Using an Audience Response System Smartphone App to Improve Resident Education in the Pediatric Intensive Care Unit.

In the Pediatric Intensive Care Unit (PICU), most teaching occurs during bedside rounds, but technology now provides new opportunities to enhance education. Specifically, smartphone apps allow rapid communication between instructor and student. We hypothesized that using an audience response system (ARS) app can identify resident knowledge gaps, guide teaching, and enhance education in the PICU. Third-year pediatric residents rotating through the PICU participated in ARS-based education or received traditional teaching. Before rounds, experimental subjects completed an ARS quiz using the Socrative app. Concomitantly, the fellow leading rounds predicted quiz performance. Then, discussion points based on the incorrect answers were used to guide instruction. Scores on the pre-rotation test were similar between groups. On the post-rotation examination, ARS participants did not increase their scores more than controls. The fellow's prediction of performance was poor. Residents felt that the method enhanced their education whereas fellows reported that it improved their teaching efficiency. Although there was no measurable increase in knowledge using the ARS app, it may still be a useful tool to rapidly assess learners and help instructors provide learner-centered education

Reducing Unplanned Extubations in a Pediatric Intensive Care Unit: A Systematic Approach

Objective. To prospectively determine the rate of unplanned extubations and contributing factors and determine whether a targeted intervention program would be successful in decreasing the rate of unplanned extubations. Design. Prospective, observational study. Setting. A 10-bed Pediatric Intensive Care Unit (PICU). Patients. All intubated pediatric patients during two time periods: September 1, 2000–March 31, 2001 and November 1, 2001–April 30, 2002. Interventions. After determining the rate and causes of unplanned extubation, a program was developed consisting of education and a formalized endotracheal tube taping policy. Data were then collected after implementation of the program. Measurements and Main Results. Prior to the implementation of the program, there were 10 (14.7%) unplanned extubations for a rate of 6.4 unplanned extubations per 100 ventilated days. Of the ten unplanned extubations, reintubation was required in 2 (20%). Inadequate sedation, poor taping, and improper position of the endotracheal tube were the items most frequently cited as causing an unplanned extubation. Following the program, there were two (3.4%) unplanned extubations for 1.0 unplanned extubations per 100 ventilated days. Neither patient required reintubation. There were no significant differences (P > .05) in age, weight, endotracheal tube size, or duration of intubation in the two time periods. However, there was a significant decrease in both the number (P = .03) and the rate (P = .04) of unplanned extubations after the implementation of the quality improvement program. Conclusions. The rate of unplanned extubation in a PICU can be decreased with a quality improvement program that targets the institution's specific needs

Critically rotating stars in binaries - an unsolved problem -

In close binaries mass and angular momentum can be transferred from one star to the other during Roche-lobe overflow. The efficiency of this process is not well understood and constitutes one of the largest uncertainties in binary evolution. One of the problems lies in the transfer of angular momentum, which will spin up the accreting star. In very tight systems tidal friction can prevent reaching critical rotation, by locking the spin period to the orbital period. Accreting stars in systems with orbital periods larger than a few days reach critical rotation after accreting only a fraction of their mass, unless there is an effective mechanism to get rid of angular momentum. In low mass stars magnetic field might help. In more massive stars angular momentum loss will be accompanied by strong mass loss. This would imply that most interacting binaries with initial orbital periods larger than a few days evolve very non-conservatively. In this contribution we wish to draw attention to the unsolved problems related to mass and angular momentum transfer in binary systems. We do this by presenting the first results of an implementation of spin up by accretion into the TWIN version of the Eggleton stellar evolution code.Comment: 5 pages, 1 figure, to appear in the proceedings of the conference "Unsolved Problems in Stellar Physics", Cambridge, 2-6 July 200

Diverging volumetric trajectories following pediatric traumatic brain injury.

Traumatic brain injury (TBI) is a significant public health concern, and can be especially disruptive in children, derailing on-going neuronal maturation in periods critical for cognitive development. There is considerable heterogeneity in post-injury outcomes, only partially explained by injury severity. Understanding the time course of recovery, and what factors may delay or promote recovery, will aid clinicians in decision-making and provide avenues for future mechanism-based therapeutics. We examined regional changes in brain volume in a pediatric/adolescent moderate-severe TBI (msTBI) cohort, assessed at two time points. Children were first assessed 2-5 months post-injury, and again 12 months later. We used tensor-based morphometry (TBM) to localize longitudinal volume expansion and reduction. We studied 21 msTBI patients (5 F, 8-18 years old) and 26 well-matched healthy control children, also assessed twice over the same interval. In a prior paper, we identified a subgroup of msTBI patients, based on interhemispheric transfer time (IHTT), with significant structural disruption of the white matter (WM) at 2-5 months post injury. We investigated how this subgroup (TBI-slow, N = 11) differed in longitudinal regional volume changes from msTBI patients (TBI-normal, N = 10) with normal WM structure and function. The TBI-slow group had longitudinal decreases in brain volume in several WM clusters, including the corpus callosum and hypothalamus, while the TBI-normal group showed increased volume in WM areas. Our results show prolonged atrophy of the WM over the first 18 months post-injury in the TBI-slow group. The TBI-normal group shows a different pattern that could indicate a return to a healthy trajectory

Functional Brain Hyperactivations Are Linked to an Electrophysiological Measure of Slow Interhemispheric Transfer Time after Pediatric Moderate/Severe Traumatic Brain Injury.

Increased task-related blood oxygen level dependent (BOLD) activation is commonly observed in functional magnetic resonance imaging (fMRI) studies of moderate/severe traumatic brain injury (msTBI), but the functional relevance of these hyperactivations and how they are linked to more direct measures of neuronal function remain largely unknown. Here, we investigated how working memory load (WML)-dependent BOLD activation was related to an electrophysiological measure of interhemispheric transfer time (IHTT) in a sample of 18 msTBI patients and 26 demographically matched controls from the UCLA RAPBI (Recovery after Pediatric Brain Injury) study. In the context of highly similar fMRI task performance, a subgroup of TBI patients with slow IHTT had greater BOLD activation with higher WML than both healthy control children and a subgroup of msTBI patients with normal IHTT. Slower IHTT treated as a continuous variable was also associated with BOLD hyperactivation in the full TBI sample and in controls. Higher WML-dependent BOLD activation was related to better performance on a clinical cognitive performance index, an association that was more pronounced within the patient group with slow IHTT. Our previous work has shown that a subgroup of children with slow IHTT after pediatric msTBI has increased risk for poor white matter organization, long-term neurodegeneration, and poor cognitive outcome. BOLD hyperactivations after msTBI may reflect neuronal compensatory processes supporting higher-order capacity demanding cognitive functions in the context of inefficient neuronal transfer of information. The link between BOLD hyperactivations and slow IHTT adds to the multi-modal validation of this electrophysiological measure as a promising biomarker

Models for the lithium abundances of multiple populations in globular clusters and the possible role of the Big Bang lithium

Globular cluster stars show chemical abundance patterns typical of hot-CNO processing. Lithium is easily destroyed by proton capture in stellar environments, so its abundance may be crucial to discriminate among different models proposed to account for multiple populations. In order to reproduce the observed O-Na anticorrelation and other patterns typical of multiple populations, the formation of second generation stars must occur from the nuclearly processed stellar ejecta, responsible of the chemical anomalies, diluted with pristine gas having the composition of first generation stars. The lithium abundance in the unprocessed gas -which is very likely to be equal to the lithium abundance emerging from the Big Bang- affects the lithium chemical patterns among the cluster stars. This paper focuses on a scenario in which processed gas is provided by asymptotic giant branch (AGB) stars. We examine the predictions of this scenario for the lithium abundances of multiple populations. We study the role of the non-negligible lithium abundance in the ejecta of massive AGB (A(Li)~2), and, at the same time, we explore how our models can constrain the extremely large ---and very model dependent--- lithium yields predicted by recent super--AGB models. We show that the super--AGB yields may be tested by examining the lithium abundances in a large set of blue main sequence stars in wCen and/or NGC2808. In addition, we examine the different model results obtained by assuming for the pristine gas either the Big Bang abundance predicted by the standard models (A(Li)=2.6-2.7), or the abundance detected at the surface of population II stars (A(Li)=2.2-2.3). Once a chemical model is well constrained, the O--Li distribution could perhaps be used to shed light on the primordial lithium abundance

Hectospec, the MMT's 300 Optical Fiber-Fed Spectrograph

The Hectospec is a 300 optical fiber fed spectrograph commissioned at the MMT in the spring of 2004. A pair of high-speed six-axis robots move the 300 fiber buttons between observing configurations within ~300 s and to an accuracy ~25 microns. The optical fibers run for 26 m between the MMT's focal surface and the bench spectrograph operating at R~1000-2000. Another high dispersion bench spectrograph offering R~5,000, Hectochelle, is also available. The system throughput, including all losses in the telescope optics, fibers, and spectrograph peaks at ~10% at the grating blaze in 1" FWHM seeing. Correcting for aperture losses at the 1.5" diameter fiber entrance aperture, the system throughput peaks at $\sim$17%. Hectospec has proven to be a workhorse instrument at the MMT. Hectospec and Hectochelle together were scheduled for 1/3 of the available nights since its commissioning. Hectospec has returned \~60,000 reduced spectra for 16 scientific programs during its first year of operation.Comment: 68 pages, 28 figures, to appear in December 2005 PAS

Fruit intake and abdominal aortic calcification in elderly women: A prospective cohort study

© 2016 by the authors; licensee MDPI, Basel, Switzerland. Cardiovascular disease (CVD) is the leading cause of death worldwide. There is a consistent inverse relationship between fruit intake with CVD events and mortality in cross-sectional and prospective observational studies, but the relationship of fruit intake with measurements of atherosclerosis in humans is less clear. Nutritional effects on abdominal aortic calcification (AAC), a marker for subclinical intimal and medial atherosclerotic vascular disease, have not been studied previously. The aim of this study was to examine the cross-sectional relationship of total and individual fruit (apple, pear, orange and other citrus, and banana) intake with AAC, scored between 0 and 24. The current study assessed baseline data for a cohort of 1052 women over 70 years of age who completed both a food frequency questionnaire assessing fruit intake, and underwent AAC measurement using dual energy X-ray absorptiometry. AAC scores were significantly negatively correlated with total fruit and apple intakes (p 0.25). In multivariable-adjusted logistic regression, each standard deviation (SD; 50 g/day) increase in apple intake was associated with a 24% lower odds of having severe AAC (AAC score >5) (odd ratio OR): 0.76 (0.62, 0.93), p = 0.009). Total and other individual fruit intake were not associated with increased odds of having severe AAC. Apple but not total or other fruit intake is independently negatively associated with AAC in older women

Sub-cortical and brainstem sites associated with chemo-stimulated increases in ventilation in humans

We investigated the neural basis for spontaneous chemo-stimulated increases in ventilation in awake, healthy humans. Blood oxygen level dependent (BOLD) functional MRI was performed in nine healthy subjects using T2weighted echo planar imaging. Brain volumes (52 transverse slices, cortex to high spinal cord) were acquired every 3.9 s. The 30 min paradigm consisted of six, 5-min cycles, each cycle comprising 45 s of hypoxic-isocapnia, 45 s of isooxic-hypercapnia and 45 s of hypoxic-hypercapnia, with 55 s of non-stimulatory hyperoxic-isocapnia (control) separating each stimulus period. Ventilation was significantly (p < 0.001) increased during hypoxic-isocapnia, isooxic-hypercapnia and hypoxic-hypercapnia (17.0, 13.8, 24.9 L/min respectively) vs. control (8.4 L/min) and was associated with significant (p < 0.05, corrected for multiple comparisons) signal increases within a bilateral network that included the basal ganglia, thalamus, red nucleus, cerebellum, parietal cortex, cingulate and superior mid pons. The neuroanatomical structures identified provide evidence for the spontaneous control of breathing to be mediated by higher brain centres, as well as respiratory nuclei in the brainstem

An ultraviolet-selected galaxy redshift survey - III: Multicolour imaging and non-uniform star formation histories

(abridged) We present panoramic u' and optical ground-based imaging observations of a complete sample of low-redshift (0<z<0.4) galaxies selected in the ultraviolet (UV) at 2000A using the balloon-borne FOCA instrument of Milliard et al. This survey is highly sensitive to newly-formed massive stars, and hence to actively star-forming galaxies. We use the new data to further investigate the stellar population and star formation properties of this sample. When combined with our earlier spectroscopic surveys, these new data allow us to compare star-formation measures derived from aperture-corrected Ha line fluxes, UV(2000A) and u'(3600A) continuum fluxes on a galaxy-by-galaxy basis. As expected from our earlier studies, we find broad correlations between the dust-corrected star-formation diagnostics, though the scatter is larger than that from observational errors, with significant offsets from trends expected according to simple star-formation history (SFH) models. Varying metallicities and/or initial mass functions seem unable to explain the observed discrepancies. We investigate the star-formation properties further by modelling the observed spectroscopic and photometric properties of the galaxies in our survey. Nearly half of the galaxies surveyed possess features that appear incompatible with simple constant or smoothly declining SFHs, favouring instead irregular or temporally-varying SFHs. We demonstrate how this can reconcile the majority of our observations, and determine empirical corrections to calculate intrinsic star formation rates from measures based on UV (or u') observations alone. We discuss the broader implications of our finding that a significant fraction of star-forming galaxies have complex SFHs, particularly in the context of recent determinations of the cosmic SFH.Comment: MNRAS; post-referee report version. 16 pages, 10 figure