Teaching Quality Improvement in a Pediatric Residency Program

The Accreditation Council for Graduate Medical Education (ACGME) requires residents to demonstrate competence in practice-based learning and improvement (PBLI) and systems-based practice (SBP), two competencies dependent on the principles and practice of quality improvement (QI). In addition, pediatric residents at VCUHS are required to complete a QI project during their residency. We judged the pediatric residents to be sub-par in achieving these competencies as demonstrated by the quality of projects submitted during the last academic year, and set out to improve the QI education they receive by designing a longitudinal curriculum integrating both didactic (using lectures and on-line modules provided through the Institute for Healthcare Improvement) and experiential learning (by having residents develop their own QI projects). In the Fall of 2017, we added a structured PBLI experience to this curriculum through the residents’ primary group clinical practice in order to provide a hands-on learning opportunity. Each resident practice group was tasked with design, implementation, and analysis of a QI project based on the groups’ practice data. We reasoned that the learning acquired through participation in a structured QI experience, through the group practice, will enhance their understanding of QI principles and therefore improve their completion of personal projects. Implementation and data gathering is currently on-going

The Coarse Geometry of Merger Trees in \Lambda CDM

We introduce the contour process to describe the geometrical properties of merger trees. The contour process produces a one-dimensional object, the contour walk, which is a translation of the merger tree. We portray the contour walk through its length and action. The length is proportional to to the number of progenitors in the tree, and the action can be interpreted as a proxy of the mean length of a branch in a merger tree. We obtain the contour walk for merger trees extracted from the public database of the Millennium Run and also for merger trees constructed with a public Monte-Carlo code which implements a Markovian algorithm. The trees correspond to halos of final masses between 10^{11} h^{-1} M_sol and 10^{14} h^{-1} M_sol. We study how the length and action of the walks evolve with the mass of the final halo. In all the cases, except for the action measured from Markovian trees, we find a transitional scale around 3 \times 10^{12} h^{-1} M_sol. As a general trend the length and action measured from the Markovian trees show a large scatter in comparison with the case of the Millennium Run trees.Comment: 7 pages, 5 figures, submitted to MNRA

The unorthodox evolution of major merger remnants into star-forming spiral galaxies

Galaxy mergers are believed to play a key role in transforming star-forming disk galaxies into quenched ellipticals. Most of our theoretical knowledge about such morphological transformations does, however, rely on idealised simulations where processes such as cooling of hot halo gas into the disk and gas accretion in the post-merger phase are not treated in a self-consistent cosmological fashion. In this paper we study the morphological evolution of the stellar components of four major mergers occurring at z=0.5 in cosmological hydrodynamical zoom-simulations. In all simulations the merger reduces the disk mass-fraction, but all galaxies simulated at our highest resolution regrow a significant disk by z=0 (with a disk fraction larger than 24%). For runs with our default physics model, which includes galactic winds from star formation and black hole feedback, none of the merger remnants are quenched, but in a set of simulations with stronger black hole feedback we find that major mergers can indeed quench galaxies. We conclude that major merger remnants commonly evolve into star-forming disk galaxies, unless sufficiently strong AGN feedback assists in the quenching of the remnant.Comment: 15 pages, 9 figures, Accepted for publication in MNRA

Hydrodynamical simulations of cluster formation with central AGN heating

We analyse a hydrodynamical simulation model for the recurrent heating of the central intracluster medium (ICM) by active galactic nuclei (AGN). Besides the self-gravity of the dark matter and gas components, our approach includes the radiative cooling and photoheating of the gas, as well as a subresolution multiphase model for star formation and supernova feedback. Additionally, we incorporate a periodic heating mechanism in the form of hot, buoyant bubbles, injected into the intragalactic medium (IGM) during the active phases of the accreting central AGN. We use simulations of isolated cluster halos of different masses to study the bubble dynamics and the heat transport into the IGM. We also apply our model to self-consistent cosmological simulations of the formation of galaxy clusters with a range of masses. Our numerical schemes explore a variety of different assumptions for the spatial configuration of AGN-driven bubbles, for their duty cycles and for the energy injection mechanism, in order to obtain better constraints on the underlying physical picture. We argue that AGN heating can substantially affect the properties of both the stellar and gaseous components of clusters of galaxies. Most importantly, it alters the properties of the central dominant (cD) galaxy by reducing the mass deposition rate of freshly cooled gas out of the ICM, thereby offering an energetically plausible solution to the cooling flow problem. At the same time, this leads to reduced or eliminated star formation in the central cD galaxy, giving it red stellar colours as observed.Comment: 22 pages, 15 figures, minor revisions, MNRAS accepte

Shock finding on a moving-mesh: I. Shock statistics in non-radiative cosmological simulations

Cosmological shock waves play an important role in hierarchical structure formation by dissipating and thermalizing kinetic energy of gas flows, thereby heating the universe. Furthermore, identifying shocks in hydrodynamical simulations and measuring their Mach number accurately is critical for calculating the production of non-thermal particle components through diffusive shock acceleration. However, shocks are often significantly broadened in numerical simulations, making it challenging to implement an accurate shock finder. We here introduce a refined methodology for detecting shocks in the moving-mesh code AREPO, and show that results for shock statistics can be sensitive to implementation details. We put special emphasis on filtering against spurious shock detections due to tangential discontinuities and contacts. Both of them are omnipresent in cosmological simulations, for example in the form of shear-induced Kelvin-Helmholtz instabilities and cold fronts. As an initial application of our new implementation, we analyse shock statistics in non-radiative cosmological simulations of dark matter and baryons. We find that the bulk of energy dissipation at redshift zero occurs in shocks with Mach numbers around ${\cal M}\approx2.7$. Furthermore, almost $40\%$ of the thermalization is contributed by shocks in the warm hot intergalactic medium (WHIM), whereas $\approx60\%$ occurs in clusters, groups and smaller halos. Compared to previous studies, these findings revise the characterization of the most important shocks towards higher Mach numbers and lower density structures. Our results also suggest that regions with densities above and below $\delta_b=100$ should be roughly equally important for the energetics of cosmic ray acceleration through large-scale structure shocks.Comment: 16 pages, 13 figures, published in MNRAS, January 201

Zooming in on major mergers: dense, starbursting gas in cosmological simulations

We introduce the `Illustris zoom simulation project', which allows the study of selected galaxies forming in the $\Lambda$CDM cosmology with a 40 times better mass resolution than in the parent large-scale hydrodynamical Illustris simulation. We here focus on the starburst properties of the gas in four cosmological simulations of major mergers. The galaxies in our high-resolution zoom runs exhibit a bursty mode of star formation with gas consumption timescales 10 times shorter than for the normal star formation mode. The strong bursts are only present in the simulations with the highest resolution, hinting that a too low resolution is the reason why the original Illustris simulation showed a dearth of starburst galaxies. Very pronounced bursts of star formation occur in two out of four major mergers we study. The high star formation rates, the short gas consumption timescales and the morphology of these systems strongly resemble observed nuclear starbursts. This is the first time that a sample of major mergers is studied through self-consistent cosmological hydrodynamical simulations instead of using isolated galaxy models setup on a collision course. We also study the orbits of the colliding galaxies and find that the starbursting gas preferentially appears in head-on mergers with very high collision velocities. Encounters with large impact parameters do typically not lead to the formation of starbursting gas.Comment: 13 pages, 7 figures, Accepted for publication in MNRA