Perception of Pediatric Readiness Across a Health System\u27s Emergency Departments

The recent pandemic and pediatric respiratory syncytial virus surge have reinvigorated pediatric care readiness conversations. National strategies and associations exist to guide health systems in improving the quality of emergency care offered to pediatric populations by first assessing readiness for care. These research strategies center on survey implementation and staff engagement in general emergency departments with the goal to improve staff readiness to care for pediatric patients that may present for treatment. What impact would developing a consolidated pediatric readiness program that includes: pediatric emergency care coordinator designation for each emergency department, pediatric readiness education and committee engagement have on health system emergency department staff’s perception of pediatric readiness in their hospitals? Evidence strongly supported a multi-faceted implementation plan to address challenges of varied emergency departments and relationship with higher pediatric care center hospital within the health system. Using researched pediatric readiness quality improvement initiatives, a consolidated pediatric readiness program was defined for the health system to include pediatric emergency care coordinator designation for each emergency department, pediatric readiness education, and corporate level pediatric readiness committee structure. Analysis focused on staff perceptions through a quality improvement study method with pre-survey, implementation of quality improvement initiatives across the organization, and post-survey to evaluate system changes. Evaluating emergency departments across a health system provided for varied geographic, patient volume, and other considerations, and results allowed for conversation around pediatric readiness program implementation in other health systems framed by the analysis of emergency department staff perceptions. Implementing a consolidated pediatric readiness program customized to the health system allowed for the opportunity to impact the perception of readiness across the health system

Energy estimators for random series path-integral methods

We perform a thorough analysis on the choice of estimators for random series path integral methods. In particular, we show that both the thermodynamic (T-method) and the direct (H-method) energy estimators have finite variances and are straightforward to implement. It is demonstrated that the agreement between the T-method and the H-method estimators provides an important consistency check on the quality of the path integral simulations. We illustrate the behavior of the various estimators by computing the total, kinetic, and potential energies of a molecular hydrogen cluster using three different path integral techniques. Statistical tests are employed to validate the sampling strategy adopted as well as to measure the performance of the parallel random number generator utilized in the Monte Carlo simulation. Some issues raised by previous simulations of the hydrogen cluster are clarified.Comment: 15 pages, 1 figure, 3 table

Heat capacity estimators for random series path-integral methods by finite-difference schemes

Previous heat capacity estimators used in path integral simulations either have large variances that grow to infinity with the number of path variables or require the evaluation of first and second order derivatives of the potential. In the present paper, we show that the evaluation of the total energy by the T-method estimator and of the heat capacity by the TT-method estimator can be implemented by a finite difference scheme in a stable fashion. As such, the variances of the resulting estimators are finite and the evaluation of the estimators requires the potential function only. By comparison with the task of computing the partition function, the evaluation of the estimators requires k + 1 times more calls to the potential, where k is the order of the difference scheme employed. Quantum Monte Carlo simulations for the Ne_13 cluster demonstrate that a second order central-difference scheme should suffice for most applications.Comment: 11 pages, 4 figure

Taming the rugged landscape: production, reordering, and stabilization of selected cluster inherent structures in the X_(13-n)Y_n system

We present studies of the potential energy landscape of selected binary Lennard-Jones thirteen atom clusters. The effect of adding selected impurity atoms to a homogeneous cluster is explored. We analyze the energy landscapes of the studied systems using disconnectivity graphs. The required inherent structures and transition states for the construction of disconnectivity graphs are found by combination of conjugate gradient and eigenvector-following methods. We show that it is possible to controllably induce new structures as well as reorder and stabilize existing structures that are characteristic of higher-lying minima. Moreover, it is shown that the selected structures can have experimentally relevant lifetimes.Comment: 12 pages, 14 figures, submitted to J. Chem. Phys. Reasons for replacing a paper: figures 2, 3, 7 and 11 did not show up correctl

Sensitivity and Tolerance of Riparian Arthropod Communities to Altered Water Resources along a Drying River

Rivers around the world are drying with increasing frequency, but little is known about effects on terrestrial animal communities. Previous research along the San Pedro River in southeastern AZ, USA, suggests that changes in the availability of water resources associated with river drying lead to changes in predator abundance, community composition, diversity, and abundance of particular taxa of arthropods, but these observations have not yet been tested manipulatively

Coordinated trafficking of synaptic vesicle and active zone proteins prior to synapse formation

<p>Abstract</p> <p>Background</p> <p>The proteins required for synaptic transmission are rapidly assembled at nascent synapses, but the mechanisms through which these proteins are delivered to developing presynaptic terminals are not understood. Prior to synapse formation, active zone proteins and synaptic vesicle proteins are transported along axons in distinct organelles referred to as piccolo-bassoon transport vesicles (PTVs) and synaptic vesicle protein transport vesicles (STVs), respectively. Although both PTVs and STVs are recruited to the same site in the axon, often within minutes of axo-dendritic contact, it is not known whether or how PTV and STV trafficking is coordinated before synapse formation.</p> <p>Results</p> <p>Here, using time-lapse confocal imaging of the dynamics of PTVs and STVs in the same axon, we show that vesicle trafficking is coordinated through at least two mechanisms. First, a significant proportion of STVs and PTVs are transported together before forming a stable terminal. Second, individual PTVs and STVs share pause sites within the axon. Importantly, for both STVs and PTVs, encountering the other type of vesicle increases their propensity to pause. To determine if PTV-STV interactions are important for pausing, PTV density was reduced in axons by expression of a dominant negative construct corresponding to the syntaxin binding domain of syntabulin, which links PTVs with their KIF5B motor. This reduction in PTVs had a minimal effect on STV pausing and movement, suggesting that an interaction between STVs and PTVs is not responsible for enhancing STV pausing.</p> <p>Conclusions</p> <p>Our results indicate that trafficking of STVs and PTVs is coordinated even prior to synapse development. This novel coordination of transport and pausing might provide mechanisms through which all of the components of a presynaptic terminal can be rapidly accumulated at sites of synapse formation.</p