Mixed-realism simulation of adverse event disclosure: an educational methodology and assessment instrument.

INTRODUCTION: Physicians have an ethical duty to disclose adverse events to patients or families. Various strategies have been reported for teaching disclosure, but no instruments have been shown to be reliable for assessing them.The aims of this study were to report a structured method for teaching adverse event disclosure using mixed-realism simulation, develop and begin to validate an instrument for assessing performance, and describe the disclosure practice of anesthesiology trainees. METHODS: Forty-two anesthesiology trainees participated in a 2-part exercise with mixed-realism simulation. The first part took place using a mannequin patient in a simulated operating room where trainees became enmeshed in a clinical episode that led to an adverse event and the second part in a simulated postoperative care unit where the learner is asked to disclose to a standardized patient who systematically moves through epochs of grief response. Two raters scored subjects using an assessment instrument we developed that combines a 4-element behaviorally anchored rating scale (BARS) and a 5-stage objective rating scale. RESULTS: The performance scores for elements within the BARS and the 5-stage instrument showed excellent interrater reliability (Cohen's κ = 0.7), appropriate range (mean range for BARS, 4.20-4.47; mean range for 5-stage instrument, 3.73-4.46), and high internal consistency (P < 0.05). CONCLUSIONS: We have demonstrated a comprehensive methodology using a mixed-realism simulation that engages learners in an adverse event and allows them to practice disclosure to a structured range of patient responses. We have developed a reliable 2-part instrument with strong psychometric properties for assessing disclosure performance

Radar returns from ground clutter in vicinity of airports

The objective of this project is to develop a dynamic simulation of the received signals from natural and man-made ground features in the vicinity of airports. The simulation is run during landing and takeoff stages of a flight. Vugraphs of noteworthy features of the simulation, ground clutter data bases, the development of algorithms for terrain features, typical wave theory results, and a gravity wave height profile are given

Evaluating Educational Interventions in Emergency Medicine

This article presents the proceedings of the 2012 Academic Emergency Medicine consensus conference breakout group charged with identifying areas necessary for future research regarding effectiveness of educational interventions for teaching emergency medicine ( EM ) knowledge, skills, and attitudes outside of the clinical setting. The objective was to summarize both medical and nonmedical education literature and report the consensus formation methods and results. The authors present final statements to guide future research aimed at evaluating the best methods for understanding and developing successful EM curricula using all types of educational interventions.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/94811/1/acem12022.pd

The use of simulation to prepare and improve responses to infectious disease outbreaks like COVID-19: practical tips and resources from Norway, Denmark, and the UK.

In this paper, we describe the potential of simulation to improve hospital responses to the COVID-19 crisis. We provide tools which can be used to analyse the current needs of the situation, explain how simulation can help to improve responses to the crisis, what the key issues are with integrating simulation into organisations, and what to focus on when conducting simulations. We provide an overview of helpful resources and a collection of scenarios and support for centre-based and in situ simulations

Reporting Guidelines for Health Care Simulation Research: Extensions to the CONSORT and STROBE Statements.

INTRODUCTION Simulation-based research (SBR) is rapidly expanding but the quality of reporting needs improvement. For a reader to critically assess a study, the elements of the study need to be clearly reported. Our objective was to develop reporting guidelines for SBR by creating extensions to the Consolidated Standards of Reporting Trials (CONSORT) and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statements. METHODS An iterative multistep consensus-building process was used on the basis of the recommended steps for developing reporting guidelines. The consensus process involved the following: (1) developing a steering committee, (2) defining the scope of the reporting guidelines, (3) identifying a consensus panel, (4) generating a list of items for discussion via online premeeting survey, (5) conducting a consensus meeting, and (6) drafting reporting guidelines with an explanation and elaboration document. RESULTS The following 11 extensions were recommended for CONSORT item 1 (title/abstract), item 2 (background), item 5 (interventions), item 6 (outcomes), item 11 (blinding), item 12 (statistical methods), item 15 (baseline data), item 17 (outcomes/estimation), item 20 (limitations), item 21 (generalizability), and item 25 (funding). The following 10 extensions were recommended for STROBE: item 1 (title/abstract), item 2 (background/rationale), item 7 (variables), item 8 (data sources/measurement), item 12 (statistical methods), item 14 (descriptive data), item 16 (main results), item 19 (limitations), item 21 (generalizability), and item 22 (funding). An elaboration document was created to provide examples and explanation for each extension. CONCLUSIONS We have developed extensions for the CONSORT and STROBE Statements that can help improve the quality of reporting for SBR

CD56negCD16+NK cells are activated mature NK cells with impaired effector function during HIV-1 infection

BACKGROUND: A subset of CD3(neg)CD56(neg)CD16(+) Natural Killer (NK) cells is highly expanded during chronic HIV-1 infection. The role of this subset in HIV-1 pathogenesis remains unclear. The lack of NK cell lineage-specific markers has complicated the study of minor NK cell subpopulations. RESULTS: Using CD7 as an additional NK cell marker, we found that CD3(neg)CD56(neg)CD16(+) cells are a heterogeneous population comprised of CD7(+) NK cells and CD7(neg) non-classical myeloid cells. CD7(+)CD56(neg)CD16(+) NK cells are significantly expanded in HIV-1 infection. CD7(+)CD56(neg)CD16(+) NK cells are mature and express KIRs, the C-type lectin-like receptors NKG2A and NKG2C, and natural cytotoxicity receptors similar to CD7(+)CD56(+)CD16(+) NK cells. CD7(+)CD56(neg) NK cells in healthy donors produced minimal IFNγ following K562 target cell or IL-12 plus IL-18 stimulation; however, they degranulated in response to K562 stimulation similar to CD7(+)CD56(+) NK cells. HIV-1 infection resulted in reduced IFNγ secretion following K562 or cytokine stimulation by both NK cell subsets compared to healthy donors. Decreased granzyme B and perforin expression and increased expression of CD107a in the absence of stimulation, particularly in HIV-1-infected subjects, suggest that CD7(+)CD56(neg)CD16(+) NK cells may have recently engaged target cells. Furthermore, CD7(+)CD56(neg)CD16(+) NK cells have significantly increased expression of CD95, a marker of NK cell activation. CONCLUSIONS: Taken together, CD7(+)CD56(neg)CD16(+) NK cells are activated, mature NK cells that may have recently engaged target cells

Quantification and Comparison of Microplastic Contents in Wild Mussels and Maricultured Oysters from Humboldt Bay, California Using Enzymatic Digestion Methods

This research evaluates the microplastic contents of commercially maricultured Pacific oysters (Crassostrea gigas) and wild mussels (Mytilus edulis) from Humboldt Bay (HB), California. Ten bivalves were collected from each of three different locations in HB: North Bay, Entrance Bay, and South Bay. Oysters were purchased directly from a commercial oyster farmer who cultivates them in the North Bay. Bivalves were digested with proteolytic enzyme complexes, vacuum filtered, and microplastics were quantified by microscopic examination of filters. All samples contained microplastics, with plastic fibers being the most abundant items. Significantly different concentrations of microplastic particles (plastic particles/g tissue wet mass) were found between mussels collected from different locations and from the cultured oysters (p = 0.000). Mussels from North Bay contained the highest average concentration of microplastics (6.29 ± 1.73 items/g) and were significantly different from all other groups. Microplastic concentrations in Entrance Bay (3.39 ± 1.19 items/g) and South Bay (2.29 ± 1.75 items/g) mussels were intermediate and not significantly different from each other (p = 0.452). Oysters contained the lowest microplastic concentrations (0.72 ± 0.34 items/g) and were significantly different from North Bay (p = 0.000) and Entrance Bay (p = 0.001) mussels, but not from the South Bay mussels (p = 0.104). Half of the samples from each location were digested using the enzyme complex Corolase 7089 and the other half were digested with Corolase 8000, both supplied by AB Enzymes Inc. All samples treated with Corolase 8000 digested completely, whereas some of the samples treated with Corolase 7089 did not achieve complete digestion, suggesting that Corolase 8000 is more efficient for this purpose. No significant difference in microplastic recovery was found between the two treatments (p=0.253).https://digitalcommons.humboldt.edu/inrsep_posters/1016/thumbnail.jp