Implementation of a Trauma-Informed Challenging Interactions Reporting Tool to Improve our Clinical Learning Environment

PROBLEM

Workplace mistreatment is a contributor to resident burnout; understanding and intervening against mistreatment is one key tool in mitigating burnout. While Accreditation Council for Graduate Medical Education (ACGME) survey data alerts programs to general mistreatment trends, those data are not detailed enough to inform local interventions. Our team designed and implemented a Challenging Interactions Reporting Tool (CIRT) to characterize the experiences of our trainees at a granular level and to inform targeted interventions for improvement.

APPROACH

Our CIRT was offered to 158 residents in August 2020 via REDCap. Residents submit electronic reports that are reviewed weekly by program leaders who develop action plans for each report. Reporters can identify themselves or can choose to remain anonymous. When "hot spots" for mistreatment are identified in our hospital, we implement a targeted systems-level intervention.

OUTCOMES

Residents filed 275 reports between August 2020 and December 2022. Reports represented all training environments and involved all interprofessional members of clinical teams. Residents reported awareness of, use of, and satisfaction with the tool.

NEXT STEPS

Our program created the CIRT as a tool to inform local interventions for improving the safety of our clinical learning environment. We continue to disseminate our tool across our hospital's GME programs and are now measuring the impact of our interventions.

Measurement of the ^{13}C(α, n_{0})^{16}O Differential Cross Section from 0.8 to 6.5 MeV

The cross section of the ^{13}C(α,n)^{16}O reaction is needed for nuclear astrophysics and applications to a precision of 10% or better, yet inconsistencies among 50 years of experimental studies currently lead to an uncertainty of ≈15%. Using a state-of-the-art neutron detection array, we have performed a high resolution differential cross section study covering a broad energy range. These measurements result in a dramatic improvement in the extrapolation of the cross section to stellar energies potentially reducing the uncertainty to ≈5% and resolving long standing discrepancies in higher energy data.

Study of 3He(n,p)3H reaction at cosmological energies with trojan horse method

In the network of reactions present in the Big Bang nucleosynthesis, the 3He(n, p)3H has an important role which impacts the final 7Li abundance. The Trojan Horse Method (THM) has been applied to the 3He(d, pt)H reaction in order to extract the astrophysical S(E)-factor of the 3He(n, p)3H in the Gamow energy range. The experiment will be described in the present work together with the first preliminary results.

Crystal structure of kristiansenite: a case of class IIB twinning by metric merohedry

The structure of the new disilicate kristiansenite, Ca2ScSn(Si2O7)(Si2O6OH), has been solved and refined from a crystal polysynthetically twinned by metric merohedry. The Bravais lattice is mC, with parameters a = 10.028(1), b = 8.408(1), c = 13.339(2) Å, α = 90.01(1), β = 109.10(1), γ = 90.00(1)°, but the space-group type is C1 (Z = 4). The twin law is m´, and the two components of the twin have nearly identical volumes: as a consequence, the Laue group of the twin is practically 2/m. By taking into account the twinning, an anisotropic refinement of the structure in C1 converged to R1 = 0.0242 for 259 refined parameters and 4862 observed reflections. The effects of the twinning by metric merohedry and of the volume ratio of the components on the symmetry of the diffraction pattern are discussed. The triclinic structure approximates within about 0.1 Å the monoclinic symmetry, the lower symmetry resulting mainly from cation ordering. Kristiansenite represents a new type of silicate structure and the first known case with the presence of protonated and normal disilicate groups at the same time. The disilicate groups and the other polyhedra centred on cations lie on different alternating (101) planes.

[Current trends in the diagnosis and therapy of anal pruritus. Review of 238 cases]

Perianal pruritus may be caused by a variety of factors. Of these, the most frequently occurring are proctological, infections, dermatological, dietary, and systemic. The results of a study carried out on 238 patients from 1980 to 1984 are reported. The survey was carried out with the aim of defining the frequency of pruritus in relation to the triggering cause, to sex and to age. It is emphasised that diagnosis is often difficult and requires the measurement of the following parameters: blood glucose levels, blood, nitrogen levels, ESR, haemochrome, hepatic functions, in addition to a gynaecological examination, analysis of faeces, proctocolonoscopy, skin biopsy and other tests. These are carried out to determine whether anal pruritus is a symptom of a systemic disease, or whether it is brought about by local causes. Treatment measures adopted are reported. Treatment is mainly symptomatic and aetiological for cases caused by local disturbances.