TYPE: Abstract Publication TOPIC: Critical Care PURPOSE: Conventional coagulation tests (CCT) and thromboelastography platelet mapping (TEGPM) are used to assess coagulation status of patients preoperatively. This study investigated the correlation among these tests in patients with forms of intracranial hemorrhage (ICH). METHODS: This retrospective chart review studied patients admitted with ICH to a single center neuroscience ICU from SEP 2018-SEP 2019. It utilized EHR lab results in a mesh search of the following terms: IPH, SAH, SDH, and PT-INR, PTT, TEGPM. The search identified 206 unique patients with the assigned search criteria present on admission. Variable significance analyzed using paired t test. Matched-pair analysis of abnormal and normal coagulation states performed using McNemar’s test. RESULTS: Overall, 62/206 patients (30%) were concordant in both CCT and TEGPM results. 29/206 patient test pairs (14%) matched as Hypocoagulable. Normal and Hypercoagulable patient test pairs matched in 8.7% and 7.3% respectively. 176/206 (85.4%) TEGPM patient tests identified coagulopathies. 138/206 (66.9%) CCT were Normal. TEGPM identified significantly more abnormal coagulation states in ICH than CCT (85.4% v 33%) (p<0.01). Lastly, 73/206 (35.4%) patients identified as Hypocoagulable by TEGPM were identified as Normal by CCT (FN=0.41). CONCLUSIONS: In ICH, complex coagulation states exist. CCT and TEGPM results are poorly correlated in ICH patients at admission. TEGPM identifies more coagulopathic states in ICH than CCT. CLINICAL IMPLICATIONS: TEGPM may be more useful than Conventional Coagulation Tests and should be used to assess the preoperative coagulation status in patients admitted with ICH. DISCLOSURE: No significant relationships. KEYWORDS: Coagulation, Intracranial Hemorrhage, TEG

A commercial kitchen can be an aggressive environment. Research on aggression in kitchens and the hospitality sector is important as it illuminates environmental, vocational and cultural issues. This article explores how upmarket chefs, many of whom are now proprietors, have experienced aggression. Information for this article was collected during a wider study on how the impact of compulsory celebrity within kitchen culture has affected upmarket chef proprietors [1]. Its contribution is in providing a New Zealand context to research on kitchen aggression. Data were analysed, grouped and coded using grounded theory methods, which allow findings to be extracted from the data without using any preconceived theoretical framework [2]. Analysis revealed that all chefs had experienced aggressive behaviour or had been the perpetrators themselves. Research such as this hopes to encourage frank discussion that can demystify aggression and reduce harm. Aggressive behaviour within kitchens can be faced by all, including kitchen workers, front of house staff, management, proprietors and suppliers. It can be a factor in poor staff morale and result in staff turnover [1, 3]. The inclination for a person to act aggressively in a kitchen can be influenced by environmental conditions including an uneven workload, low margins, poor wages, irregular working hours, and difficult working conditions such as insufficient space and heat. All of these factors create an ‘aggression-ready’ environment [4]. Further, kitchens are hierarchical in structure with those who may be the most susceptible to aggressive acts also being those least likely to have the confidence, status or ability to voice their concerns. It takes years of training to be a chef, and it is during this process that aggression is most likely to be experienced [5]. Well-known chef Gordon Ramsay calls this “the knowledge”, stating: ‘‘this job is the pits when you’re learning. You have to bow down and stay focused until the knowledge is tucked away … The weak disappear off the face of the earth” [6]. However, aggression within kitchens is now being publicly discussed, with websites such as ‘FairKitchens’ (https://www.fairkitchens.com) spotlighting negative kitchen culture and creating a space for shared stories and industry unity. Other research is taking place, such as the five-year-funded, Australian-wide industry study focusing on the mental health of chefs and examining adverse practices within kitchen culture [7]. Initiatives and research such as this seek to contribute to real-world solutions. The research above strongly suggests that the culture and environmental conditions that result in aggressive acts in commercial kitchens are real. From a New Zealand perspective, all 20 chefs interviewed had experienced aggression. Reflecting on his early vocational experiences, one interviewee, James, stated: “It was a tough environment; I got my hand fractured by one of the head apprentices with one of those big wooden spoons. Probably I said something I shouldn’t of. I got hit. However, I thrived in it.” Troy supported the assumption that part of the learning involved accepting physical aggression: “It was discipline. We didn’t think about it like being hit, you expect it, but it taught you, because you had to be perfect all the time.” Because this research focussed on chef proprietors, these comments may reflect a time when aggression was seen as an important part of being a chef. However, with experience and on reflection, several participants lamented their own aggressive actions. June stated, “It was just natural … I stomped on a lot of people. I thought that everybody else wanted to get to the top so therefore I was probably harsher on people than what I needed to be.” Some chefs now focus on their own and their staffs’ general well-being. Jeremy discussed that, “I always like to work with people that didn’t yell and scream. I don’t think that’s appropriate in a kitchen because it is already hard enough. Without some chef yelling and screaming at you … staff are the most important.” These statements perhaps reflect a desire, a need, and the will for kitchen cultural change. Additionally, it shows the importance of educating individuals entering the commercial kitchen environment about the stressors that they will face and how to deal with them, with the aim of reducing the occurrences, severity and overall harm that aggressive acts cause. It is only through the education and support of young chefs entering kitchens, and acknowledgement by more experienced chefs that the kitchen culture needs to change, that lasting benefits for all will occur. Read the full research here: https://openrepository.aut.ac.nz/handle/10292/9559 Corresponding author Scott Wright can be contacted at: scott.wright@aut.ac.nz References (1) Wright, S. D. The Compulcelebrity Effect: Upmarket Chef Proprietors and Compulsory Celebrity. Master’s Thesis, Auckland University of Technology, 2015. https://openrepository.aut.ac.nz/handle/10292/9559 (accessed Nov 25, 2017). (2) Díaz-Andrade, A. (2009). Interpretive Research Aiming at Theory Building: Adopting and Adapting the Case Study Design. The Qualitative Report 2009, 14 (1), 42–60. https://nsuworks.nova.edu/tqr/vol14/iss1/3 (3) Johns, N.; Menzel, P. J. (1999). If You Can’t Stand the Heat!: Kitchen Violence and Culinary Art. Hospitality Management 1999, 18 (2), 99–109. https://doi.org/10.1016/S0278-4319(99)00013-4 (4) Meloury, J.; Signal, T. (2014). When the Plate is Full: Aggression among Chefs. International Journal of Hospitality Management 2014, 41, 97–103. https://doi.org/10.1016/j.ijhm.2014.05.006 (5) James, S. (2006). Learning to Cook: Production Learning Environment in Kitchens. Learning Environments Research 2006, 9 (1), 1–22. https://doi.org/10.1007/s10984-005-9001-5 (6) Duncan, A. Andrew Duncan Meets Gordon Ramsay. Radio Times Feb, 2001, 10 (16), 8–12. (7) Robinson, R.; Whitelaw, P.; Lyman, D.; Rogers, L. (2019). Are Things Just Too Hot in the Kitchen? Chefs’ Mental Health & Wellbeing. Presented at the Travel and Tourism Research Association Conference, June 25–27, Melbourne, Australia.

The natural environment has been a missing topic from education and public policy forums concerning an aging society. This study examines demographic trends and several socio-demographic influences on attitudes, concerns, and active support for environmental issues among older adults in a retirement "hot spot" in the New West. A sample of 394 older adults in southwestern Utah was obtained from questionnaires mailed to those randomly selected from a larger dataset, and through hand-distributed questionnaires at selected RV parks. We found a high degree of variability among respondents in regard to environmental attitudes and concerns. Despite a personal attitudinal desire to protect the environment, most older adults did not want to become involved in protective actions for the environment. We found that residency status and religious affiliation emerged as the strongest relationships with measures of attitudes and concerns, and willingness to support the environment. The most influential factors associated with willingness to take action in support of the environment were having higher levels of active/social concerns, and higher levels of awareness of environmental consequences. The New West is one of the fastest-growing areas for demographic aging, and the opinions and actions of older adults will play a significant role in the stewardship and sustainability of natural resources, particularly in retirement hot spots.

Smoking cessation counseling by practitioners occurs at low rates in spite of strong evidence that counseling increases quit rates and reduces patient mortality. In a preliminary study, 1060 New York State physicians completed a survey concerning use of the Agency for Health Care Policy and Research (AHCPR) Guidelines, perceived autonomy and perceived competence for counseling, perceived autonomy support from insurers, and barriers to counseling. Considered together, perceived autonomy, perceived competence and perceived autonomy support predicted time devoted to counseling and use of the AHCPR guidelines. The primary, longitudinal study of 220 health care practitioners who attended a smoking cessation workshop predicted change in the practitioners' perceived autonomy and perceived competence for counseling as a function of the degree to which they experienced the workshop instructor as autonomy-supportive. In turn, change in perceived autonomy predicted change in time spent counseling and change in use of the AHCPR guidelines.

Chelonacarus elongatus n. gen., n. sp. is proposed for a cheyletoid mite (Acari: Prostigmata) of the family Cloacaridae found in the cloacal tissue of the endangered green turtle Chelonia mydas Linnaeus, 1758 from the Atlantic coast of the Republic of Panama. In females, the new genus is distinguished from other genera of turtle cloacarids by the elongate slender shape of the idiosoma, the shape and pattern of sclerotization of the dorsal shield, and the fused distal ends of apodemes II. A combination of other features that distinguish the newly proposed genus is the smooth surface of the pedipalps, single dorsal spine on tibiae I-IV, no setae on coxa IV, terminal position of the vulva, and the strongly developed pair of ventral spines on tarsi I-II. This is the first record of cloacarids from sea turtles. The similarity of adult cloacarids in the genus Chelonacarus from sea turtles (Chelonioidea) and Cloacarus Camin et al., 1967 from snapping turtles (Chelydridae) lends support to the hypothesis of some paleontologists that these 2 groups of turtles are linked phylogenetically.

The purpose of this study was to examine the multidimensional nature of caregiver burden by specifically analyzing the patterns of association between five dimensions of burden as measured by the Caregiver Burden Inventory [1] and selected demographic, health, functioning, and well-being indicators. Subscales measuring each dimension were internally consistent and relatively independent in a sample of 160 caregivers. Time dependence burden was most influenced by patient impairment and caregiving involvement, whereas emotional burden was largely a function of caregiving satisfaction. Most of the variance in developmental burden was explained by depression and caregiving satisfaction. Contrary to expectations, physical health measures explained little variance in physical burden, of which most was explained by depression. Less than 10 percent of the variance in social burden was explained by depression and caregiver days sick. The findings lend support to a multidimensional view of burden and with minor modifications, the CBI appears to be a promising instrument with which to measure the construct.