Recertification and Reentry to Practice for Nurse Anesthetists: Determining Core Competencies and Evaluating Performance via High-Fidelity Simulation Technology

Introduction The National Board of Certification and Recertification for Nurse Anesthetistsaddressed a barrier to return to practice of uncertified practitioners by replacing required direct patient care experiences with high-fidelity simulation. Objectives The aims of this study were to: (a) validate a set of clinical activities for their relevance to reentry and determine if they could be replicated using simulation, (b) evaluate the content validity of an existing simulation scenario containing the proposed clinical activities and determine its substitutability for a clinical practicum, and (c) evaluate the validity of two methods to assess simulation performance. Methods A modified Delphi method incorporating an autonomous, anonymous, three-round online survey process using three unique expert certified registered nurse anesthetists groups was used to address each study aim. Results Twenty-seven clinical activities gained consensus as necessary to be assessed in the simulation. All 14 survey questions used to determine simulation content validity exceeded the minimum content validity index (CVI) value of 0.78, with a mean CVI of 0.99. The global rating scale CVI and the competency checklist CVI were 0.83 and 1.0, respectively. Conclusion The findings add to the existing literature supporting the utility of simulation for high-stakes provider assessment and certification

Das Forschungsdatenzentrum der Universität Hamburg

The more recent discussion of research data practices at relevant conferences, workshops and respective publications suggest substantially different foci of problems and solutions in managing data between scientific disciplines. There seems to be a particularly profound gap in natural science and humanities whereas social and life sciences are placed somewhere in between. Indeed data centers tailored to the specific needs of a single discipline (physics, chemistry, climate studies) are numerous in science and tend to be nearly absent for a specific humanities subject. While the former ask for and report solutions on scaling up (larger quantities of data can be run by the same application) and scaling out (larger quantities of data can use the same infrastructure), the latter are concerned with the heterogeneity of relatively small amounts of data (long-tail problem) and a divergence of agreed standards; something we may term as cross scaling. In either case, an efficiency problem has to be solved. On the one hand, huge amounts of data have to be handled within an acceptable time frame, on the other hand, many different applications with diverse functionalities have to be handled with an acceptable number of resources.  We would like to argue here that independent from the discipline either optimization problem should be addressed. Throughout the last decade, we have also observed that projects in science diversify and prefer individualized solutions which additionally hints at increasing data heterogeneity in natural science as well while, at the same time, some humanities projects produce petabytes of data. To show the necessity of a differentiated approach, the research data center of Universität Hamburg is offered as a case in point. The evolution of the center specialized in humanities projects to a research data center offering services for the whole university whereas other disciplinary data centers continue to exist side by side illustrates the entire range of tasks of data stewardship. It includes the continuous development of services while getting more and more involved in natural science projects as well as task sharing and communication with other data institutions. A core asset to understand the requirements of each discipline is a multidisciplinary team. Yet, the main organizing principle of the offered services centers around the stages of the data life cycle (1. data creation and deposit, 2. managing active data, 3. data repositories and archives, 4. data catalog and registries). The interdigitation of these stages is paramount in the long term strategy

Antley‐Bixler Syndrome: A Case Report and Discussion

Antley-Bixler Syndrome (ABS) is an autosomal recessive trait disorder characterized by multiple bone and cartilaginous abnormalities. Primary features include significant craniosynostosis, midface hypoplasia with choanal stenosis or atresia, femoral bowing, radiohumeral synostosis, and multiple joint contractures. Cardiac, renal, and gastrointestinal malformations have also been described. This report describes the management of a four-month-old male who underwent cranial vault remodeling to relieve craniosynostosis and discusses the potential concerns of the anaesthetist during care of children with Antley-Bixler Syndrome

Evidence-Based Practice for Lifelong Learning

The Institute of Medicine’s landmark report titled “To Err is Human: Building a Safer Health System,” wherein upward of 98,000 deaths annually were attributed to medical error, began to introduce the concept of evidence-based practice (EBP) to the American public and its practitioners. Since this report, clinicians have been struggling to implement and realign healthcare delivery to an evidence-based framework. This column will add to a nurse anesthetist’s foundational knowledge regarding the importance of EBP, its characteristics, and the critical steps for engaging in EBP, as well as discuss the necessary intersection of EBP with student clinical instruction

Advancing Evidence-Based Nurse Anesthesia Practice

The American Association of Nurse Anesthetists (AANA) is committed to advancing evidence-based nurse anesthesia practice. This determination is evident across multiple activities within the Association. This editorial describes the AANA\u27s evidence-based policy and process for the development of those practice-related documents that require approval from the AANA Board of Directors. Additionally, several of the Association\u27s initiatives geared toward fostering the advancement of evidence-based nurse anesthesia practice are described

Nurse Anesthetist

425p. 28 cm

Reduced Recombination Rate and Genetic Differentiation Between the M and S Forms of Anopheles gambiae s.s.

Genetic differentiation between the largely sympatric molecular forms M and S of Anopheles gambiae appears mostly limited to division 6 and part of division 5 of the X chromosome. This region is adjacent to the centromere and includes the rDNA that was used to define these forms. This localized differentiation between populations that experience gene flow strongly suggests that this region contains genes responsible for reproductive isolation. Regions adjacent to centromeres are known to experience less recombination in several species and it has recently been suggested that low recombination rates can facilitate the accumulation and maintenance of isolation genes in partially isolated populations. Therefore, we measured the recombination rate in division 5D/6 directly and estimate that it is at least 16-fold reduced across this region compared to the remainder of the X chromosome. Additionally, sequence data from four loci from field-collected mosquitoes from several West African countries show very strong differentiation between the molecular forms in division 5D/6, whereas none was observed in two loci elsewhere on the X chromosome. Furthermore, genetic variation was substantially lower in division 5D/6 compared to the two reference loci, and the inferred genealogies of the division 5D/6 genes show patterns consistent with selective sweeps. This suggests that the reduced recombination rate has increased the effect of selection on this region and that our data are consistent with the hypothesis that reduced recombination rates can play a role in the accumulation of isolation genes in the face of gene flow