The curriculum improved CPR efficacy by improving knowledge-based retention as well as self-confidence in their skillsThe State of Hawai'i ranks third in the nation for homelessness Homelessness disproportionately affects the health care of pregnant mothers and their children These homeless persons are at risk for malnutrition, physical and psychological trauma, injuries and chronic illnesses, and have difficulty accessing healthcare and social services With the generous support of a Waiwai Ola grant from AlohaCare, a non-profit health plan in Hawai'i, the Maternal-Fetal Medicine physicians at the University Health Partners of Hawai'i created a pilot program with a midwife and medical assistant to provide prenatal health care and social services for homeless mothers on the island of O'ahu This innovative project has given the midwife and medical assistant opportunities to perform needs assessments for homeless mothers and pilot new mobile health devices out in the field that can be optimized for delivering prenatal and postpartum health care for the most vulnerable populations of homeless mothers and their newbornsFollowing Joint Commission recommendations for standardizing patient handoffs, direct peer observations and feedback were utilized in order to improve patient safety related to transitions of care in the Division of Pediatric Hospital Medicine at Kapi'olani Medical Center for Women amp; Children All hospitalist attendings were trained in an evidence-based handoff bundle inclusive of team communication and feedback strategies For the initial project, each hospitalist performed 12 peer observations and feedback sessions using validated tools for verbal and written handoffs over 6 months For a subsequent "refresher" project, each hospitalist performed 6 handoff observations Attendings were surveyed several times before, during, and after completion of the multiple iterations of the project A qualitative interview was conducted 6 years after the initial handoff project In total, 204 observations were completed by 17 hospitalists during the initial project The perceived overall quality of the patient handoff improved significantly across shifts P less then 001 for the quality of each of two critical daily handoffs as did pediatric hospitalists' confidence in providing peer feedback P less then 001 Downstream effects of this activity led to additional benefits towards the cohesive growth of the division Themes from post-project qualitative interviews regarding the peer observation and feedback portion of the study included that it was "helpful," "collaborative," and inspired "camaraderie" that led to increased comfort and participation during future opportunities for observation and feedback Performing direct peer observations with feedback strengthened the workplace culture, promoted growth through collaboration, and allowed acceptance and success of future projects involving peer observations and feedbackKawasaki disease is a systemic vasculitis of unknown etiology and is the leading cause of acquired heart disease in children in the developed world Historically, Hawai'i has had the highest incidence of Kawasaki disease in the United States, likely due to the population's unique ancestral composition To analyze the epidemiology, demographics and spatiotemporal distribution of Kawasaki disease in Hawai'i, a retrospective chart review was conducted utilizing data from Kapi'olani Medical Center for Women and Children encompassing the period of 1996-2018 A total of 858 patients were analyzed with 877 episodes of Kawasaki disease On average, 37 episodes of Kawasaki disease were diagnosed annually over the 23-year period The annual incidence was 32 per 100 000 children less then 5 years of age Asian children 661 accounted for the majority of cases, followed by Native Hawaiians and Other Pacific Islanders 166 Unlike Japan and the continental United States, there was no characteristic seasonal pattern in the distribution of Kawasaki disease in Hawai'i, which may be attributed to its tropical climate or the recent changes in global weather patterns Local geographical differences in the incidence of Kawasaki disease demonstrated that the Windward Eastern coast of O'ahu had a higher rate, while the Leeward Western coast displayed a lower incidence rate This could be explained by variations in ethnic composition and weather patterns of certain areas Future studies could provide geographical weather data and statistical analysis to determine what environmental triggers are correlated with Kawasaki disease trends in the State of Hawai'iInfant botulism is a progressive process described as starting with descending weakness, facial palsies and constipation Loss of bulbar reflexes and flaccid paralysis are common in infants less than 6 months old who have infant botulism Clostridium botulinum, the bacteria that produce the toxin that causes this condition, are ubiquitous in the United States including Hawai'i, but infant botulism is rarely reported here This report describes 2 cases of infant botulism with atypical initial presentations diagnosed on O'ahu, Hawai'i Patient A is a 3-month-old male who presented with altered mental status, including inconsolability, who progressed to loss of gag reflex and constipation Due to early concern for meningitis, Patient A was treated with antibiotics, however further evaluation led to eventual positive testing for botulinum B toxin Patient B is a 2-month-old female who presented with somnolence and fever after immunizations and progressed to respiratory failure and apparent dehydration  https//wwwselleckchemcom/products/rk-701html  Because she presented shortly after receiving immunizations, metabolic disorders were strongly considered as a potential cause of symptoms, but Patient B had normal metabolic evaluation and eventually tested positive for botulinum A toxin Altered mental status and fever are unusual presentations for infant botulism Infant botulism should be considered in infants with altered mental status when the course of illness includes the development of constipation and weakness, and evaluations are not suggestive of alternative causes, including infection, metabolic diseases, and spinal muscular atrophy Early consideration and treatment of infant botulism should be considered for infants presenting with altered mental status who develop neuromuscular weakness The Infant Botulism Treatment and Prevention Program wwwinfantbotulismorg should be contacted early for assistance with diagnosis and treatment