Quality and Safety in Hospital Pediatrics During COVID-19: A National Qualitative Study

OBJECTIVE: To describe challenges in inpatient pediatric quality and safety during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: In a previous qualitative study, our team sought to broadly describe changes in pediatric inpatient care during the pandemic. For both that study and this ancillary analysis, we purposefully sampled participants from community and children’s hospitals in the 6 US states with the highest COVID-19 hospitalization rates from March to May 2020. We recruited 2 to 3 participants from each hospital (administrators, front-line physicians, nurses, caregivers) for semistructured interviews. We used constant comparative methods to identify themes regarding quality and safety challenges during the pandemic. RESULTS: We interviewed 30 participants from 12 hospitals. Participants described several impacts to clinical workflows, including decreased direct clinician-patient interactions and challenges to communication, partly addressed through innovative use of telehealth technology. Participants reported changes in the discharge and transfer process (eg, discharges, difficulties accessing specialized facilities). Participants also described impacts to hospital operations, including changes in quality monitoring and operations (eg, decreased staff, data collection), increased health risks for clinicians and staff (eg, COVID-19 exposure, testing delays), and staff and supply shortages. Participants voiced concerns that negative quality and safety impacts could include increased risk of preventable safety events and hospital readmissions, and decreased patient engagement, education, and satisfaction. CONCLUSIONS: We identified several impacts to clinical workflows and hospital operations during the pandemic that may have affected inpatient pediatric care quality and safety. Our findings highlight potentially important areas of focus for planning pandemic recovery, preparing for future pandemics, and conducting future research on inpatient pediatric quality and safety.

A locus conferring tolerance to Theileria infection in African cattle

East Coast fever, a tick-borne cattle disease caused by the Theileria parva parasite, is among the biggest natural killers of cattle in East Africa, leading to over 1 million deaths annually. Here we report on the genetic analysis of a cohort of Boran cattle demonstrating heritable tolerance to infection by T. parva (h2 = 0.65, s.e. 0.57). Through a linkage analysis we identify a 6 Mb genomic region on Bos taurus chromosome 15 that is significantly associated with survival outcome following T. parva exposure. Testing this locus in an independent cohort of animals replicates this association with survival following T. parva infection. A stop gained polymorphism in this region was found to be highly associated with survival across both related and unrelated animals, with only one of the 20 homozygote carriers (T/T) of this change succumbing to the disease in contrast to 44 out of 97 animals homozygote for the reference allele (C/C). Consequently, we present a genetic locus linked to tolerance of one of Africa's most important cattle diseases, raising the promise of marker-assisted selection for cattle that are less susceptible to infection by T. parva.

Investigations of the intrinsic corrosion and hydrogen susceptibility of metals and alloys using density functional theory

Mechanisms for materials degradation are usually inferred from electrochemical measurements and characterization performed before, during, and after exposure testing and/or failure analysis of service materials. Predicting corrosion and other materials degradation modes, such as hydrogen-assisted cracking, from first-principles has generally been limited to thermodynamic predictions from Pourbaix or Ellingham diagrams and the Galvanic series. Using electronic structure calculations, modern first-principles methods can predict ab initio the key rate-controlling processes for corrosion and hydrogen susceptibility as a function of pH, potential, and solution chemistry, and materials composition and microstructure. Herein we review density functional theory (DFT) approaches for studying the electrochemical reactions occurring on fresh metal and alloy surfaces related to environmentally assisted cracking and localized corrosion/pitting. Predicted changes in surface chemistry as a function of the environment were correlated against experimental crack growth rate data obtained for alloys 718, 725, and pipeline steel under electrochemical control. We also review the application of the method to study the effects of alloying on the chloride susceptibility of stainless steels and Ni–Cr-based corrosion-resistant alloys. Perspectives for improving the model are given, and extending it to future fields of application in corrosion science and engineering.

Effect of Vacuum Heat Treatment on the High-Temperature Oxidation Resistance of NiCrAlY Coating

NiCrAlY coatings were prepared using high-velocity oxygen fuel spraying (HVOF), and the coatings were removed from the substrate to achieve a uniform shape. Vacuum heat treatment (VHT) of the as-sprayed coatings was conducted at different temperatures (1000, 1100, and 1200 °C), and the specimens were subjected to isothermal oxidation exposure testing in air at 1100 °C for up to 21 h. The results show that the high temperature oxidation resistance of the coating increased gradually with the increase in VHT temperature, and the coating of VHT1200 had higher oxidation resistance. The high temperature oxidation resistance of the coating was related to the microstructure transformation of the coating. In VHT coatings, β-NiAl became a dispersed irregular block morphology. The γ’-Ni3Al in VHT1000 presented a granular morphology. However, in VHT1100 and VHT1200, γ’-Ni3Al became a lamellar morphology. This transformation of microstructure promotes the form of exclusive α-Al2O3 scale. With the increase in VHT temperature, the content of yttrium on coatings’ surface was increased and the pores were gradually eliminated. The concentration of yttrium on coatings’ surface prevented the formation of θ-Al2O3 and low porosity was beneficial in improving the internal oxidation of the coating.