such as the welding nugget during Capacitor Discharge Welding process, or PLA 3D printing, etc. Although, most academic journals on droplet formation, focused on issued with material transfer rate, surface tension and residual stresses, the general emphasis on the characteristics of droplet shape has been overlooked. The proposed work for this project will examine theoretical methodologies, experimental techniques, and numerical modelling, using ANSYS FLUENT, to critically analyse and highlight optimization methods regarding the formation of pendant droplet. The project will also compare results from published data with experimental and numerical work, concerning the effects of key material parameters on the droplet shape. These effects include changes in heating/cooling rates, solidification/melting progression and separation/break-up times. From these tests, a set of objectives is prepared, with an intention of improving quality, stability and productivity in modelling metal welding and 3D printing.

Keywords: computer modelling, droplet formation, material distortion, materials forming, welding

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Authors: Yingjeng James Li, Yun Jyun Ou, Chih Chi Hsu, Chiao-Chih Hu

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A fuel cell is a device that produces electric power by reacting fuel and oxidant electrochemically. There is no pollution produced from a fuel cell if hydrogen is employed as the fuel. Therefore, a fuel cell is considered as a zero emission device and is a source of green power. A membrane electrode assembly (MEA) is the key component of a fuel cell. It is, therefore, beneficial to develop MEAs with high performance. In this study, an MEA for proton exchange membrane fuel cell (PEMFC) was prepared from a 15-micron thick reinforced PEM. The active area of such MEA is 25 cm2. Carbon supported platinum (Pt/C) was employed as the catalyst for both anode and cathode. The platinum loading is 0.6 mg/cm2 based on the sum of anode and cathode. Commercially available carbon papers coated with a micro porous layer (MPL) serve as gas diffusion layers (GDLs). The original thickness of the GDL is 250 μm. It was compressed down to 163 μm when assembled into the single cell test fixture. Polarization curves were taken by using eight different test conditions. At our standard test condition (cell: 70 °C; anode: pure hydrogen, 100%RH, 1.2 stoic, ambient pressure; cathode: air, 100%RH, 3.0 stoic, ambient pressure), the cell current density is 1250 mA/cm2 at 0.6 V, and 2400 mA/cm2 at 0.4 V. At self-humidified condition and cell temperature of 55 °C, the cell current density is 1050 mA/cm2 at 0.6 V, and 2250 mA/cm2 at 0.4 V. Hydrogen crossover rate of the MEA is 0.0108 mL/min*cm2 according to linear sweep voltammetry experiments. According to the MEA’s Pt loading and the cyclic voltammetry experiments, the Pt electrochemical surface area is 60 m2/g. The ohmic part of the impedance spectroscopy results shows that the membrane resistance is about 60 mΩ*cm2 when the MEA is operated at 0.6 V.

Keywords: fuel cell, membrane electrode assembly, proton exchange membrane, reinforced

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Authors: Przemyslaw Nogly, Tobias Weinert, Daniel James, Sergio Carbajo, Dmitry Ozerov, Antonia Furrer, Dardan Gashi, Veniamin Borin, Petr Skopintsev, Kathrin Jaeger, Karol Nass, Petra Bath, Robert Bosman, Jason Koglin, Matthew Seaberg, Thomas Lane, Demet Kekilli, Steffen Brünle, Tomoyuki Tanaka, Wenting Wu, Christopher Milne, Thomas A. White, Anton Barty, Uwe Weierstall, Valerie Panneels, Eriko Nango, So Iwata, Mark Hunter, Igor Schapiro, Gebhard Schertler, Richard Neutze, Jörg Standfuss

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Ultrafast isomerization of retinal is the primary step in a range of photoresponsive biological functions including vision in humans and ion-transport across bacterial membranes. We studied the sub-picosecond structural dynamics of retinal isomerization in the light-driven proton pump bacteriorhodopsin using an X-ray laser. Twenty snapshots with near-atomic spatial and temporal resolution in the femtosecond regime show how the excited all-trans retinal samples conformational states within the protein binding pocket prior to passing through a highly-twisted geometry and emerging in the 13-cis conformation. The aspartic acid residues and functional water molecules in proximity of the retinal Schiff base respond collectively to formation and decay of the initial excited state and retinal isomerization. These observations reveal how the protein scaffold guides this remarkably efficient photochemical reaction.

Keywords: bacteriorhodopsin, free-electron laser, retinal isomerization mechanism, time-resolved crystallography

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Authors: Melissa Langevin, Natalie Ward, Colleen Fitzgibbons, Christa Ramsey, Melanie Hogue, Anna Theresa Lobos

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Description: Root Cause Analysis (RCA) is used by health care teams to examine adverse events (AEs) to identify causes which then leads to recommendations for prevention Despite widespread use, RCA has limitations. Best practices have not been established for implementing recommendations or tracking the impact of interventions after AEs. During phase 1 of this study, we used simulation to analyze two fictionalized AEs that occurred in hospitalized paediatric patients to identify and understand how the errors occurred and generated recommendations to mitigate and prevent recurrences. Scenario A involved an error of commission (inpatient drug error), and Scenario B involved detecting an error that already occurred (critical care drug infusion error). Recommendations generated were: improved drug labeling, specialized drug kids, alert signs and clinical checklists. Aim: Use simulation to optimize interventions recommended post critical event analysis prior to implementation in the clinical environment. Methods: Suggested interventions from Phase 1 were designed and tested through scenario simulation in the clinical environment (medicine ward or pediatric intensive care unit). Each scenario was simulated 8 times. Recommendations were tested using different, voluntary teams and each scenario was debriefed to understand why the error was repeated despite interventions and how interventions could be improved. Interventions were modified with subsequent simulations until recommendations were felt to have an optimal effect and data saturation was achieved. Along with concrete suggestions for design and process change, qualitative data pertaining to employee communication and hospital standard work was collected and analyzed. Results: Each scenario had a total of three interventions to test. In, scenario 1, the error was reproduced in the initial two iterations and mitigated following key intervention changes. In scenario 2, the error was identified immediately in all cases where the intervention checklist was utilized properly. Independently of intervention changes and improvements, the simulation was beneficial to identify which of these should be prioritized for implementation and highlighted that even the potential solutions most frequently suggested by participants did not always translate into error prevention in the clinical environment. Conclusion: We conclude that interventions that help to change process (epinephrine kit or mandatory checklist) were more successful at preventing errors than passive interventions (signage, change in memory aids). Given that even the most successful interventions needed modifications and subsequent re-testing, simulation is key to optimizing suggested changes. Simulation is a safe, practice changing modality for institutions to use prior to implementing recommendations from RCA following AE reviews.

Keywords: adverse events, patient safety, pediatrics, root cause analysis, simulation

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Authors: Joy Winston James, Abdul Kadher Jilani

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This review article provides a comprehensive overview of social engineering attacks, specifically those executed through the Kali Linux operating system. It aims to present an in-depth analysis of the background and importance of social engineering in cybersecurity, the tools, and techniques used in these attacks, real-world case studies that demonstrate their effectiveness, and ethical considerations that need to be taken into account while using them. The article highlights the Kali Linux tools that are commonly used in social engineering attacks, including SET, Metasploit, and BeEF, and discusses techniques such as phishing, pretexting, and baiting that are crucial in conducting successful social engineering attacks. It further explores real-world case studies that demonstrate the effectiveness of these techniques, emphasizing the importance of implementing effective countermeasures to reduce the risk of successful social engineering attacks. Moreover, the article sheds light on ethical considerations that need to be taken into account while using social engineering tools, emphasizing the importance of using them ethically and legally. Finally, the article provides potential countermeasures such as two-factor authentication, strong password policies, and regular security audits to help individuals and organizations better protect themselves against this growing threat. By understanding the tools and techniques used in social engineering attacks and implementing appropriate countermeasures, individuals and organizations can minimize the risk of successful social engineering attacks and improve their cybersecurity posture. To illustrate the effectiveness of social engineering attacks, we present real-world case studies that demonstrate how easily individuals and organizations can fall prey to these attacks. We also discuss ethical considerations that must be taken into account while using social engineering tools, emphasizing the need for responsible and legal use of these tools.

Keywords: pen testing, hacking, Kali Linux, social engineering

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Authors: Sophie Mills, Constantinos Aristotelous, Leila L. Touil, Richard C. W. James

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Objectives: Historical studies of the anatomy of the spinal accessory nerve (SAN) have reported conflicting results regarding its relationship with the internal jugular vein (IJV). A literature review was undertaken to establish the prevalence of anatomical variations of the SAN encountered during routine neck dissection surgery in order to increase awareness and reduce morbidity associated with iatrogenic SAN injury. Materials and Methods: The largest systematic review to date was performed using PRISMA-ScR guidelines, which yielded nine articles following the application of inclusion and exclusion criteria. A case report is also included, which demonstrates the rare anatomical relationship of the SAN traversing a fenestrated IJV, seen for the first time in the senior author’s career. Results: The mean number of dissections per study was 119, of which 55.6% (n=5) studies were performed on cadaver subjects, and 44.4% (n=4) were surgical dissections. Incidences of the SAN lateral to the IJV and medial to the IJV ranged from 38.9%-95.7% and 2.8%-57.4%, respectively. Over half of the studies reported incidences of the SAN traversing the IJV in 0.9%-2.8% of dissections. One study reported an isolated variant of the SAN dividing around the IJV with a prevalence of 0.5%. Conclusion: At the level of the posterior belly of the digastric muscle, the surgeon can anticipate the identification of the SAN lateral to the IJV in approximately three-quarters of cases, whilst around one-quarter are estimated to be medial. A mean of 1.6% of SANs traverses a fenestration of the vein. It is essential for surgeons to be aware of these anatomical variations and their prevalence to prevent injury to vital structures during surgery.

Keywords: anatomical variant, internal jugular vein, neck dissection, spinal accessory nerve

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Authors: Sammy Kibor, Filip Huyghe, Marc Kochzius, James Kairo

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Goldstripe Sardinella, Sardinella gibbosa, (Bleeker, 1849) is a commercially and ecologically important small pelagic fish common in the Western Indian Ocean region. The present study aimed to assess genetic diversity and population structure of the species in the Kenya-Tanzania transboundary area using mtDNA and msDNA markers. Some 630 bp sequence in the mitochondrial DNA (mtDNA) Cytochrome C Oxidase I (COI) and five polymorphic microsatellite DNA loci were analyzed. Fin clips of 309 individuals from eight locations within the transboundary area were collected between July and December 2018. The S. gibbosa individuals from the different locations were distinguishable from one another based on the mtDNA variation, as demonstrated with a neighbor-joining tree and minimum spanning network analysis. None of the identified 22 haplotypes were shared between Kenya and Tanzania. Gene diversity per locus was relatively high (0.271-0.751), highest Fis was 0.391. The structure analysis, discriminant analysis of Principal component (DAPC) and the pair-wise (FST = 0.136 P < 0.001) values after Bonferroni correction using five microsatellite loci provided clear inference on genetic differentiation and thus evidence of population structure of S. gibbosa along the Kenya-Tanzania coast. This study shows a high level of genetic diversity and the presence of population structure (Φst =0.078 P < 0.001) resulting to the existence of four populations giving a clear indication of minimum gene flow among the population. This information has application in the designing of marine protected areas, an important tool for marine conservation.

Keywords: marine connectivity, microsatellites, population genetics, transboundary

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Authors: Ethan James

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Over one billion people worldwide suffer from some level of vision loss or blindness as a result of progressive retinal diseases. Many patients, particularly in developing areas, are incorrectly diagnosed or undiagnosed whatsoever due to unconventional diagnostic tools and screening methods. Artificial intelligence (AI) based on deep learning (DL) convolutional neural networks (CNN) have recently gained a high interest in ophthalmology for its computer-imaging diagnosis, disease prognosis, and risk assessment. Optical coherence tomography (OCT) is a popular imaging technique used to capture high-resolution cross-sections of retinas. In ophthalmology, DL has been applied to fundus photographs, optical coherence tomography, and visual fields, achieving robust classification performance in the detection of various retinal diseases including macular degeneration, diabetic retinopathy, and retinitis pigmentosa. However, there is no complete diagnostic model to analyze these retinal images that provide a diagnostic accuracy above 90%. Thus, the purpose of this project was to develop an AI model that utilizes machine learning techniques to automatically diagnose specific retinal diseases from OCT scans. The algorithm consists of neural network architecture that was trained from a dataset of over 20,000 real-world OCT images to train the robust model to utilize residual neural networks with cyclic pooling. This DL model can ultimately aid ophthalmologists in diagnosing patients with these retinal diseases more quickly and more accurately, therefore facilitating earlier treatment, which results in improved post-treatment outcomes.

Keywords: artificial intelligence, deep learning, imaging, medical devices, ophthalmic devices, ophthalmology, retina

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Authors: Aneesh Joshi, Sagil James

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Cold Spray (CS) process is deposition of solid particles over a substrate above a certain critical impact velocity. Unlike thermal spray processes, CS process does not melt the particles thus retaining their original physical and chemical properties. These characteristics make CS process ideal for various engineering applications involving metals, polymers, ceramics and composites. The bonding mechanism involved in CS process is extremely complex considering the dynamic nature of the process. Though CS process offers great promise for several engineering applications, the realization of its full potential is limited by the lack of understanding of the complex mechanisms involved in this process and the effect of critical process parameters on the deposition efficiency. The goal of this research is to understand the complex nanoscale mechanisms involved in CS process. The study uses Molecular Dynamics (MD) simulation technique to understand the material deposition phenomenon during the CS process. Impact of a single crystalline copper nanoparticle on copper substrate is modelled under varying process conditions. The quantitative results of the impacts at different velocities, impact angle and size of the particles are evaluated using flattening ratio, von Mises stress distribution and local shear strain. The study finds that the flattening ratio and hence the quality of deposition was highest for an impact velocity of 700 m/s, particle size of 20 Å and an impact angle of 90°. The stress and strain analysis revealed regions of shear instabilities in the periphery of impact and also revealed plastic deformation of the particles after the impact. The results of this study can be used to augment our existing knowledge in the field of CS processes.

Keywords: cold spray process, molecular dynamics simulation, nanoparticles, particle impact

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Authors: Rocio Herrero Romero, Lucie Cluver, James Hall, Janina Steinert

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Educational delay and non-completion are major policy concerns in South Africa. However, little research has focused on predictors for educational delay amongst adolescents in disadvantaged areas. This study has two aims: first, to use data integration approaches to compare the educational delay of 599 adolescents aged 16 to 18 from disadvantaged communities to national and provincial representative estimates in South Africa. Second, the paper also explores predictors for educational delay by comparing adolescents out of school (n=64) and at least one year behind (n=380), with adolescents in the age-appropriate grade or higher (n=155). Multinomial logistic regression models using self-report and administrative data were applied to look for significant associations of risk and protective factors. Significant risk factors for being behind (rather than in age-appropriate grade) were: male gender, past grade repetition, rural location and larger school size. Risk factors for being out of school (rather than in the age-appropriate grade) were: past grade repetition, having experienced problems concentrating at school, household poverty, and food insecurity. Significant protective factors for being in the age-appropriate grade (rather than out of school) were: living with biological parents or grandparents and access to school counselling. Attending school in wealthier communities was a significant protective factor for being in the age-appropriate grade (rather than behind). Our results suggest that both personal and contextual factors –family and school- predicted educational delay. This study provides new evidence to the significant effects of personal, family, and school characteristics on the educational outcomes of adolescents from disadvantaged communities in South Africa. This is the first longitudinal and quantitative study to systematically investigate risk and protective factors for post-compulsory educational outcomes amongst South African adolescents living in disadvantaged communities.

Keywords: disadvantaged communities, quantitative analysis, school delay, South Africa

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Authors: Gordon James Knowles

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Historically the Chinatown district in Sandwich Islands has been plagued with the traditional vice crimes of illegal drugs, gambling, and prostitution since the early 1800s. However, a new form of psychologically addictive arcade style table gambling machines has become the dominant form of illegal revenue made in Honolulu, Hawaii. This study attempts to document the drive, desire, or will to play and wager with arcade style video gaming and understand the role of illegal game rooms in facilitating pathological gambling addiction. Indicators of police corruption by Chinese organized crime syndicates related to protection rackets, bribery, and pay-offs were revealed. Information fusion from a police science and sociological intelligence perspective indicates insurgent warfare is being waged on the streets of Honolulu by the People’s Republic of China. This state-sponsored communist terrorism in the Hawaiian Islands used “contactless” irregular warfare entailing: (1) the deployment of psychologically addictive gambling machines, (2) the distribution of the physically addictive fentanyl drug as a lethal chemical weapon, and (3) psychological warfare by circulating pro-China anti-American propaganda newspapers targeted at the small island populace.

Keywords: Chinese and Polynesian organized crime, china daily newspaper, electronic arcade style table games, gaming technology addiction, illegal compulsive gambling, and police intelligence

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Authors: James Ormrod

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This paper is concerned with volunteer livestock checking. Based on a pilot study consisting of ‘go-along’ interviews with livestock checkers, it argues that there are limitations to the insights that can be generated from approaches to ‘discourse analysis’ that would focus only on the verbalizable aspects of the practice. Volunteer livestock checking takes place across Europe as part of conservation projects aimed at maintaining particular habitats through the reintroduction of grazing animals. Volunteers are variously called ‘urban shepherds’, because these practices often take place on urban fringes, or ‘lookerers’, as their role is to make visual checks on the animals. Pilot research that took place on the South Downs (a chalk downland habitat on the South Coast of the UK) involved researchers accompanying volunteers as they checked on livestock. They were asked to give an account of what they were doing and then answer semi-structured interview questions. Participants drew on popular discourses on conservation and biodiversity, as framed by the local council who run the programme. They also framed their relationships to the animals in respect to the more formal limitations of their role as identified through the conservation programme. And yet these discourses, significant as they are, do not adequately explain why volunteers are drawn to, and emotionally invested in, lookering. The methodology employed allowed participants instead to gesture to features of the landscape and to recall memories, and for the researchers to see how volunteers interacted with the animals and the landscape in embodied and emotionally loaded ways. The paper argues that a psychosocial perspective that pays attention to the contradictions and tensions made visible through this methodology helps develop a fuller understanding of volunteer livestock checking as a social practice.

Keywords: conservation, human-animal relations, lookering, volunteering

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Authors: Williams A. Adu, Cynthia A. Danquah, Paul P. S. Ossei, Selase Ativui, Michael Ofori, James Asenso, George Owusu

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Background Silicosis is an occupational disease of the lung that is caused by chronic exposure to silica dust. There is a higher frequency of co-existence of silicosis with tuberculosis (TB), ultimately resulting in lung fibrosis and respiratory failure. Chronic intake of synthetic drugs has resulted in undesirable side effects. Diosgenin is a steroidal saponin that has been shown to exert a therapeutic effect on lung injury. Therefore, we investigated the ability of diosgenin to reduce the susceptibility of silica-induced TB in rats. Method Silicosis was induced by intratracheal instillation of 50 mg/kg crystalline silica in Sprague Dawley rats. Different doses of diosgenin (1, 10, and 100 mg/kg), Mycobacterium smegmatis and saline were administered for 30 days. Afterwards, 5 of the rats from each group were sacrificed, and the 5 remaining rats in each group, except the control, received Mycobacterium smegmatis. Treatment of diosgenin continued until the 50th day, and the rats were sacrificed at the end of the experiment. The result was analysed using a one-way analysis of variance (ANOVA) with a Graph-pad prism Result At a half-maximal inhibition concentration of 48.27 µM, diosgenin inhibited the growth of Mycobacterium smegmatis. There was a marked decline in the levels of immune cell infiltration and cytokines production. Lactate dehydrogenase and total protein levels were significantly reduced compared to control. There was an increase in the survival rate of the treatment group compared to the control. Conclusion Diosgenin ameliorated silica-induced pulmonary tuberculosis by declining the levels of inflammatory and pro-inflammatory cytokines and, in effect, significantly reduced the susceptibility of rats to pulmonary TB.

Keywords: silicosis, tuberculosis, diosgenin, fibrosis, crystalline silica

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Authors: Enyia James Diwa, Dodeye Ina Igbong, Archibong Archibong Eso

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Gas turbine operators have been faced with the dramatic financial setback resulting from compressor fouling. In a highly deregulated power industry where there is stiffness in the market competition, has made it imperative to improvise means of reducing maintenance cost in other to yield maximum profit. Compressor fouling results from the deposition of contaminants in the presence of oil and moisture on the compressor blade or annulus surfaces, which leads to a loss in flow capacity and compressor efficiency. These combined effects reduce power output, increase heat rate and cause creep life reduction. This paper also contains a model of two gas turbine engines via Cranfield University software known as TURBOMATCH, which is simulation software for detecting engine fouling rate. The model engines are of different configurations and capacities, and are operating in two different modes of constant output power and turbine inlet temperature for a two and three stage filter system. The idea is to investigate the more economically viable filtration systems by gas turbine users based on performance only. It has been demonstrated in the results that the two spool engine is a little more beneficial compared to the single spool. This is as a result of a higher pressure ratio of the two spools as well as the deceleration of the high-pressure compressor and high-pressure turbine speed in a constant TET. Meanwhile, the inlet filtration system was properly designed and balanced with a well-timed and economical compressor washing regime/scheme to control compressor fouling. The different technologies of inlet air filtration and compressor washing are considered and an attempt at optimization with respect to the cost of a combination of both control measures are made.

Keywords: inlet filtration, pressure loss, single spool, two spool

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Authors: Davies Obaromi, Qin Yongsong, James Ndege

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To interpolate scattered or regularly distributed data, there are imprecise or exact methods. However, there are some of these methods that could be used for interpolating data in a regular grid and others in an irregular grid. In spatial epidemiology, it is important to examine how a disease prevalence rates are distributed in space, and how they relate with each other within a defined distance and direction. In this study, for the geographic and graphic representation of the disease prevalence, linear and biharmonic spline methods were implemented in MATLAB, and used to identify, localize and compare for smoothing in the distribution patterns of tuberculosis (TB) in Eastern Cape Province. The aim of this study is to produce a more “smooth” graphical disease map for TB prevalence patterns by a 3-D curve fitting techniques, especially the biharmonic splines that can suppress noise easily, by seeking a least-squares fit rather than exact interpolation. The datasets are represented generally as a 3D or XYZ triplets, where X and Y are the spatial coordinates and Z is the variable of interest and in this case, TB counts in the province. This smoothing spline is a method of fitting a smooth curve to a set of noisy observations using a spline function, and it has also become the conventional method for its high precision, simplicity and flexibility. Surface and contour plots are produced for the TB prevalence at the provincial level for 2012 – 2015. From the results, the general outlook of all the fittings showed a systematic pattern in the distribution of TB cases in the province and this is consistent with some spatial statistical analyses carried out in the province. This new method is rarely used in disease mapping applications, but it has a superior advantage to be assessed at subjective locations rather than only on a rectangular grid as seen in most traditional GIS methods of geospatial analyses.

Keywords: linear, biharmonic splines, tuberculosis, South Africa

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Authors: Lucien N. James, Mulala D. Simatele

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As a country that already faces hydrological and climatological challenges, South Africa’s socio-economic situation only complicates water resource management. This is observable through the state of rivers in the Gauteng Province such as the Hennops and Jukskei which are plagued by pollution from surrounding urban areas. While communities in the Hennops River basin contribute to its degradation, their potential in improved water resource management strategies is yet to be established. Therefore, the aim of this study was to investigate the myriad of ways in which stakeholder and community engagement, mobilisation, as well as participation can be harnessed in contested urban spaces to facilitate a sustainable management system for river basins. Through meetings, clean-up campaigns, and a community workshop, the community of Tembisa and several key informants were engaged. The role of communities and their perceptions on an integrated and participatory approach to solving the Hennops River basin’s current pollution crisis were therefore explored. The findings of this study suggest that meaningful participation is tied to the level of awareness within communities as well as the amount of support attributed to active involvement through the initiatives of stakeholders such as NonGovernmental Organisations. For meaningful participation to take place, more needs to be done to shift communities away from a “bystander” position to a more active role. An approach to community engagement is therefore proposed arguing for the further support of stakeholder-driven initiatives and the raising of awareness around environmental challenges in poorer communities. The findings of this study demonstrate the value of engagement with stakeholders and communities, highlighting ways through which better water management and environmental governance can be achieved in South Africa.

Keywords: community participation, integrated water resource management, river basin management, stakeholder engagement

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Authors: Tan Dexian Arthur, James Wei Ming Kwek, Ian Loh, Lee Tee Sin

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Statement of the Problem: Mucoceles most commonly affect the frontal sinus, which results from chronic obstruction of the sinus ostium or cystic dilatation of mucous glands with ductal obstruction. They are known to cause bony erosion of the sinus walls, which can lead to large defects. These defects were typically managed by obliteration or cranialization of the frontal sinus. Although short term outcomes of conservative management of significant posterior table defects from fractures are promising, there have been no studies on the long-term outcomes of large dehiscences in the posterior wall of the frontal sinus. Methodology & Findings : Computed Tomography (CT) Paranasal Sinuses images were analyzed and found complete spontaneous osteogenesis of a large dehiscent frontal sinus posterior wall, secondary to a large mucocele, 9 years from functional endoscopic sinus surgery with the defect managed conservatively. Conclusion & Significance: The dura is well known for its osteogenic properties. Prior studies have showed that dura could induce osteogenesis in cutaneous tissue in the absence of other central nervous system structures. It was also demonstrated that osteogenesis and chondrogenesis were possible in zygomatic fractures by transplanting neonatal dura grafts to the bony defects in rats. Extrapolating from these studies, the authors postulate that the presence of dura beneath the bony deformity of the posterior frontal sinus wall had likely initiated the osteogenesis and restored the bony defect in the patient. In our literature review, we did not find any reports of spontaneous osteogenesis of large frontal sinus defects. While our experience is incidental, it reinforces the osteogenetic potential of an intact dura and further highlights that selected large defects of the posterior wall of the frontal sinus can be conservatively managed.

Keywords: paranasal sinus mucocele, mucocele, osteogenesis, dehiscence

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Authors: Amin AminiKhafri, James M. Dawson-Edwards, Ryan M. Simpson, Simaan M. AbouRizk

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Earned value management (EVM) has been introduced as an integrated method to combine schedule, budget, and work breakdown structure (WBS). EVM provides various indices to demonstrate project performance including the cost performance index (CPI). CPI is also used to forecast final project cost at completion based on the cost performance during the project execution. Knowing the final project cost during execution can initiate corrective actions, which can enhance project outputs. CPI, however, is not constant during the project, and calculating the final project cost using a variable index is an inaccurate and challenging task for practitioners. Since CPI is based on the cumulative progress values and because of the learning curve effect, CPI variation dampens and stabilizes as project progress. Although various definitions for the CPI stability have been proposed in literature, many scholars have agreed upon the definition that considers a project as stable if the CPI at 20% completion varies less than 0.1 from the final CPI. While 20% completion point is recognized as the stability point for military development projects, construction projects stability have not been studied. In the current study, an empirical study was first conducted using construction project data to determine the stability point for construction projects. Early findings have demonstrated that a majority of construction projects stabilize towards completion (i.e., after 70% completion point). To investigate the effect of CPI stability on cost forecast accuracy, the correlation between CPI stability and project cost at completion forecast accuracy was also investigated. It was determined that as projects progress closer towards completion, variation of the CPI decreases and final project cost forecast accuracy increases. Most projects were found to have 90% accuracy in the final cost forecast at 70% completion point, which is inlined with findings from the CPI stability findings. It can be concluded that early stabilization of the project CPI results in more accurate cost at completion forecasts.

Keywords: cost performance index, earned value management, empirical study, final project cost

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Authors: C. E. Chinma, S. O. Azeez, J. C. Anuonye, O. B. Ocheme, C. M. Yakubu, S. James, E. U. Ohuoba, I. A. Baba

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There is growing interest in the use of rice bran protein in food formulation due to its hypoallergenic protein, high nutritional value and health promoting potentials. For the first time, the amino acid profile, protein digestibility, antioxidant, and functional properties of protein concentrate from some local varieties of rice bran from Nigeria were studied for possible food applications. Protein concentrates were prepared from rice bran and analysed using standard methods. Results showed that protein content of Kwandala, Yardass, Jeep, and Jamila were 69.24%, 69.97%, 68.73%, and 71.62%, respectively while total essential amino acid were 52.71, 53.03, 51.86, and 55.75g/100g protein, respectively. In vitro protein digestibility of protein concentrate from Kwandala, Yardass, Jeep and Jamila were 90.70%, 91.39%, 90.57% and 91.63% respectively. DPPH radical inhibition of protein from Kwandala, Yardass, Jeep, and Jamila were 48.15%, 48.90%, 47.56%, and 53.29%, respectively while ferric reducing ability power were 0.52, 0.55, 0.47 and 0.67mmol TE per gram, respectively. Protein concentrate from Jamila had higher onset (92.57oC) and denaturation temperature (102.13oC), and enthalpy (0.72J/g) than Jeep (91.46oC, 101.76oC, and 0.68J/g, respectively), Kwandala (90.32oC, 100.54oC and 0.57J/g, respectively), and Yardass (88.94oC, 99.45oC, and 0.51J/g, respectively). In vitro digestibility of protein from Kwandala, Yardas, Jeep, and Jamila were 90.70%, 91.39%, 90.57% and 91.63% respectively. Oil absorption capacity of Kwandala, Yardass, Jeep, and Jamila were 3.61, 3.73, 3.40, and 4.23g oil/g sample respectively, while water absorption capacity were 4.19, 4.32, 3.55 and 4.48g water/g sample, respectively. Protein concentrates had low bulk density (0.37-0.43g/ml). Protein concentrate from Jamila rice bran had the highest foam capacity (37.25%), followed by Yardass (34.20%), Kwandala (30.14%) and Jeep (28.90%). Protein concentrates showed low emulsifying and gelling capacities. In conclusion, protein concentrate prepared from these local rice bran varieties could serve as functional ingredients in food formulations and for enriching low protein foods.

Keywords: rice bran protein, amino acid profile, protein digestibility, antioxidant and functional properties

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Authors: Cheryl Forchuk, Sandra Fisman, Steve Cordes, Dan Catunto, Katherine Krakowski, Melissa Jeffrey, John D’Oria

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The discharge of youth aged 16-25 from hospital into homelessness is a prevalent issue despite research indicating social, safety, health and economic detriments on both the individual and community. Lack of stable housing for youth discharged into homelessness results in long-term consequences, including exacerbation of health problems and costly health care service use and hospital readmission. People experiencing homelessness are four times more likely to be readmitted within one month of discharge and hospitals must spend $2,559 more per client. Finding safe housing for these individuals is imperative to their recovery and transition back to the community. People discharged from hospital to homelessness experience challenges, including poor health outcomes and increased hospital readmissions. Youth are the fastest-growing subgroup of people experiencing homelessness in Canada. The needs of youth are unique and include supports related to education, employment opportunities, and age-related service barriers. This study aims to identify the needs of youth at risk of homelessness by evaluating the efficacy of the “Preventing Discharge to No Fixed Address – Youth” (NFA-Y) program, which aims to prevent youth from being discharged from hospital into homelessness. The program connects youth aged 16-25 who are inpatients at London Health Sciences Centre and St. Joseph’s Health Care London to housing and financial support. Supports are offered through collaboration with community partners: Youth Opportunities Unlimited, Canadian Mental Health Association Elgin Middlesex, City of London Coordinated Access, Ontario Works, and Salvation Army’s Housing Stability Bank. This study was reviewed and approved by Western University’s Research Ethics Board. A series of interviews are being conducted with approximately ninety-three youth participants at three time points: baseline (pre-discharge), six, and twelve months post-discharge. Focus groups with participants, health care providers, and community partners are being conducted at three-time points. In addition, administrative data from service providers will be collected and analyzed. Since homelessness has a detrimental effect on recovery, client and community safety, and healthcare expenditure, locating safe housing for psychiatric patients has had a positive impact on treatment, rehabilitation, and the system as a whole. If successful, the findings of this project will offer safe policy alternatives for the prevention of homelessness for at-risk youth, help set them up for success in their future years, and mitigate the rise of the homeless youth population in Canada.

Keywords: youth homelessness, no-fixed address, mental health, homelessness prevention, hospital discharge

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Authors: Melissa K. Hord, Stephen P. Whiteside

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With lifetime prevalence rates ranging from 6% to 15%, anxiety disorders are among the most common childhood mental health diagnoses. Anxiety disorders diagnosed in childhood generally show an unremitting course, lead to additional psychopathology and interfere with social, emotional, and academic development. Effective evidence-based treatments include cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRI’s). However, if anxious children receive any treatment, it is usually through primary care, typically consists of medication, and very rarely includes evidence-based psychotherapy. Despite the high prevalence of anxiety disorders, there have only been two independent research labs that have investigated long-term results for CBT treatment for all childhood anxiety disorders and two for specific anxiety disorders. Generally, the studies indicate that the majority of youth maintain gains up to 7.4 years after treatment. These studies have not been replicated. In addition, little is known about the additional mental health care received by these patients in the intervening years after anxiety treatment, which seems likely to influence maintenance of gains for anxiety symptoms as well as the development of additional psychopathology during the subsequent years. The original sample consisted of 335 children ages 7 to 17 years (mean 13.09, 53% female) diagnosed with an anxiety disorder in 2010. Medical record review included provider billing records for mental health appointments during the five years after anxiety treatment. The subsample for this study was classified into three groups: 64 children who received CBT in an anxiety disorders clinic, 56 who received treatment from a psychiatrist, and 10 who were seen in a primary care setting. Chi-square analyses resulted in significant differences in mental health care utilization across the five years after treatment. Youth receiving treatment in primary care averaged less than one appointment each year and the appointments continued at the same rate across time. Children treated by a psychiatrist averaged approximately 3 appointments in the first two years and 2 in the subsequent three years. Importantly, youth treated in the anxiety clinic demonstrated a gradual decrease in mental health appointments across time. The nuanced differences will be presented in greater detail. The results of the current study have important implications for developing dissemination materials to help guide parents when they are selecting treatment for their children. By including all mental health appointments, this study recognizes that anxiety is often comorbid with additional diagnoses and that receiving evidence-based treatment may have long-term benefits that are associated with improvements in broader mental health. One important caveat might be that the acuity of mental health influenced the level of care sought by patients included in this study; however, taking this possibility into account, it seems those seeking care in a primary care setting continued to require similar care at the end of the study, indicating little improvement in symptoms was experienced.

Keywords: anxiety, children, mental health, outcomes

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Authors: Kara Rosenblatt, Kevin Badgett, James Eldridge

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There is a preponderance of information regarding the overall effectiveness of charter schools and their ability to increase academic achievement compared to traditional district schools. Most research on the topic is focused on comparing long and short-term outcomes, academic achievement in mathematics and reading, and locale (i.e., urban, v. Rural). While the lingering unanswered questions regarding effectiveness continue to loom for school leaders, data on charter schools suggests that enrollment increases by 10% annually and that charter schools educate more than 2 million U.S. students across 40 states each year. Given the increasing share of U.S. students educated in charter schools, it is important to better understand possible differences in student achievement defined in multiple ways for students in charter schools and for those in Independent School District (ISD) settings in the state of Texas. Data were retrieved from the Texas Education Agency’s (TEA) repository that includes data organized annually and available on the TEA website. Specific data points and definitions of achievement were based on characterizations of achievement found in the relevant literature. Specific data points include but were not limited to graduation rate, student performance on standardized testing, and teacher-related factors such as experience and longevity in the district. Initial findings indicate some similarities with the current literature on long-term student achievement in English/Language Arts; however, the findings differ substantially from other recent research related to long-term student achievement in social studies. There are a number of interesting findings also related to differences between achievement for students in charters and ISDs and within different types of charter schools in Texas. In addition to findings, implications for leadership in different settings will be explored.

Keywords: charter schools, ISDs, student achievement, implications for PK-12 school leadership

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Authors: Marisa Chrysochoou, James Mahoney, Kay Wille

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Pyrrhotite is an iron-sulfide mineral which releases sulfuric acid when exposed to water and oxygen. The presence of this mineral in concrete foundations across Connecticut and Massachusetts in the US is causing in some cases premature failure. This has resulted in a devastating crisis for all parties affected by this type of failure which can take up to 15-25 years before internal damage becomes visible on the surface. This study shares laboratory results aimed to investigate the fundamental mechanisms of pyrrhotite reaction and to further the understanding of its deterioration kinetics within concrete. This includes the following analyses: total sulfur, wavelength dispersive X-ray fluorescence, expansion, reaction rate combined with ion-chromatography, as well as damage evolution using electro-chemical acceleration. This information is coupled to a statistical analysis of over 150 analyzed concrete foundations. Those samples were obtained and process using a developed and validated sampling method that is minimally invasive to the foundation in use, provides representative samples of the concrete matrix across the entire foundation, and is time and cost-efficient. The processed samples were then analyzed using a developed modular testing method based on total sulfur and wavelength dispersive X-ray fluorescence analysis to quantify the amount of pyrrhotite. As part of the statistical analysis the results were grouped into the following three categories: no damage observed and no pyrrhotite detected, no damage observed and pyrrhotite detected and damaged observed and pyrrhotite detected. As expected, a strong correlation between amount of pyrrhotite, age of the concrete and damage is observed. Information from the laboratory investigation and from the statistical analysis of field samples will aid in forming a scientific basis to support the decision process towards sustainable financial and administrative solutions by state and local stakeholders.

Keywords: concrete, pyrrhotite, risk of failure, statistical analysis

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Authors: Melissa Dorsey

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Moral distress and compassion fatigue plague nurses in the Cardiothoracic Intensive Care Unit (CTICU) and cause an unnecessary level of turnover. Dueling Burnout describes an initiative that was implemented in the CTICU to reduce the level of burnout the nurses endure by encouraging dual roles with collaborating departments. Purpose: Critical care nurses are plagued by burnout, moral distress, and compassion fatigue due to the intensity of care provided. The purpose of the dual role program was to decrease these issues by providing relief from the intensity of the critical care environment while maintaining full-time employment. Relevance/Significance: Burnout, moral distress, and compassion fatigue are leading causes of Cardiothoracic Critical Care (CTCU) turnover. A contributing factor to burnout is the workload related to serving as a preceptor for a constant influx of new nurses (RN). As a result of these factors, the CTICU averages 17% nursing turnover/year. The cost, unit disruption, and, most importantly, distress of the clinical nurses required an innovative approach to create an improved work environment and experience. Strategies/Implementation/Methods: In May 2018, a dual role pilot was initiated for nurses. The dual role constitutes .6 full-time equivalent hours (FTE) worked in CTICU in combination with .3 FTE worked in the Emergency Department (ED). ED nurses who expressed an interest in cross-training to CTICU were also offered the dual role opportunity. The initial hypothesis was that full-time employees would benefit from a change in clinical setting leading to increased engagement and job satisfaction. The dual role also presents an opportunity for professional development through the expansion of clinical skills in another specialty. Success of the pilot led to extending the dual role to areas beyond the ED. Evaluation/Outcomes/Results: The number of dual role clinical nurses has grown to 22. From the dual role cohort, only one has transferred out of CTICU. This is a 5% turnover rate for this group of nurses as compared to the average turnover rate of 17%. A role satisfaction survey conducted with the dual role cohort found that because of working in a dual role, 76.5% decreased their intent to leave, 100% decreased their level of burnout, and 100% reported an increase in overall job satisfaction. Nurses reported the ability to develop skills that are transferable between departments. Respondents emphasized the appreciation gained from working in multiple environments; the dual role served to transform their care. Conclusions/Implications: Dual role is an effective strategy to retain experienced nurses, decrease burnout and turnover, improve collaboration, and provide flexibility to meet staffing needs. The dual role offers RNs an expansion of skills, relief from high acuity and orientee demands, while improving job satisfaction.

Keywords: nursing retention, burnout, pandemic, strategic staffing, leadership

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Authors: Deborah Weidner, Melissa Morgera

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The model of care delivery in the Behavioral Health Network (BHN) is integrated across all five regions of Hartford Healthcare and thus spans the entirety of the state of Connecticut, with care provided in seven inpatient settings and over 30 ambulatory outpatient locations. While safety has been a core priority of the BHN in alignment with High Reliability practices, safety initiatives have historically been facilitated locally in each region or within each entity, with interventions implemented locally as opposed to throughout the network. To address this, the BHN introduced a network wide Safety Huddle during 2022. Launched in January, the BHN Safety Huddle brought together internal stakeholders, including medical and administrative leaders, along with executive institute leadership, quality, and risk management. By bringing leaders together and introducing a network-wide safety huddle into the way we work, the benefit has been an increase in awareness of safety events occurring in behavioral health areas as well as increased systemization of countermeasures to prevent future events. One significant discussion topic presented in huddles has pertained to environmental design and patient access to potentially dangerous items, addressing some of the most relevant factors resulting in harm to patients in inpatient and emergency settings for behavioral health patients. The safety huddle has improved visibility of potential environmental safety risks through the generation of over 15 safety alerts cascaded throughout the BHN and also spurred a rapid improvement project focused on standardization of patient belonging searches to reduce patient access to potentially dangerous items on inpatient units. Safety events pertaining to potentially dangerous items decreased by 31% as a result of standardized interventions implemented across the network and as a result of increased awareness. A second positive outcome originating from the BHN Safety Huddle was implementation of a recommendation to increase the emergency Narcan®(naloxone) supply on hand in ambulatory settings of the BHN after incidents involving accidental overdose resulted in higher doses of naloxone administration. By increasing the emergency supply of naloxone on hand in all ambulatory and residential settings, colleagues are better prepared to respond in an emergency situation should a patient experience an overdose while on site. Lastly, discussions in safety huddle spurred a new initiative within the BHN to improve responsiveness to assaultive incidents through a consultation service. This consult service, aligned with one of the network’s improvement priorities to reduce harm events related to assaultive incidents, was borne out of discussion in huddle in which it was identified that additional interventions may be needed in providing clinical care to patients who are experiencing multiple and/ or frequent safety events.

Keywords: quality, safety, behavioral health, risk management

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