Simulation in Nursing: Historical Analysis and Theoretical Modeling in Support of a Targeted Clinical Training Intervention

The use of simulation is widespread in healthcare education, and the potential impact of its use large. This is especially true for nursing education as we look to address problems with obtaining clinical experiences, develop critical thinking skills and create methods to measure the impact of simulation interventions. There is substantial empirical evidence in support of predictive relationships between simulation training interventions and knowledge acquisition. This has been extensively demonstrated with the use of a variety of simulation training modalities from standardized patients to human patient simulators. However, data to support changes in clinical practice and improved patient outcomes are quite limited, including attempts to measure the impact of simulation education on retention and transference of knowledge and skill for more complex healthcare process. Additionally, literature searches reveal that only a handful of authors have engaged in the types of foundational work that any emerging science needs. For example, while pieces of the simulation process have been examined in detail, few have attempted to describe what the process of simulation entails at a macro level. Within the past few years some researchers have begun to ask whether there is a causal or predictive relationship present, but few have explored what these associations may look like structurally and what the evidence for them is. The overall objectives of this current research were to: 1) perform an historical review of simulation in healthcare; 2) use this review to outline a new theoretical model of healthcare simulation; and, 3) conduct a small-scale study aimed at pilot-testing and describing part of that model. Hierarchical Task Analysis (HTA) was used to derive an optimum task set for the standard induction of general anesthesia (OTS-SIGA). New Student Registered Nurse Anesthetists (SRNAs) were trained to this task set, and their adherence to the process steps in the clinical setting was then assessed. We also attempted to measure whether repeating the HTA-derived OTS-SIGA simulation training would have an impact on knowledge and transference of simulation-developed skills to the clinical environment. These measures necessitated the development of associated data collection tools and processes for rater training

Simulated rescue airway use by laypersons with scripted telephonic instruction.

BACKGROUND: The King LT-D is a supraglottic airway with the potential for use by trained first responders in settings where access to advanced life support interventions by a physician or Emergency Medical Services may be delayed. OBJECTIVES: To determine the success rate of novice users in the telephone-directed placement of the King LT-D airway during a simulated respiratory arrest in order to establish the feasibility of conducting further study into use of the device by first responders after minimal training. METHODS: We conducted a prospective study using 30 undergraduate students without medical training and a high-fidelity simulator. Subjects were instructed using a telephone-directed protocol to assess the airway, place the King LT-D and ventilate the simulator. Subjects were assessed on the successful placement of the King LT-D, time to placement, and perceived ease of use of the device. A Likert scale was used to identify the participant\u27s perceptions. Subjects with CPR/AED certification were compared to those without such training. Data were analyzed using descriptive statistics and a t-test. RESULTS: The King airway was successfully placed in 80% (95% CI: 65; 95) of attempts. Success rate did not differ with prior CPR training. The median time to successful placement was 1min 50s (95% CI: 1min 6s; 2min 39s). The participants perceived the King LT-D to be easy to place in 90% (27/30) of cases. CONCLUSION: The King LT-D is simple enough to use, that it can be successfully placed by novice users with minimal telephonic instruction. This suggests that further studies could be conducted to determine the effect of King LT-D use on quality of airway management in scenarios depicting management of cardiac arrest by first responders in areas with delayed access to ALS interventions

Widespread gas hydrate instability on the upper U.S. Beaufort margin

Author Posting. © American Geophysical Union, 2014. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Journal of Geophysical Research: Solid Earth 119 (2014): 8594–8609, doi:10.1002/2014JB011290.The most climate-sensitive methane hydrate deposits occur on upper continental slopes at depths close to the minimum pressure and maximum temperature for gas hydrate stability. At these water depths, small perturbations in intermediate ocean water temperatures can lead to gas hydrate dissociation. The Arctic Ocean has experienced more dramatic warming than lower latitudes, but observational data have not been used to study the interplay between upper slope gas hydrates and warming ocean waters. Here we use (a) legacy seismic data that constrain upper slope gas hydrate distributions on the U.S. Beaufort Sea margin, (b) Alaskan North Slope borehole data and offshore thermal gradients determined from gas hydrate stability zone thickness to infer regional heat flow, and (c) 1088 direct measurements to characterize multidecadal intermediate ocean warming in the U.S. Beaufort Sea. Combining these data with a three-dimensional thermal model shows that the observed gas hydrate stability zone is too deep by 100 to 250 m. The disparity can be partially attributed to several processes, but the most important is the reequilibration (thinning) of gas hydrates in response to significant (~0.5°C at 2σ certainty) warming of intermediate ocean temperatures over 39 years in a depth range that brackets the upper slope extent of the gas hydrate stability zone. Even in the absence of additional ocean warming, 0.44 to 2.2 Gt of methane could be released from reequilibrating gas hydrates into the sediments underlying an area of ~5–7.5 × 103 km2 on the U.S. Beaufort Sea upper slope during the next century.This work was supported by the U.S. Department of Energy (DOE), grant DE-FE0010180 to SMU and a USGS-DOE interagency agreement DE-FE0005806.2015-06-0

Oceanic sediment accumulation rates predicted via machine learning algorithm: towards sediment characterization on a global scale

AbstractObserved vertical sediment accumulation rates (n = 1031) were gathered from ~ 55 years of peer reviewed literature. Original methods of rate calculation include long-term isotope geochronology (14C,210Pb, and137Cs), pollen analysis, horizon markers, and box coring. These observations are used to create a database of global, contemporary vertical sediment accumulation rates. Rates were converted to cm year−1, paired with the observation's longitude and latitude, and placed into a machine learning–based Global Predictive Seabed Model (GPSM). GPSM finds correlations between the data and established global "predictors" (quantities known or estimable everywhere, e.g., distance from coastline and river mouths). The result, using a k-nearest neighbor (k-NN) algorithm, is a 5-arc-minute global map of predicted benthic vertical sediment accumulation rates. The map generated provides a global reference for vertical sedimentation from coastal to abyssal depths. Areas of highest sedimentation, ~ 3–8 cm year−1, are generally river mouth proximal coastal zones draining relatively large areas with high maximum elevations and with wide, shallow continental shelves (e.g., the Gulf of Mexico and the Amazon Delta), with rates falling exponentially towards the deepest parts of the oceans. The exception is Oceania, which displays significant vertical sedimentation over a large area without draining the large drainage basins seen in other regions. Coastal zones with relatively small drainage basins and steep shelves display vertical sedimentation of ~ 1 cm year−1, which is limited to the near shore when compared with shallow, wide margins (e.g., the western coasts of North and South America). Abyssal depth rates are functionally zero at the time scale examined (~ 10−4 cm year−1) and increase one order of magnitude near the Mid-Atlantic Ridge and at the Galapagos Triple Junction

A Multidisciplinary Intubation Algorithm for Suspected COVID-19 Patients in the Emergency Department

Introduction: Intubation of patients suspected of having coronavirus disease 2019 (COVID-19) is considered to be a high-risk procedure due to the aerosolization of viral particles. In an effort to minimize the risk of exposure and optimize patient care, we sought to develop, test, provide training, and implement a standardized algorithm for intubating these high-risk patients at our institution.Methods: We developed an initial intubation algorithm, incorporating strategic use of equipment and incorporating emerging best practices. By combining simulation-based training sessions and rapid-cycle improvement methodology with physicians, nurses, and respiratory therapists, and incorporating their feedback into the development, we were able to optimize the process prior to implementation. Training sessions also enabled the participants to practice the algorithm as a team. Upon completion of each training session, participants were invited to complete a brief online survey about their overall experience.Results: An algorithm and training system vetted by simulation and actual practice were developed. A training video and dissemination package were made available for other emergency departments to adopt. Survey results were overall positive, with 97.92% of participants feeling confident in their role in the intubation process, and many participants citing the usefulness of the multidisciplinary approach to the training.Conclusion: A multidisciplinary, team-based approach to the development and training of a standardized intubation algorithm combining simulation and rapid-cycle improvement methodology is a useful, effective process to respond to rapidly evolving clinical information and experiences during a global pandemic

A machine-learning derived model of seafloor sediment accumulation

Abstract Previous studies regarding the depositional pattern and quantity of accumulated seafloor sediment tend to be regional, limited in scope and involving costly and time-consuming geologic field campaigns and laboratory work. Presented herein is a global map of predicted modern (postindustrial, 20th and 21st century) oceanic mass accumulation rates of 5-arc-minute pitch and in log10-space, trained on observed marine mass accumulation rates from 43 peer reviewed sources (n = 1744) and predicted using a k-nearest neighbor geospatial algorithm. The resultant model predicts ~3.3 × 104 Mt. yr−1 of sediment accumulating onto the sea floor (R2 = 0.88). Most sediment accumulates proximal to major river outlets and deltas. Continental regions with the highest sediment accumulation are Asia and Oceania. This model is the first of its kind to predict the rate and quantity of sediment accumulating on to the ocean floor, globally, using decades of regional real-world observations. The generated global map of modern, benthic mass accumulation rates also serves to highlight areas of interest for future study in related fields, such as sediment dynamics and seafloor stability

Influence of simulation in Malaysian healthcare education and research (ISIM-HERE): a two-decade experience

The use of simulation as a teaching methodology in medical institutions has been in Malaysia for over two decades. This study aimed to evaluate the current scenarios of simulation impact and utilization in Malaysian academic healthcare institutions (AHIs). We conducted a population-based survey on all AHIs in Malaysia including public and private. We performed an online survey followed by a face-to-face interview evaluating the number of institutions that used simulation, duration of experience, purpose, funding, users’ category and healthcare domain, research activities, dedicated-trained staff and the challenges faced. Out of 75 healthcare institutions approached, 38 agreed to participate in this study. Twenty-two (57.9%) were public hospitals while 16 (42.1%) were private institutions. Thirty-five (92.1%) out of 38 institutions used simulation as a teaching method. The majority (15, 42.9%) had less than five years’ experience, and about a third (11, 31.4%) used simulation for teaching, training and performance assessment. Nurses (30, 26.1%) were the main users followed by physicians and paramedic (19, 16.5% each respectively). In-hospital and procedural group were the top two domains of utilizers. Almost three quarters (25, 71.4%) have dedicated support staff to manage the centre. Funding was mainly from internal institutional support mechanisms. Seven different categories of challenges were identified, the biggest being financial support. In summary, even though healthcare simulation has been in Malaysia for the past two decades but the most substantial impact happened over the last five years. Utilization was mainly for teaching, training, and performance assessment with minimal use in research

Mechanistic insights into a hydrate contribution to the Paleocene-Eocene carbon cycle perturbation from coupled thermohydraulic simulations

During the Paleocene-Eocene Thermal Maximum (PETM), the carbon isotopic signature (δ13C) of surface carbon-bearing phases decreased abruptly by at least 2.5 to 3.0‰. This carbon isotope excursion (CIE) has been attributed to widespread methane hydrate dissociation in response to rapid ocean warming. We ran a thermohydraulic modeling code to simulate hydrate dissociation due to ocean warming for various PETM scenarios. Our results show that hydrate dissociation in response to such warming can be rapid but suggest that methane release to the ocean is modest and delayed by hundreds to thousands of years after the onset of dissociation, limiting the potential for positive feedback from emission-induced warming. In all of our simulations at least half of the dissociated hydrate methane remains beneath the seabed, suggesting that the pre-PETM hydrate inventory needed to account for all of the CIE is at least double that required for isotopic mass balance

In Situ Temperature Measurements at the Svalbard Continental Margin: Implications for Gas Hydrate Dynamics

During expedition MARIA S. MERIAN MSM57/2 to the Svalbard margin offshore Prins Karls Forland, the seafloor drill rig MARUM-MeBo70 was used to assess the landward termination of the gas hydrate system in water depths between 340 and 446 m. The study region shows abundant seafloor gas vents, clustered at a water depth of ~400 m. The sedimentary environment within the upper 100 meters below seafloor (mbsf) is dominated by ice-berg scours and glacial unconformities. Sediments cored included glacial diamictons and sheet-sands interbedded with mud. Seismic data show a bottom simulating reflector terminating ~30 km seaward in ~760 m water depth before it reaches the theoretical limit of the gas hydrate stability zone (GHSZ) at the drilling transect. We present results of the first in situ temperature measurements conducted with MeBo70 down to 28 mbsf. The data yield temperature gradients between ~38°C km-1 at the deepest site (446 m) and ~41°C km-1 at a shallower drill site (390 m). These data constrain combined with in situ pore-fluid data, sediment porosities, and thermal conductivities the dynamic evolution of the GHSZ during the past 70 years for which bottom water temperature records exist. Gas hydrate is not stable in the sediments at sites shallower than 390 m water depth at the time of acquisition (August 2016). Only at the drill site in 446 m water depth, favorable gas hydrate stability conditions are met (maximum vertical extent of ~60 mbsf); however, coring did not encounter any gas hydrates