A Quality Improvement Project: Adopting the Standards of Best Practice in Simulation: Debriefing with PEARLS

Background There is evidence the best practices of simulation, specifically, the use of debriefing, will assist the new graduate nurse’s transition into the profession by increasing their clinical judgment. This quality improvement (QI) project explored the pedagogy of High Fidelity Simulation and Debriefing as a solution for the lag in New Graduate Nurse (NGN) practice readiness. The specific aims of this project were: 1) to teach the NGN residency educators how to implement Standard: Debriefing of the International Nursing Association for Clinical Simulation and Learning (INACSL) Standards of Best Practices: SimulationSM by focusing on the role of the debriefer; 2) to teach NGN residency educators to use the Promoting Excellence and Reflective Learning in Simulation (PEARLS) (Eppich & Cheng, 2015) methodology of debriefing; and 3) to assess if the Lasater Clinical Judgment Rubric (LCJR) is applicable for measuring NGNs’ clinical judgment development. Project Design This QI project examined the use of simulation and reflective debriefing on two groups: the residency educators and the NGN. The project employed two, single-comparison group pre/post testing to evaluate: 1) the effect PEARLS on educators’ debriefing effectiveness; 2) the use of PEARLS on NGN clinical judgment; 3) the applicability of the LCJR for evaluating the NGN development of clinical judgment. Eight NGN residency educators were taught to use PEARLS as a method to implement the INACSL Standard: Debriefing. The DASH instrument was used to for pre/post teaching comparison of educators’ debriefing efficiency and the LCJR was used to compare NGN clinical judgment. Results Overall, when compared to baseline scores, the summative DASH scores were higher. Eighty-eight percent of the residency educators advanced in every DASH subscale with two exceptions: two different educators stayed the same on elements five and six, respectively. The LCJR was used to evaluate the NGN’s development of clinical judgment at beginning and end of their residency program. One hundred percent (n = 6) of the summative LCJR scores were higher than baseline. Of the eleven subscales, 33% of the NGN demonstrated progression on all eleven subscales. Fifty percent demonstrated progression on 10 of the 11 subscales. One hundred percent of the NGNs demonstrated progress on four subscales. A questionnaire using a Likert scale found all residency educators strongly agreed the LCJR was applicable for evaluating NGNs’ development of clinical judgment and should be adopted as the standard measurement of NGN readiness for independent practice. Additionally, all strongly agreed the PEARLS method of debriefing should be adopted as the standard measurement of the residency educator’s debriefing efficiency. Conclusions & Recommendations The residency educators’ effectiveness at reflective debriefing improved when they used the PEARLS method of debriefing. Based on this improvement, it is recommended that they adopt the PEARLS method as the standard method used in their NGN residency program. Additionally, because all educators strongly agreed in the LCJR’s applicability for measuring NGN clinical judgment, they should adopt and use it as a determinant for NGN readiness for practice

Too close for comfort: spatial patterns in acorn barnacle populations

Spatial patterns in aggregations form as a result of the interplay between costs and benefits experienced by individuals. Such self-organisation of aggregations can be explained using a zonal model in which a short-range zone of repulsion and longer-range zone of attraction surrounding individuals leads to emergent pattern properties. The signal of these processes can be detected using spatial pattern analyses. Furthermore, in sessile organisms, post-settlement mortality reveals the relative costs and benefits of positions within the aggregation. Acorn barnacles are known to require contact with conspecifics for reproduction and are therefore believed to aggregate for this purpose; isolated individuals may also be more susceptible to abiotic stress and predation. At short distances, however, competition for space and resources is likely to occur. In this study spatial patterns of barnacles (Semibalanus balanoides L.) were analysed using pair-correlation functions. Individuals were dispersed at distances below 0.30 cm, but peak relative density occurred at a distance of 0.36 cm from conspecifics. This is much closer than required for reproductive access, implying a strong aggregative drive, up to the point of physical contact with neighbours. Nevertheless, analysis of dead barnacles illustrated that such proximity carries a cost as barnacles with many neighbours were more likely to have died. The inferences obtained from these patterns are that barnacles aggregate as closely as they can, and that local neighbourhood competition is a powerful determinant of mortality. These processes give rise to the observed pattern properties

Zeugma as the provenance of 12 mosaic fragments at Bowling Green State University

Bowling Green State University (BGSU) in Ohio is the current owner of 12 sections of floor mosaic dating to the 2nd-3rd c. A.D. Purchased by the university in 1965, these mosaic fragments were believed to be from the site of Antioch. In 2010-11, the mosaics were conserved and installed in BGSU’s Wolfe Center. In the following year the first-named author, organizing a symposium to celebrate the new display of the mosaics, invited R. Molholt to be the keynote speaker. During the course of preparing their respective papers for the symposium, she and Molholt uncovered evidence that an Antioch provenance for the mosaics was most unlikely, and Molholt determined that the mosaic fragments were almost certainly from the site of Zeugma. We offer here a preliminary publication of the fragments, along with evidence to support our proposed provenance

Atomic tiles: Manipulative resources for exploring bonding and molecular structure

A simple manipulative resource, Atomic Tiles, is described for scaffolding the learning of Lewis structures without using algorithmic, rule-based methods of drawing. Students use Atomic Tiles to (1) create models of bonding that lead to drawing Lewis structures, (2) use the structures they create to infer patterns required for rational structures and common organic functional groups, (3) translate between Lewis structures and molecular models, and (4) use molecular models to identify isomers

The Role of Ligand Steric Bulk in New Monovalent Aluminum Compounds

The article of record as published may be located at https://doi.org/10.1021/acs.jpca.7b02075The tetrameric Al(I) cyclopentadienyl compound Al4Cp*4 (Cp* = C5Me5) is a prototypical low-valence Al compound, with delocalized bonding between four Al(I) atoms and η5 ligands bound to the cluster exterior. The synthesis of new [AlR]4 (R = C5Me4Pr, C5Me4iPr) tetramers is presented. Though these systems failed to crystallize, comparison of variable-temperature 27Al NMR data with density functional theory (DFT) calculations indicate that these are Al4R4 tetramers analogous to Al4Cp*4 but with increased ligand steric bulk. NMR, DFT, and Atoms in Molecules analyses show that these clusters are enthalpically more stable as tetramers than the Cp* variant, due in part to noncovalent interactions across the bulkier ligand groups. Thermochemistry calculations for the low-valence metal interactions were found to be extremely sensitive to the DFT methodology used; the M06-2X functional with a cc-pVTZ basis set is shown to provide very accurate values for the enthalpy of tetramerization and 27Al NMR shifts. This computational method is then used to predict geometrical structures, noncovalent ligand interactions, and monomer/tetramer equilibrium in solution for a series of Al(I) cyclopentadienyl compounds of varying steric bulk

A Systematic Study of Hidden Sector Dark Matter: Application to the Gamma-Ray and Antiproton Excesses

In hidden sector models, dark matter does not directly couple to the particle content of the Standard Model, strongly suppressing rates at direct detection experiments, while still allowing for large signals from annihilation. In this paper, we conduct an extensive study of hidden sector dark matter, covering a wide range of dark matter spins, mediator spins, interaction diagrams, and annihilation final states, in each case determining whether the annihilations are s-wave (thus enabling efficient annihilation in the universe today). We then go on to consider a variety of portal interactions that allow the hidden sector annihilation products to decay into the Standard Model. We broadly classify constraints from relic density requirements and dwarf spheroidal galaxy observations. In the scenario that the hidden sector was in equilibrium with the Standard Model in the early universe, we place a lower bound on the portal coupling, as well as on the dark matter's elastic scattering cross section with nuclei. We apply our hidden sector results to the observed Galactic Center gamma-ray excess and the cosmic-ray antiproton excess. We find that both of these excesses can be simultaneously explained by a variety of hidden sector models, without any tension with constraints from observations of dwarf spheroidal galaxies.Comment: 40 pages, 11 figures, matches the JHEP version, references adde

Gastrointestinal Tract As Entry Route for Hantavirus Infection

Background: Hantaviruses are zoonotic agents that cause hemorrhagic fevers and are thought to be transmitted to humans by exposure to aerosolized excreta of infected rodents. Puumala virus (PUUV) is the predominant endemic hantavirus in Europe. A large proportion of PUUV-infected patients suffer from gastrointestinal symptoms of unclear origin. In this study we demonstrate that PUUV infection can occur via the alimentary tract. Methods: We investigated susceptibility of the human small intestinal epithelium for PUUV infection and analyzed the resistance of virions to gastric juice. As model for intestinal virus translocation we performed infection experiments with human intestinal Caco-2 monolayers. In animal experiments we infected Syrian hamsters with PUUV via the intragastric route and tested seroconversion and protective immunity against subsequent Andes virus challenge. Results: PUUV retained infectivity in gastric juice at pH >3. The virus invaded Caco-2 monolayers in association with endosomal antigen EEA1, followed by virus replication and loss of epithelial barrier function with basolateral virus occurrence. Cellular disturbance and depletion of the tight junction protein ZO-1 appeared after prolonged infection, leading to paracellular leakage (leak flux diarrhea). Moreover, animal experiments led to dose-dependent seroconversion and protection against lethal Andes virus challenge. Conclusions: We provide evidence that hantavirus can infect the organism via the alimentary tract and suggest a novel aspect of hantavirus infection and pathogenesis. Significance: Hantaviruses are zoonotic pathogens causing severe hemorrhagic fevers worldwide. They are transmitted to humans by small mammals. To date, these viruses were thought to infect exclusively through the airborne route by inhalation of aerosols from infectious animal droppings or by rodent bites. In our work we could show that the alimentary tract is an alternative path of infection for hantaviruses, meaning a new association of virus and disease. These findings have impact on current textbook knowledge and bring many implications for hantavirus epidemiology and outbreak prevention measures