Pediatric Kennedy Terminal Ulcer

Photograph of Fossett's circus loads, 2 AEC Matadors - KKN412 - and trailers, taken Forest site, 28 September 1959 whole side view

More than S.K.I.N. Deep: Decreasing Pressure Ulcer Development in the Pediatric Intensive Care Unit

Pressure ulcers are defined as localized areas of tissue destruction that develop when soft tissue is compressed between a bony prominence and an external surface for a prolonged period of time. Although any hospitalized child is at risk for the development of a pressure ulcer, the critically ill child is at increased risk. The critical care environment poses special challenges to preventing the development of pressure ulcers secondary to the high acuity of patients and the highly invasive nature of interventions and therapies those patients receive. The incidence of pediatric pressure ulcer development in the critical care population has been reported to be as high as 10.2 to 27%. This prospective, quasi-experimental study was conducted in order to determine whether a specific pressure ulcer prevention bundle was associated with a significant reduction in pressure ulcer development in infants 0 to 3 months old in the pediatric intensive care unit. The four main components of the pressure ulcer prevention bundle were (S) support surfaces, (K) keep turning every 2 hours, (I) incontinence management, and (N) nutrition consultation. The second element of the study was a survey of the nursing staff of the pediatric intensive care unit to gain a better understanding of the barriers and facilitators to implementing the S.K.I.N. care pressure ulcer prevention bundle. The implementation of the S.K.I.N. care bundle is associated with a significant drop in pressure ulcer incidence from 18.8% to 6.8%. The infants who developed pressure ulcers in the experimental group received significantly more mechanical support and had significantly longer lengths of stay than the infants who did not develop a pressure ulcer. The survey demonstrated that competing demands on nurses\u27 time as the biggest barrier to implementation of the pressure ulcer prevention bundle. Having appropriate supplies and easy access to the support surfaces were the biggest facilitators of implementing the bundle

Creation and Implementation of a Pediatric Advanced Practice Nurse Critical Care Fellowship Program

Advanced practice registered nurses (APRNs) who begin their careers in the pediatric intensive care unit (PICU) may be challenged in this practice environment. Inadequate prior experience as a staff nurse, limited opportunities for clinical placements in the PICU during graduate education, and being in a fast-paced, high-acuity practice environment without prior exposure to critically ill children are practice challenges in the PICU setting. The goal of postgraduate education training programs (fellowship programs) for the acute care pediatric nurse practitioner (ACPNP) is to prepare students to become beginner practitioners who can function effectively in the acute care setting within a few months of being hired, much like that of their physician counterparts who complete a fellowship. The health care environment continues to be influenced by trends in national health care reform, shifts in the models for physician training, and the Accreditation Council for Graduate Medical Education resident duty hour restrictions. These emerging trends have given health care organizations the opportunity to evaluate their current care delivery and training models. It is expected that the demand for APRNs with specialty training will increase. The aim of this article is to describe our experience in the creation and implementation of a critical care pediatric nurse practitioner (CCPNP) fellowship training program at a large midwestern U.S. tertiary care center. It is expected that the demand for APRNs with specialty training will increase. When this fellowship was created, there were no known fellowships available for pediatric nurse practitioners (PNPs) interested in pediatric critical care. To meet the needs of these providers, a focused training program is required to provide specific preparation and competencies to practice to the full extent of the provider\u27s license. A recent recommendation is for health care administrators to consider implementing fellowship training programs to assist nurse practitioners transitioning into specialty roles (Kells, Dunn, Melchiono, & Burke, 2015). We used several online search engines to identify pediatric health care institutions with active advanced practice provider postgraduate fellowships. Our search in June 2017 identified fellowship programs in primary care, pediatric hematology/oncology, palliative care, neuro-critical care, and urgent care/emergency department. To our knowledge, this fellowship program was the first of its kind and seeks to provide postgraduate specialty training and education focused on the unique requirements of critically ill children and their families to help fill a knowledge gap when entering practice in this highly specialized practice environment

A Survey of NAPNAP Members’ Clinical and Professional Research Priorities

Introduction The purpose of this methodological article is to describe the development, implementation, and analysis of the survey used to determine NAPNAP members\u27 ranking of research priorities, to describe the top priorities ranked by participants, and to determine if priorities differed by area of practice (primary, acute, or specialty care) or participant age. Method A cross-sectional descriptive design with an online survey was used. Completed by 324 NAPNAP members, the survey consisted of a demographic section and 90 statements in two domains: Clinical Priorities and Professional Role Priorities. Results Survey respondents strongly supported the top priorities with an average overall mean score of 4.0 or above on a 5-point Likert scale. Only three of the top 10 clinical and professional priorities differed by area of practice. No clinical priorities and only three professional priorities differed by age. Discussion The survey results were used to develop the NAPNAP Research Agenda. Both the survey results and the agenda can provide guidance for the NAPNAP Board, committees and interests groups as they develop initiatives and programs

LSST: from Science Drivers to Reference Design and Anticipated Data Products

(Abridged) We describe here the most ambitious survey currently planned in the optical, the Large Synoptic Survey Telescope (LSST). A vast array of science will be enabled by a single wide-deep-fast sky survey, and LSST will have unique survey capability in the faint time domain. The LSST design is driven by four main science themes: probing dark energy and dark matter, taking an inventory of the Solar System, exploring the transient optical sky, and mapping the Milky Way. LSST will be a wide-field ground-based system sited at Cerro Pach\'{o}n in northern Chile. The telescope will have an 8.4 m (6.5 m effective) primary mirror, a 9.6 deg$^2$ field of view, and a 3.2 Gigapixel camera. The standard observing sequence will consist of pairs of 15-second exposures in a given field, with two such visits in each pointing in a given night. With these repeats, the LSST system is capable of imaging about 10,000 square degrees of sky in a single filter in three nights. The typical 5$\sigma$ point-source depth in a single visit in $r$ will be $\sim 24.5$ (AB). The project is in the construction phase and will begin regular survey operations by 2022. The survey area will be contained within 30,000 deg$^2$ with $\delta<+34.5^\circ$, and will be imaged multiple times in six bands, $ugrizy$, covering the wavelength range 320--1050 nm. About 90\% of the observing time will be devoted to a deep-wide-fast survey mode which will uniformly observe a 18,000 deg$^2$ region about 800 times (summed over all six bands) during the anticipated 10 years of operations, and yield a coadded map to $r\sim27.5$. The remaining 10\% of the observing time will be allocated to projects such as a Very Deep and Fast time domain survey. The goal is to make LSST data products, including a relational database of about 32 trillion observations of 40 billion objects, available to the public and scientists around the world.Comment: 57 pages, 32 color figures, version with high-resolution figures available from https://www.lsst.org/overvie

Microchannel cooling for the LHCb VELO Upgrade I

The LHCb VELO Upgrade I, currently being installed for the 2022 start of LHC Run 3, uses silicon microchannel coolers with internally circulating bi-phase \cotwo for thermal control of hybrid pixel modules operating in vacuum. This is the largest scale application of this technology to date. Production of the microchannel coolers was completed in July 2019 and the assembly into cooling structures was completed in September 2021. This paper describes the R\&D path supporting the microchannel production and assembly and the motivation for the design choices. The microchannel coolers have excellent thermal peformance, low and uniform mass, no thermal expansion mismatch with the ASICs and are radiation hard. The fluidic and thermal performance is presented.Comment: 31 pages, 27 figure