Background: Inadequate supply of filtering facepiece respirators (FFR) for healthcare workers during a global pandemic such as the novel coronavirus outbreak (SARS-CoV-2) is a serious public health issue. Aim: The objective of this review was to synthesize existing data on the effectiveness of ultraviolet germicidal irradiation (UVGI) on N95 FFR decontamination. Methods: We conducted a systematic review on UVGI in N95 FFRs by using Embase, Medline, Global Health, Google Scholar, WHO feed, and MedRxiv. Two reviewers independently determined study eligibility and extracted and verified predefined data fields. Original research reporting on N95 FFR function, decontamination, or mask fit following UVGI were included. Findings and Conclusions: Twelve studies were identified, comprising of 53 different UVGI intervention arms and 43 N95 FFR models. In all cases, FFRs maintained National Institute for Occupational Safety and Health (NIOSH) certification standards following UVGI. Aerosol penetration averaged 1.19% (0.70-2.48%) and 1.14% (0.57-2.63%) for control and UVGI arms respectively. Airflow resistance for the control arms averaged 9.79 mm H2O (7.97-11.70 mm H2O) vs 9.85 mm H2O (8.33-11.44 mm H2O) for UVGI treatment arms. All UVGI protocols employing a cumulative dose >20,000 J/m2 resulted in a 2 log reduction in viral load. A >3 log reduction was observed in 7 UVIG arms using a dose >40,000 J/m2. Impact of UVIG on fit was evaluated in two studies (16,200; 32,400 J/m2) and did not find evidence of compromise. Altogether, our findings suggest that further work in this area should use a cumulative UV-C dose of 40,000 J/m2 or greater, and confirm appropriate mask fit following decontamination.

The present studies focused on the role and socialization of biographical master narratives – cultural narratives that prescribe the types and ordering of events that should occur in one’s personal life identity narrative – by focusing on adolescent and emerging adult gender identity development. We employed a combined explanatory and triangulation mixed methods design. Study 1a ( n = 414) was a survey study examining the expected biographical master narrative events for men and women, and the content of master narrative deviation and conformity in an emerging adult sample. In Study 1b ( n = 14) we interviewed participants from Study 1a about their conformity and deviation narratives, as well as their socialization experiences regarding gendered biographical master narratives. In Study 2 mothers and adolescents ( n = 11 pairs), engaged in conversation about expected life course events, as well as a follow-up interview about their conversation. We first found that there are more gender differences in the personal experiences of conformity to and deviation from master narratives compared to the expectations of the life course (Study 1a). Second, deviating is related to more engagement in identity processes (Study 1a). Third, emerging adults report contradictions in retrospective reports of socialization messages regarding expectations (Study 1b), a finding confirmed in a discourse analysis of mothers and their adolescents (Study 2). Overall, across the studies, we see that (a) adolescents and emerging adults are engaged in a delicate balance of negotiating between various cultural and familial messages, as well as personal experiences, about gender identity particularly in regards to gender equality and, (b) there is a complex relation between socialization messages about gender equality that may make some biographical master narratives about the expected life course events for men and women more resistant to change.

The present studies focused on the role and socialization of biographical master narratives – cultural narratives that prescribe the types and ordering of events that should occur in one’s personal life identity narrative – by focusing on adolescent and emerging adult gender identity development. We employed a combined explanatory and triangulation mixed methods design. Study 1a (n = 414) was a survey study examining the expected biographical master narrative events for men and women, and the content of master narrative deviation and conformity in an emerging adult sample. In Study 1b (n = 14) we interviewed participants from Study 1a about their conformity and deviation narratives, as well as their socialization experiences regarding gendered biographical master narratives. In Study 2 mothers and adolescents (n = 11 pairs), engaged in conversation about expected life course events, as well as a follow-up interview about their conversation. We first found that there are more gender differences in the personal experiences of conformity to and deviation from master narratives compared to the expectations of the life course (Study 1a). Second, deviating is related to more engagement in identity processes (Study 1a). Third, emerging adults report contradictions in retrospective reports of socialization messages regarding expectations (Study 1b), a finding confirmed in a discourse analysis of mothers and their adolescents (Study 2). Overall, across the studies, we see that 1) adolescents and emerging adults are engaged in a delicate balance of negotiating between various cultural and familial messages, as well as personal experiences, about gender identity particularly in regards to gender equality and, 2) there is a complex relation between socialization messages about gender equality that may make some biographical master narratives about the expected life course events for men and women more resistant to change.

IntroductionDelivering unexpected news to families can lead to emotionally charged conversations that cause discomfort and feelings of ineffectiveness in pediatric postgraduate trainees. Although prenatal screening exists, over 80% of trisomy 21 diagnoses continue to be made postnatally to unsuspecting parents who report a desire for better communication from health care professionals when they first receive the news of their child's diagnosis. Recognizing this area for improvement as reported in the literature, as well as the expressed desire from fellows in the University of Ottawa neonatal-perinatal medicine program for additional protected time to preemptively practice such disclosures, this trisomy 21 Scenario-Oriented Learning in Ethics workshop was developed.MethodsDuring the workshop, trainees are introduced to an evidence-based communication framework that provides them with strategies to facilitate clear knowledge translation and promote rapport with families for this specific clinical scenario. Participants are divided into small groups and practice disclosing a trisomy 21 diagnosis to a standardized patient in the role of a new mother. Each small group is supported by two trained facilitators who are experts in delivering life-altering news.ResultsThe pilot workshop was completed by 21 postgraduate trainees from the University of Ottawa. Qualitative evaluations were overwhelmingly positive, with feedback indicating high levels of perceived usefulness for the workshop.DiscussionBy preemptively practicing evidence-based communication, we hope to increase trainee confidence and preparation for trisomy 21 disclosures and improve parents' feelings regarding the quality of communication and support provided while receiving real-life trisomy 21 diagnoses.

Objectives To describe the characteristics, critical care resource requirements, and outcomes of children who were hospitalized after a Pediatric Intensive Care Unit (PICU) consult in the Emergency Department (ED). Methods In this single-centre retrospective cohort study, we conducted chart reviews for children (<18 years) hospitalized following a PICU consult in the ED to examine patient characteristics, timing of consult, ED length of stay, Medical Emergency Team (MET) utilization, PICU nursing workload, and critical care interventions for children who were and were not admitted to the PICU. Results During the one-year study period, 247 PICU consults were performed in the ED resulting in 161 (65.2%) direct admissions to PICU and 1 indirect PICU admission via the ward. Of 105 children with complex chronic conditions, 73 (69.5%) were admitted to PICU, including 32 (91.4%) of 35 children with chronic home ventilatory needs, only 2 (6.2%) of whom received a critical care intervention beyond respiratory support. Within 24 h of hospitalization, 112 (69.1%) of 162 PICU admissions received a critical care-specific intervention. Of 86 (34.8%) ward admissions, 16 (18.6%) were reviewed by the MET. Children admitted to the ward had a significantly longer post-consult ED length of stay than children admitted to PICU (median 428 min vs. 130 min; p <0.0001). Conclusions Over two-thirds of children admitted to PICU from the ED required early critical care interventions, with the remainder potentially benefitting from closer monitoring or a higher frequency of non-critical care interventions than can be reasonably provided on general inpatient wards. More research is needed to evaluate critical care and hospital resource utilization when children are triaged to the ward following a PICU consult in the ED.