Peace Arch Hospital

Virtual reality has been used to alleviate pain and anxiety in a variety of medical procedures. The authors sought to explore the effects of virtual reality in common awake minor plastic surgery procedures where children may experience discomfort. A randomized controlled trial compared virtual reality to standard-of-care distraction among children aged 6 to 16 years undergoing awake minor plastic surgery procedures at a quaternary children's hospital. Primary outcome was change in Faces Pain Scale-Revised pain score, and secondary outcomes included change in Venham Situational Anxiety Scale score, procedure duration, administration of local anesthetic, and pain/anxiety management satisfaction. Mean pain and anxiety scores were similar in both groups (p = 0.60 and p = 0.18, respectively), and procedure duration was shorter with virtual reality (22 minutes versus 29 minutes; p = 0.002). Duration remained shorter in a linear regression model accounting for procedure type (p = 0.01). Similar proportions of children received additional local anesthetic after the initial dose (virtual reality, n = 6; standard of care, n = 9; p = 0.19) and median pain management satisfaction was similar (virtual reality, 9 of 10; standard of care, 9 of 10; p = 0.41). Median anxiety management satisfaction was similar (virtual reality, 9 of 10; standard of care, 9 of 10; p = 0.05). Younger children reported more "fun" than older children with virtual reality (p = 0.02). Surgeons reported interest "using virtual reality again" in 83 percent of cases. The use of virtual reality for awake pediatric plastic surgery reduced procedure time but not pain or anxiety compared to standard of care in children aged 6 to 16 years. Virtual reality was safe and well-liked and should be considered as an additional tool. Increased efficiency may allow more cases to be performed. Therapeutic, II.

Abstract Stream channel morphology forms the template upon which hydraulic aspects of aquatic habitat are created, yet spatial and temporal variability in habitat imposed by changing morphology is not well understood. This paper presents a conceptual model linking sediment supply patterns to spatial and temporal variability in channel form and aquatic habitat. To evaluate this model, change over time in three habitat variables is quantified using a 2D hydrodynamic modeling approach. A 45‐year record of topographic data from Carnation Creek, a catchment in coastal British Columbia, is used for the flow modeling. Using the Nays2DH modeling platform, water depths and velocities are simulated in eight channel segments located at different positions relative to locations of historical colluvial input using seven flow levels ranging from 3% to 400% of mean annual discharge (0.02 to 3.31 m s ). Results indicate that habitat availability changes through time as a result of sediment supply‐driven changes to channel morphology and wood loads, but patterns in habitat vary as a function of dominant channel segment morphology. Spatial and temporal variability in morphology also influences the relationship between habitat availability and river discharge, leading to non‐stationary habitat‐discharge rating curves. When habitat areas are predicted by applying these curves to daily flow series spanning annual dry seasons, over 50% of the variance in cumulative seasonal habitat area can be explained by year‐to‐year changes in channel morphology and wood loading, indicating that changing morphology is an important factor for driving temporal habitat variability. This variance is related to the morphological variability of a channel segment, which in turn is associated with the segment position relative to zones of colluvial input. Collectively, these results suggest that variability in habitat is impacted by channel morphology, and can be evaluated partly on the basis of a channel's sediment supply regime. © 2019 John Wiley & Sons, Ltd.

The following two articles document the recent unfolding of hate demonstrations targeting Japan's Korean minority population (hereafter Zainichi Koreans). This introduction provides historical context for the organized expressions of hate against Zainichi Koreans. Earlier analyses of Japan's far right have emphasized how internet communications, explicit expressions of bigotry, and the frustrations of the “lost” generation, contributed to an emergent subculture of grassroots conservatism.

ABSTRACTSeveral new Early Cretaceous tracksites from the Lower Cretaceous Xiagou Formation of Gansu Province (China) with tracks of large sauropods and ornithopods are described. Previously reported bird tracks were missing due to human negligence. The studied specimens are preserved as impressions and shallow and deep natural track casts. These dinosaur tracks are first reported from the Jiuquan area in the Changma Basin, matching well with the skeletal record of diverse non-avian dinosaur-bird faunas of this region. Moreover, they add new data to the dinosaur ichnofaunas of the Lanzhou-Minhe Basin (Gansu Province) and indicate a wide distribution of dinosaur-bird assemblages in the Early Cretaceous. Regarding morphology, sauropod, and ornithopod tracks from the Lanzhou-Minhe Basin and the Jiuquan area are very similar to each other. Titanosauriform trackmakers are assumed for the sauropod tracks and possibly iguanodontids have left the large, tridactyl ornithopod tracks. Of particular interest are well-preserved, deep natural track casts of large ornithopods and sauropods preserving ridges and grooves as well as striation marks on the lateral sides of the casts that allow the reconstruction of complex pathways of the foot within the substrate. One particular sauropod pes–manus track cast even indicates lateral and vertical sliding within the sediment because of the presence of “double impressions of digits” on the bottom.

The purpose of this research was to critically examine the factors that contribute to turnover of experienced nurses' including their decision to leave practice settings and seek alternate nursing employment. In this study, we explore experienced nurses' decision-making processes and examine the personal and environmental factors that influenced their decision to leave. Nursing turnover remains a pressing problem for healthcare delivery. Turnover contributes to increased recruitment and orientation cost, reduced quality patient care and the loss of mentorship for new nurses. A qualitative, interpretive descriptive approach was used to guide the study. Interviews were conducted with 12 registered nurses, averaging 16 years in practice. Participants were equally represented from an array of acute care inpatient settings. The sample drew on perspectives from point-of-care nurses and nurses in leadership roles, primarily charge nurses and clinical nurse educators. Nurses' decisions to leave practice were influenced by several interrelated work environment and personal factors: higher patient acuity, increased workload demands, ineffective working relationships among nurses and with physicians, gaps in leadership support and negative impacts on nurses' health and well-being. Ineffective working relationships with other nurses and lack of leadership support led nurses to feel dissatisfied and ill equipped to perform their job. The impact of high stress was evident on the health and emotional well-being of nurses. It is vital that healthcare organisations learn to minimise turnover and retain the wealth of experienced nurses in acute care settings to maintain quality patient care and contain costs. This study highlights the need for healthcare leaders to re-examine how they promote collaborative practice, enhance supportive leadership behaviours, and reduce nurses' workplace stressors to retain the skills and knowledge of experienced nurses at the point-of-care.

To report the use of silicone tracheal stoma stents for temporary tracheostomy in dogs with upper airway obstruction. Retrospective review of medical records for dogs in which silicone tracheal stoma stents were placed. Eighteen dogs had a silicone tracheal stoma stent placed for maintenance of a tracheostomy stoma for periods ranging from three hours to eight months. No intra-operative or immediate postoperative complications were recorded. In 11 dogs the stent was removed by simple traction after a period ranging from 36 hours to 6 weeks, and the tracheal stoma was left to heal by second intention. Five of the 18 dogs were determined as being tracheostomy dependent and underwent conversion to permanent tracheostomy after a period ranging from five days to eight months following stent placement. One dog was euthanased after three months, with the stent still in place, because of poor respiratory function, and one dog died of unrelated reasons. In 6 of 10 dogs (60%) where the stent was in place for five days or more, granulation tissue formation caused dislodgement of the stent. Silicone tracheal stoma stents may be used as an alternative to conventional tracheostomy tubes in selected dogs with upper airway obstruction. Long-term use of the stent beyond five days is not recommended because of granulation tissue formation. The long-term consequences of partial tracheal ring resection are unknown.

We studied microsatellite DNA variation in 15 populations of northwestern North American pygmy whitefish ( Prosopium coulterii (Eigenmann and Eigenmann, 1892)), an enigmatic freshwater fish thought to be highly fragmented by residency in deep, cold postglacial lakes. Population subdivision (θ) across 10 loci was 0.12 (P < 0.001) across samples, but one western Alaskan population was more divergent than all others (θ = 0.31–0.41, P < 0.001). Within the Williston Reservoir watershed (WRW), θ averaged 0.08 (P < 0.001) and was positively associated with both the geographic distance between localities (r2= 0.36, P < 0.001) and the number of branch points interconnecting them (r2= 0.33, P < 0.001). Differentiation among populations was modeled as the sum of the genetic distances for the stream sections interconnecting them (r2= 0.74). Differences among subwatersheds with the WRW accounted for 5.1% of the total variation in allele frequencies (P < 0.001). Assignment tests suggested limited movement among lakes, with most inferred dispersal between adjacent watersheds. Coalescent analysis strongly supported a gene flow–drift equilibrium model of population structure over a drift-only model. Effective management of diversity in pygmy whitefish requires the maintenance of stream networks that interconnect lakes within a watershed.

In this article, I explore the historical background and context to the theoretical eclecticism described by the participants interviewed for a research study. The initial aim was to test the relevance of the vicarious traumatisation (vt) or vt literature with a group of sexual abuse therapists. The participants interviewed were all working as sexual abuse therapists in group and individual practices, many of whom worked in the field before there were well articulated theories of trauma assessment and treatment in the 1970s and 1980s. With the available theory, they actively developed their own unique frameworks for practice and became pioneers in the field. The findings of this research suggest that the practitioners' reference to diverse sources of theory is both a resource and protective factor which, when synthesised, is drawn upon to support the day-to-day work of sexual abuse therapy.