Malignant Hyperthermia Simulation

Malignant Hyperthermia Simulation Rachael Tse, BSN, RN and Michael Quidort, BSN, RN Faculty Sponsor: Anne Sauri, CRNA, DNP and Julia Feczko, CRNA, DNP Background: Malignant hyperthermia (MH) is a life-threatening condition in which survival is highly dependent on early recognition and prompt treatment. The purpose of this DNP project was to examine the impact of an in vivo high-fidelity malignant hyperthermia simulation on CRNA confidence in crisis management. Objectives: Does a high-fidelity simulation training exercise improve CRNAs’ confidence in identifying signs and symptoms during a MH crisis? Does a simulation-based training exercise improve CRNAs’ confidence in the management of a MH crisis? Does a simulation-based training exercise improve CRNAs’ confidence in teamwork dynamics, including establishing and delegating roles during a MH crisis? Does a simulation-based training exercise improve CRNAs’ confidence in their ability to prioritize interventions during a MH crisis? Method: A multigroup pre/post survey design was used to compare CRNA confidence in the management of a MH crisis. The study included a voluntary sample of CRNAs at Advocate Christ Medical Center. Participants were asked to complete a pre survey measuring confidence in the management of MH prior to a high fidelity simulation focused on MH crisis management. Following the simulation, a debriefing was facilitated and participants were then asked to complete a post survey. Results: Three simulations were conducted to obtain a total of nine CRNAs. Mean confidence score on the pre survey was M= 3.89 and the mean confidence score on the post survey was M= 5.47, showing an increase of mean confidence score of 1.57 points (SD = 0.62) (p \u3c 0.000) on a six point Likert scale, indicating the simulation increased confidence of CRNAs in the management of MH crisis. Post surveys demonstrated improved confidence in four specific categories as evidence by an increase in mean scores in management 1.84 points (p \u3c 0.000), delegation 1.61 points (p \u3c 0.000), prioritization 0.72 points (p \u3c 0.000), signs and symptoms 0.5 points (p \u3c 0.029). Conclusion: Participation in a high fidelity MH simulation increased CRNA confidence in the management of a MH crisis. Keywords: Malignant Hyperthermia, Simulation, Anesthesia, Crisis Management, Confidence, Teamwork Dynamics, High Fidelity Simulatio

Perception of healthy and unhealthy food among Chinese adolescents

Purpose The purpose of this paper is to explore snacking behavior and perspectives on healthy and unhealthy food choices among adolescents in Mainland China. Design/methodology/approach Four focus-group interviews were conducted. Altogether 24 participants were recruited in Changsha, a second-tier city in China, through a convenience sampling process. They were asked to report their snacking behaviors, identify whether certain snacks are healthy or unhealthy and elaborate on factors affecting food choices. Findings Snacking was prevalent among the participants. The most frequently consumed snacks included fruit, milk and instant noodles. Participants’ evaluations for the healthiness of foods were based on the actual nutritional values of those foods, the effects on growth and body weight and word-of-mouth. Choice of snack was driven mainly by taste, image, convenience and health consciousness. Research limitations/implications The finding was based on a non-probability sample. The paper also did not explore the contexts where snacks were consumed. Practical implications Parents can make healthy snacks more accessible at home and at schools. Educators can teach adolescents how to read food labels. Schools can increase the availability of healthy snacks on campus. Social marketers can promote healthy snacks by associating them with fun and high taste. Originality/value This is the first paper on snacking behaviors among adolescents conducted in a second-tier city in China using focus-group methodology. Keywords: Qualitative methods, Adolescence, Obesity, Consumer socialization, Children and foodpostprin

Path integral Monte Carlo simulations of silicates

We investigate the thermal expansion of crystalline SiO$_2$ in the $\beta$-- cristobalite and the $\beta$-quartz structure with path integral Monte Carlo (PIMC) techniques. This simulation method allows to treat low-temperature quantum effects properly. At temperatures below the Debye temperature, thermal properties obtained with PIMC agree better with experimental results than those obtained with classical Monte Carlo methods.Comment: 27 pages, 10 figures, Phys. Rev. B (in press

Shrinking Point Bifurcations of Resonance Tongues for Piecewise-Smooth, Continuous Maps

Resonance tongues are mode-locking regions of parameter space in which stable periodic solutions occur; they commonly occur, for example, near Neimark-Sacker bifurcations. For piecewise-smooth, continuous maps these tongues typically have a distinctive lens-chain (or sausage) shape in two-parameter bifurcation diagrams. We give a symbolic description of a class of "rotational" periodic solutions that display lens-chain structures for a general $N$-dimensional map. We then unfold the codimension-two, shrinking point bifurcation, where the tongues have zero width. A number of codimension-one bifurcation curves emanate from shrinking points and we determine those that form tongue boundaries.Comment: 27 pages, 6 figure

Frequency-Dependent Squeezing for Advanced LIGO

The first detection of gravitational waves by the Laser Interferometer Gravitational-wave Observatory (LIGO) in 2015 launched the era of gravitational wave astronomy. The quest for gravitational wave signals from objects that are fainter or farther away impels technological advances to realize ever more sensitive detectors. Since 2019, one advanced technique, the injection of squeezed states of light is being used to improve the shot noise limit to the sensitivity of the Advanced LIGO detectors, at frequencies above $\sim 50$ Hz. Below this frequency, quantum back action, in the form of radiation pressure induced motion of the mirrors, degrades the sensitivity. To simultaneously reduce shot noise at high frequencies and quantum radiation pressure noise at low frequencies requires a quantum noise filter cavity with low optical losses to rotate the squeezed quadrature as a function of frequency. We report on the observation of frequency-dependent squeezed quadrature rotation with rotation frequency of 30Hz, using a 16m long filter cavity. A novel control scheme is developed for this frequency-dependent squeezed vacuum source, and the results presented here demonstrate that a low-loss filter cavity can achieve the squeezed quadrature rotation necessary for the next planned upgrade to Advanced LIGO, known as "A+."Comment: 6 pages, 2 figures, to be published in Phys. Rev. Let

Wireless communication with chaos

Peer reviewedPublisher PD

Effects on the immune system associated with living near a pesticide dump site.

In this paper, we report results of the second phase of a larger study designed to evaluate the effects on the immune system of living near a Superfund site containing organochlorine pesticides, volatile organic compounds, and metals. Phase II was conducted to determine whether living near the site, consisting of six locations in Aberdeen, North Carolina, is associated with higher plasma organochlorine levels, immune suppression, or DNA damage. Each of 302 residents of Aberdeen and neighboring communities provided a blood specimen, underwent a skin test, and answered a questionnaire. Blood specimens were analyzed for organochlorine pesticides, immune markers, and micronuclei. Of 20 organochlorines tested, only DDE was detected in the blood of participants (except for one individual). Age-adjusted mean plasma DDE levels were 4.05 ppb for Aberdeen residents and 2.95 ppb (p = 0.01) for residents of neighboring communities. Residents of 40-59 years of age who lived within a mile of any site, but particularly the Farm Chemicals site, had higher plasma DDE levels than residents who lived farther away. Residents who lived near the Farm Chemicals site before versus after 1985 also had higher plasma DDE levels. Overall, there were few differences in immune markers between residents of Aberdeen and the neighboring communities. However, residents who lived closer to the dump sites had statistically significantly lower mitogen-induced lymphoproliferative activity than residents who lived farther away (p < 0.05). Residential location was not consistently associated with frequency of micronuclei or skin test responses. Although some statistically significant differences in immune markers were noted in association with residential location, the magnitude of effects are of uncertain clinical importance

Microstructured Fibre Taper with Constant Outer Diameter

Department of Electrical Engineerin

The electronic structure of amorphous silica: A numerical study

We present a computational study of the electronic properties of amorphous SiO2. The ionic configurations used are the ones generated by an earlier molecular dynamics simulations in which the system was cooled with different cooling rates from the liquid state to a glass, thus giving access to glass-like configurations with different degrees of disorder [Phys. Rev. B 54, 15808 (1996)]. The electronic structure is described by a tight-binding Hamiltonian. We study the influence of the degree of disorder on the density of states, the localization properties, the optical absorption, the nature of defects within the mobility gap, and on the fluctuations of the Madelung potential, where the disorder manifests itself most prominently. The experimentally observed mismatch between a photoconductivity threshold of 9 eV and the onset of the optical absorption around 7 eV is interpreted by the picture of eigenstates localized by potential energy fluctuations in a mobility gap of approximately 9 eV and a density of states that exhibits valence and conduction band tails which are, even in the absence of defects, deeply located within the former band gap.Comment: 21 pages of Latex, 5 eps figure