Recertification and Reentry to Practice for Nurse Anesthetists: Determining Core Competencies and Evaluating Performance via High-Fidelity Simulation Technology

Introduction The National Board of Certification and Recertification for Nurse Anesthetistsaddressed a barrier to return to practice of uncertified practitioners by replacing required direct patient care experiences with high-fidelity simulation. Objectives The aims of this study were to: (a) validate a set of clinical activities for their relevance to reentry and determine if they could be replicated using simulation, (b) evaluate the content validity of an existing simulation scenario containing the proposed clinical activities and determine its substitutability for a clinical practicum, and (c) evaluate the validity of two methods to assess simulation performance. Methods A modified Delphi method incorporating an autonomous, anonymous, three-round online survey process using three unique expert certified registered nurse anesthetists groups was used to address each study aim. Results Twenty-seven clinical activities gained consensus as necessary to be assessed in the simulation. All 14 survey questions used to determine simulation content validity exceeded the minimum content validity index (CVI) value of 0.78, with a mean CVI of 0.99. The global rating scale CVI and the competency checklist CVI were 0.83 and 1.0, respectively. Conclusion The findings add to the existing literature supporting the utility of simulation for high-stakes provider assessment and certification

A study of all-fluid, high-temperature-sensing probes

Fluidics concept applied to miniaturized all-fluid high temperature sensing probes for use in hypervelocity wind tunnel

Why Major Programs Need Innovation Support Labs: An Example from the Space Shuttle Launch Program at KSC

For over 30 years the Kennedy Space Center (KSC) has processed the Space Shuttle; handling all hands-on aspects from receiving the Orbiter, External Tanks, Solid Rocket Booster Segments, and Payloads, through certification, check-out, and assembly, and ending with fueling, count-down, and launch. A team of thousands have worked this highly complicated, yet supremely organized, process and have, as a consequence, generated an exceptional amount of technology to solve a host of problems. This paper describes the contributions of one team that formed with the express purpose to help solve some of these diverse Shuttle ground processing problems

Can microsatellite data allow identification of oleaster Plio-Pleistocene refuge zones in the Mediterranean Basin?

International audienc

Estimation of Orbital Neutron Detector Spatial Resolution by Systematic Shifting of Differential Topographic Masks

We present a method and preliminary results related to determining the spatial resolution of orbital neutron detectors using epithermal maps and differential topographic masks. Our technique is similar to coded aperture imaging methods for optimizing photonic signals in telescopes [I]. In that approach photon masks with known spatial patterns in a telescope aperature are used to systematically restrict incoming photons which minimizes interference and enhances photon signal to noise. Three orbital neutron detector systems with different stated spatial resolutions are evaluated. The differing spatial resolutions arise due different orbital altitudes and the use of neutron collimation techniques. 1) The uncollimated Lunar Prospector Neutron Spectrometer (LPNS) system has spatial resolution of 45km FWHM from approx. 30km altitude mission phase [2]. The Lunar Rennaissance Orbiter (LRO) Lunar Exploration Neutron Detector (LEND) with two detectors at 50km altitude evaluated here: 2) the collimated 10km FWHM spatial resolution detector CSETN and 3) LEND's collimated Sensor for Epithermal Neutrons (SETN). Thus providing two orbital altitudes to study factors of: uncollimated vs collimated and two average altitudes for their effect on fields-of-view

Niche differentiation is spatially and temporally regulated in the rhizosphere.

The rhizosphere is a hotspot for microbial carbon transformations, and is the entry point for root polysaccharides and polymeric carbohydrates that are important precursors to soil organic matter (SOM). However, the ecological mechanisms that underpin rhizosphere carbohydrate depolymerization are poorly understood. Using Avena fatua, a common annual grass, we analyzed time-resolved metatranscriptomes to compare microbial functions in rhizosphere, detritusphere, and combined rhizosphere-detritusphere habitats. Transcripts were binned using a unique reference database generated from soil isolate genomes, single-cell amplified genomes, metagenomes, and stable isotope probing metagenomes. While soil habitat significantly affected both community composition and overall gene expression, the succession of microbial functions occurred at a faster time scale than compositional changes. Using hierarchical clustering of upregulated decomposition genes, we identified four distinct microbial guilds populated by taxa whose functional succession patterns suggest specialization for substrates provided by fresh growing roots, decaying root detritus, the combination of live and decaying root biomass, or aging root material. Carbohydrate depolymerization genes were consistently upregulated in the rhizosphere, and both taxonomic and functional diversity were highest in the combined rhizosphere-detritusphere, suggesting coexistence of rhizosphere guilds is facilitated by niche differentiation. Metatranscriptome-defined guilds provide a framework to model rhizosphere succession and its consequences for soil carbon cycling

Instantaneous Normal Mode Analysis of Supercooled Water

We use the instantaneous normal mode approach to provide a description of the local curvature of the potential energy surface of a model for water. We focus on the region of the phase diagram in which the dynamics may be described by the mode-coupling theory. We find, surprisingly, that the diffusion constant depends mainly on the fraction of directions in configuration space connecting different local minima, supporting the conjecture that the dynamics are controlled by the geometric properties of configuration space. Furthermore, we find an unexpected relation between the number of basins accessed in equilibrium and the connectivity between them.Comment: 5 pages, 4 figure

Liquid-liquid equilibrium for monodisperse spherical particles

A system of identical particles interacting through an isotropic potential that allows for two preferred interparticle distances is numerically studied. When the parameters of the interaction potential are adequately chosen, the system exhibits coexistence between two different liquid phases (in addition to the usual liquid-gas coexistence). It is shown that this coexistence can occur at equilibrium, namely, in the region where the liquid is thermodynamically stable.Comment: 6 pages, 8 figures. Published versio

Interface Roughening in a Hydrodynamic Lattice-Gas Model with Surfactant

Using a hydrodynamic lattice-gas model, we study interface growth in a binary fluid with various concentrations of surfactant. We find that the interface is smoothed by small concentrations of surfactant, while microemulsion droplets form for large surfactant concentrations. To assist in determining the stability limits of the interface, we calculate the change in the roughness and growth exponents $\alpha$ and $\beta$ as a function of surfactant concentration along the interface.Comment: 4 pages with 4 embedded ps figures. Requires psfig.tex. Will appear in PRL 14 Oct 199

Transitions between Inherent Structures in Water

The energy landscape approach has been useful to help understand the dynamic properties of supercooled liquids and the connection between these properties and thermodynamics. The analysis in numerical models of the inherent structure (IS) trajectories -- the set of local minima visited by the liquid -- offers the possibility of filtering out the vibrational component of the motion of the system on the potential energy surface and thereby resolving the slow structural component more efficiently. Here we report an analysis of an IS trajectory for a widely-studied water model, focusing on the changes in hydrogen bond connectivity that give rise to many IS separated by relatively small energy barriers. We find that while the system \emph{travels} through these IS, the structure of the bond network continuously modifies, exchanging linear bonds for bifurcated bonds and usually reversing the exchange to return to nearly the same initial configuration. For the 216 molecule system we investigate, the time scale of these transitions is as small as the simulation time scale ($\approx 1$ fs). Hence for water, the transitions between each of these IS is relatively small and eventual relaxation of the system occurs only by many of these transitions. We find that during IS changes, the molecules with the greatest displacements move in small ``clusters'' of 1-10 molecules with displacements of $\approx 0.02-0.2$ nm, not unlike simpler liquids. However, for water these clusters appear to be somewhat more branched than the linear ``string-like'' clusters formed in a supercooled Lennar d-Jones system found by Glotzer and her collaborators.Comment: accepted in PR