The Decompensating Pediatric Inpatient Simulation Scenarios

Introduction: In July of 2009, Children’s National Medical Center (CNMC) Hospitalist and Emergency Department (ED) educators collaborated to create and implement unique simulation scenarios for trainees rotating on the pediatric hospitalist teams. The goal of this educational intervention is to teach and allow rehearsal of an approach to the unstable patient across three scenarios. Trainees use this high-fidelity, low-risksimulation to apply targeted clinical reasoning and their initial assessment and management strategies to core clinical problems. The three scenarios included in this resource cover altered mental status and seizure, respiratory distress and anaphylaxis, and refractory status asthmaticus, respectively. Methods:This resource contains a template, simulator technologist information, scenario progression, and guided discussion for three scenarios of worsening pediatric inpatients. Each case simulation and debriefing is intended to take approximately 30 to 45 minutes. Results: Within six months of implementation, the monthly simulation scenario series logged over 85 learner encounters at CNMC with uniformly positive evaluations indicating that learners subjectively felt that their competence in the assessment and management of unstable inpatients was improving. As trainees become even more proficient at timely recognition of sick patients, appropriate initial management, education, patient care, and safety outcomes are expected to improve. Discussion: The goal of this educational intervention is to teach and allow rehearsal of an approach to the unstable patient. Simulation such as this provide the opportunity to assess learners’ competency with specific skills as long as rubrics for evaluation are created and applied to similar scenarios. AAMC MedEdPORTAL publication ID 7993. Link to original

Cytoplasmic-Genic Male-Sterility in Interspecific Matings of Cajanus

The discovery of two stable male-sterile genes and the prevalence of adequate insect-aided cross-pollination led to the development and release of the first pigeonpea [Cajanus cajan (L.) Millsp.] hybrid in India. Commercialization of this hybrid is constrained because of the labor intensiveness of seed production and concerns about seed purity. Cytoplasmic male-steriles would effectively circumvent these constraints and revolutionize the hybrid seed industry. This paper reports the development of cytoplasmically determined male-sterility, which was accomplished by two methods: wide hybridization involving conventional backcrossing of Cajanus sericeus van der Maesen and Cajanus cajan and multiple cross genome transfer. In these matings, two forms of reversion to fertility were noticed, one influenced by low temperature and high humidity, and the other probably determined by genetic factors alone. The influence of temperature on fertility restoration as reported for Viciafaba L. is different from that seen in species crosses of Cajanus. The multiple cross genome transfer method resulted in stable cytoplasmic-genic male sterility maintainable by the pigeonpea genotypes ICPL 85030 and ICPL 90035. These male-sterile lines are in agronomically desirable backgrounds

Breeding CMS-based white seeded pigeonpea hybrids

Most people in Gujarat prefer vegetarian diets. Their protein requirement is derived from pulses, vegetables, and various milk products. However, tuar dal (pigeonpea) is, by far, the most popular and cheap source of protein in their diets. The state produces 2.4 lakh tonnes of pigeonpea annually, but this quantity is insufficient to meet the ever increasing domestic needs. Since the scope of increasing pigeonpea area in the state is limited, the emphasis is now centered on increasing its productivity. In this context, the recently developed CMS-based hybrid pigeonpea technology has shown a promise and hybrids such as ICPH 4506, ICPH 4503, ICPH 4502 and ICPH 4429 have demonstrated >50% yield advantage over the popular cultivars. The commercial hybrid seed production technology was successfully tested for over two years and, on average, yield of about 1000 kg/ha has been recorded. This paper summarizes the successful joint efforts made byICRISAT and Biogene Agritech, Ahmedabad (a private seed company) in developing and testing the first ever white-seeded high-yielding, and wilt and sterility mosaic disease resistant pigeonpea hybrid for Gujara

Long-range pollution transport during the MILAGRO-2006 campaign: a case study of a major Mexico City outflow event using free-floating altitude-controlled balloons

One of the major objectives of the Megacities Initiative: Local And Global Research Observations (MILAGRO-2006) campaign was to investigate the long-range transport of polluted Mexico City Metropolitan Area (MCMA) outflow and determine its downwind impacts on air quality and climate. Six research aircraft, including the National Center for Atmospheric Research (NCAR) C-130, made extensive chemical, aerosol, and radiation measurements above MCMA and more than 1000 km downwind in order to characterize the evolution of the outflow as it aged and dispersed over the Mesa Alta, Sierra Madre Oriental, Coastal Plain, and Gulf of Mexico. As part of this effort, free-floating Controlled-Meteorological (CMET) balloons, commanded to change altitude via satellite, made repeated profile measurements of winds and state variables within the advecting outflow. In this paper, we present an analysis of the data from two CMET balloons that were launched near Mexico City on the afternoon of 18 March 2006 and floated downwind with the MCMA pollution for nearly 30 h. The repeating profile measurements show the evolving structure of the outflow in considerable detail: its stability and stratification, interaction with other air masses, mixing episodes, and dispersion into the regional background. Air parcel trajectories, computed directly from the balloon wind profiles, show three transport pathways on 18–19 March: (a) high-altitude advection of the top of the MCMA mixed layer, (b) mid-level outflow over the Sierra Madre Oriental followed by decoupling and isolated transport over the Gulf of Mexico, and (c) low-level outflow with entrainment into a cleaner northwesterly jet above the Coastal Plain. The C-130 aircraft intercepted the balloon-based trajectories three times on 19 March, once along each of these pathways; in all three cases, peaks in urban tracer concentrations and LIDAR backscatter are consistent with MCMA pollution. In comparison with the transport models used in the campaign, the balloon-based trajectories appear to shear the outflow far more uniformly and decouple it from the surface, thus forming a thin but expansive polluted layer over the Gulf of Mexico that is well aligned with the aircraft observations. These results provide critical context for the extensive aircraft measurements made during the 18–19 March MCMA outflow event and may have broader implications for modelling and understanding long-range transport

Virtual Reality for Pediatric Sedation: A Randomized Controlled Trial Using Simulation.

INTRODUCTION: Team training for procedural sedation for pediatric residents has traditionally consisted of didactic presentations and simulated scenarios using high-fidelity mannequins. We assessed the effectiveness of a virtual reality module in teaching preparation for and management of sedation for procedures. METHODS: After developing a virtual reality environment in Second Life® (Linden Lab, San Francisco, CA) where providers perform and recover patients from procedural sedation, we conducted a randomized controlled trial to assess the effectiveness of the virtual reality module versus a traditional web-based educational module. A 20 question pre- and post-test was administered to assess knowledge change. All subjects participated in a simulated pediatric procedural sedation scenario that was video recorded for review and assessed using a 32-point checklist. A brief survey elicited feedback on the virtual reality module and the simulation scenario. RESULTS: The median score on the assessment checklist was 75% for the intervention group and 70% for the control group (P = 0.32). For the knowledge tests, there was no statistically significant difference between the groups (P = 0.14). Users had excellent reviews of the virtual reality module and reported that the module added to their education. CONCLUSIONS: Pediatric residents performed similarly in simulation and on a knowledge test after a virtual reality module compared with a traditional web-based module on procedural sedation. Although users enjoyed the virtual reality experience, these results question the value virtual reality adds in improving the performance of trainees. Further inquiry is needed into how virtual reality provides true value in simulation-based education

4′-Amino-2,2′′-dioxo-2,2′′,3,3′′-tetra­hydro-1H-indole-3-spiro-1′-cyclo­pent-3′-ene-2′-spiro-3′′-1H-indole-3′,5′,5′-tricarbonitrile dihydrate

In the title compound, C22H12N6O2·2H2O, the cyclo­pentene ring adopts an envelope conformation, with the spiro C atom bonded to the dicyano-substituted C atom deviating by 0.437 (2) Å from the plane of the remaining four atoms in the ring. The puckering and smallest displacement asymmetry parameters for the ring are q 2 = 0.275 (2) Å, ϕ = 212.4 (4)° and Δs(C2) = 2.7 (2). The dihedral angle between the two indole groups is 60.1 (1)°. The structure contains inter­molecular N—H⋯O hydrogen bonds involving the indole groups and O—H⋯O and O—H⋯N hydrogen bonds involving the water mol­ecules

Using Simulation to Measure and Improve Pediatric Primary Care Offices Emergency Readiness

Introduction : Emergencies in the pediatric primary care office are high-risk, low-frequency events that offices may be ill-prepared to manage. We developed an intervention to improve pediatric primary care office emergency preparedness involving a baseline measurement, a customized report out with action plans for improvement (based on baseline measures), and a plan to repeat measurement at 6 months. This article reports on the baseline measurement. Methods: This baseline measurement consisted of 2 components: preparedness checklists and in situ simulations. The preparedness checklists were completed in person to measure compliance with the American Academy of Pediatrics Policy Statement: preparation for emergencies in the offices of pediatricians and pediatric primary care providers, in the domains of equipment, supplies, medication, and guidelines. Two in situ simulations, a child in respiratory distress and a child with a seizure, were conducted with the offices' interprofessional teams; performance was scored using checklists. Results : Baseline measurements were conducted in 12 pediatric offices from October to December 2018. Wide variability was noted for compliance with the American Academy of Pediatrics recommendations (range = 47%–87%) and performance during in situ simulations (range = 43%–100%). Conclusions : Pediatric primary care office emergency preparedness was found to be variable. Simulation can be used to augment existing measures of emergency preparedness, such as checklists. By using simulation to measure office emergency preparedness, areas of knowledge deficit and latent safety threats were identified and are being addressed through ongoing collaboration

A Modified Delphi Study to Prioritize Content for a Simulation-based Pediatric Curriculum for Emergency Medicine Residency Training Programs

© 2019 by the Society for Academic Emergency Medicine Objectives: Pediatric training is an essential component of emergency medicine (EM) residency. The heterogeneity of pediatric experiences poses a significant challenge to training programs. A national simulation curriculum can assist in providing a standardized foundation of pediatric training experience to all EM trainees. Previously, a consensus-derived set of content for a pediatric curriculum for EM was published. This study aimed to prioritize that content to establish a pediatric simulation-based curriculum for all EM residency programs. Methods: Seventy-three participants were recruited to participate in a three-round modified Delphi project from 10 stakeholder organizations. In round 1, participants ranked 275 content items from a published set of pediatric curricular items for EM residents into one of four categories: definitely must, probably should, possibly could, or should not be taught using simulation in all residency programs. Additionally, in round 1 participants were asked to contribute additional items. These items were then added to the survey in round 2. In round 2, participants were provided the ratings of the entire panel and asked to rerank the items. Round 3 involved participants dichotomously rating the items. Results: A total of 73 participants participated and 98% completed all three rounds. Round 1 resulted in 61 items rated as definitely must, 72 as probably should, 56 as possibly could, 17 as should not, and 99 new items were suggested. Round 2 resulted in 52 items rated as definitely must, 91 as probably should, 120 as possibly could, and 42 as should not. Round 3 resulted in 56 items rated as definitely must be taught using simulation in all programs. Conclusions: The completed modified Delphi process developed a consensus on 56 pediatric items that definitely must be taught using simulation in all EM residency programs (20 resuscitation, nine nonresuscitation, and 26 skills). These data will serve as a targeted needs assessment to inform the development of a standard pediatric simulation curriculum for all EM residency programs