Assessment of Emergency Medicine Resident Performance in a Pediatric In Situ Simulation Using Multi-Source Feedback.

Introduction Multi-source feedback (MSF) is an evaluation method mandated by the Accreditation Council for Graduate Medical Education (ACGME). The Queen\u27s Simulation Assessment Tool (QSAT) has been validated as being able to distinguish between resident performances in a simulation setting. The QSAT has also been demonstrated to have excellent MSF agreement when used in an adult simulation performed in a simulation lab. Using the QSAT, this study sought to determine the degree of agreement of MSF in a single pediatric (Peds) simulation case conducted in situ in a Peds emergency department (ED). Methods This Institutional Review Board-approved study was conducted in a four-year emergency medicine residency. A Peds resuscitation case was developed with specific behavioral anchors on the QSAT, which uses a 1-5 scale in each of five categories: Primary Assessment, Diagnostic Actions, Therapeutic Actions, Communication, and Overall Assessment. Data was gathered from six participants for each simulation. The lead resident self-evaluated and received MSF from a junior peer resident, a fixed Peds ED nurse, a random ED nurse, and two faculty (one fixed, the other from a dyad). The agreement was calculated with intraclass correlation coefficients (ICC). Results The simulation was performed on 35 separate days over two academic years. A total of 106 MSF participants were enrolled. Enrollees included three faculty members, 35 team leaders, 34 peers, 33 ED registered nurses (RN), and one Peds RN; 50% of the enrollees were female (n=53). Mean QSAT scores ranged from 20.7 to 23.4. A fair agreement was demonstrated via ICC; there was no statistically significant difference between sources of MSF. Removing self-evaluation led to the highest ICC. ICC for any single or grouped non-faculty source of MSF was poor. Conclusion Using the QSAT, the findings from this single-site cohort suggest that faculty must be included in MSF. Self-evaluation appears to be of limited value in MSF with the QSAT. The degree of MSF agreement as gathered by the QSAT was lower in this cohort than previously reported for adult simulation cases performed in the simulation lab. This may be due to either the pediatric nature of the case, the location of the simulation, or both

The birth of airplane stability theory

Airplane stability theory was born at the end of the XIX century and matured around 100 years ago, when airplanes were hardly controllable yet. The success and safety of flights in the pioneer years depended upon largely unknown stability and control characteristics. Understanding the modes of airplane motion has been of paramount importance for the development of aviation. The contributions made by a few scientists in the decades preceding and following the first flight by the Wright brothers set the concepts and equations that, with minor notation aspects, have remained almost unchanged till present day.Magraner Rullan, JP.; Martinez-Val, R. (2014). The birth of airplane stability theory. Proceedings of the Institution of Mechanical Engineers, Part G: Journal of Aerospace Engineering. 228(9):1498-1506. doi:10.1177/0954410013494139S149815062289PERKINS, C. D. (1970). Development of airplane stability and control technology /1970 Von Karman Lecture/. Journal of Aircraft, 7(4), 290-301. doi:10.2514/3.44167Abzug, M. J., & Larrabee, E. E. (2002). Airplane Stability and Control, Second Edition. doi:10.1017/cbo9780511607141Graham, W. R. (1999). Asymptotic analysis of the classical aircraft stability equations. The Aeronautical Journal, 103(1020), 95-103. doi:10.1017/s0001924000027792Bryan, G. H., & Williams, W. E. (1904). The Longitudinal Stability of Aerial Gliders. Proceedings of the Royal Society of London, 73(488-496), 100-116. doi:10.1098/rspl.1904.0017Wegener, P. P. (1997). What Makes Airplanes Fly? doi:10.1007/978-1-4612-2254-5Pradeep, S., & Kamesh, S. (1999). Does the Phugoid Frequency Depend on Speed? Journal of Guidance, Control, and Dynamics, 22(2), 372-373. doi:10.2514/2.4391Phillips, W. F. (2000). Phugoid Approximation for Conventional Airplanes. Journal of Aircraft, 37(1), 30-36. doi:10.2514/2.2586Pamadi, B. N. (2004). Performance, Stability, Dynamics, and Control of Airplanes, Second Edition. doi:10.2514/4.862274Ananthkrishnan, N., & Ramadevi, P. (2002). Consistent Approximations to Aircraft Longitudinal Modes. Journal of Guidance, Control, and Dynamics, 25(4), 820-824. doi:10.2514/2.4952McRuer, D. T., Graham, D., & Ashkenas, I. (1990). Aircraft Dynamics and Automatic Control. doi:10.1515/978140085598

Assessment of Emergency Medicine Resident Performance in an Adult Simulation Using a Multisource Feedback Approach.

Introduction: The Accreditation Council for Graduate Medical Education (ACGME) specifically notes multisource feedback (MSF) as a recommended means of resident assessment in the emergency medicine (EM) Milestones. High-fidelity simulation is an environment wherein residents can receive MSF from various types of healthcare professionals. Previously, the Queen\u27s Simulation Assessment Tool (QSAT) has been validated for faculty to assess residents in five categories: assessment; diagnostic actions; therapeutic actions; interpersonal communication, and overall assessment. We sought to determine whether the QSAT could be used to provide MSF using a standardized simulation case. Methods: Prospectively after institutional review board approval, residents from a dual ACGME/osteopathic-approved postgraduate years (PGY) 1-4 EM residency were consented for participation. We developed a standardized resuscitation after overdose case with specific 1-5 Likert anchors used by the QSAT. A PGY 2-4 resident participated in the role of team leader, who completed a QSAT as self-assessment. The team consisted of a PGY-1 peer, an emergency medical services (EMS) provider, and a nurse. Two core faculty were present to administer the simulation case and assess. Demographics were gathered from all participants completing QSATs. We analyzed QSATs by each category and on cumulative score. Hypothesis testing was performed using intraclass correlation coefficients (ICC), with 95% confidence intervals. Interpretation of ICC results was based on previously published definitions. Results: We enrolled 34 team leader residents along with 34 nurses. A single PGY-1, a single EMS provider and two faculty were also enrolled. Faculty provided higher cumulative QSAT scores than the other sources of MSF. QSAT scores did not increase with team leader PGY level. ICC for inter-rater reliability for all sources of MSF was 0.754 (0.572-0.867). Removing the self-evaluation scores increased inter-rater reliability to 0.838 (0.733-0.910). There was lesser agreement between faculty and nurse evaluations than from the EMS or peer evaluation. Conclusion: In this single-site cohort using an internally developed simulation case, the QSAT provided MSF with excellent reliability. Self-assessment decreases the reliability of the MSF, and our data suggest self-assessment should not be a component of MSF. Use of the QSAT for MSF may be considered as a source of data for clinical competency committees

Two phase galaxy formation: The Gas Content of Normal Galaxies

We investigate the atomic (HI) and molecular (H_2) Hydrogen content of normal galaxies by combining observational studies linking galaxy stellar and gas budgets to their host dark matter (DM) properties, with a physically grounded galaxy formation model. This enables us to analyse empirical relationships between the virial, stellar, and gaseous masses of galaxies and explore their physical origins. Utilising a semi-analytic model (SAM) to study the evolution of baryonic material within evolving DM halos, we study the effects of baryonic infall and various star formation and feedback mechanisms on the properties of formed galaxies using the most up-to-date physical recipes. We find that in order to significantly improve agreement with observations of low-mass galaxies we must suppress the infall of baryonic material and exploit a two-phase interstellar medium (ISM), where the ratio of HI to H_2 is determined by the galactic disk structure. Modifying the standard Schmidt-Kennicutt star formation law, which acts upon the total cold gas in galaxy discs and includes a critical density threshold, and employing a star formation law which correlates with the H_2 gas mass results in a lower overall star formation rate. This in turn, allows us to simultaneously reproduce stellar, HI and H_2 mass functions of normal galaxies.Comment: 16 pages, 12 figures, 1 table. Moderate revision to match version accepted for publication in MNRA

To bite or not to bite! A questionnaire-based survey assessing why some people are bitten more than others by midges

BACKGROUND: The Scottish biting midge, Culicoides impunctatus, responsible for more than 90% of biting attacks on human beings in Scotland, is known to demonstrate a preference for certain human hosts over others. METHODS: In this study we used a questionnaire-based survey to assess the association between people's perception of how badly they get bitten by midges and their demographic, lifestyle and health related characteristics. RESULTS: Most people (85.8%) reported being bitten sometimes, often or always with only 14.2% reporting never being bitten by midges when in Scotland. There was no association between level of bites received and age, smoking, diet, exercise, medication, eating strongly flavoured foods or alcohol consumption. However, there was a strong association between the probability of being bitten and increasing height (in men) and BMI (in women). A large proportion of participants (33.8%) reported experiencing a bad/severe reaction to midge bites while 53.1% reported a minor reaction and 13.1% no reaction at all. Also, women tend to react more than men to midge bites. Additionally, the results indicated that the susceptibility to being bitten by midges is hereditary. CONCLUSIONS: This study suggests that midges prefer to bite men that are tall and women that have a large BMI, and that the tendency for a child to be bitten or not could be inherited from their parent. The study is questionnaire-based; therefore, the interpretation of the results may be limited by the subjectivity of the answers given by the respondents. Although the results are relevant only to the Scottish biting midge, the approach used here could be useful for investigating human-insect interactions for other insects, particularly those which transmit pathogens that cause disease

Outcome measurement in clinical trials for Ulcerative Colitis: towards standardisation

Clinical trials on novel drug therapies require clear criteria for patient selection and agreed definitions of disease remission. This principle has been successfully applied in the field of rheumatology where agreed disease scoring systems have allowed multi-centre collaborations and facilitated audit across treatment centres. Unfortunately in ulcerative colitis this consensus is lacking. Thirteen scoring systems have been developed but none have been properly validated. Most trials choose different endpoints and activity indices, making comparison of results from different trials extremely difficult. International consensus on endoscopic, clinical and histological scoring systems is essential as these are the key components used to determine entry criteria and outcome measurements in clinical trials on ulcerative colitis. With multiple new therapies under development, there is a pressing need for consensus to be reached

Empirical modelling of the BLASTPol achromatic half-wave plate for precision submillimetre polarimetry

A cryogenic achromatic half-wave plate (HWP) for submillimetre astronomical polarimetry has been designed, manufactured, tested and deployed in the Balloon-borne Large-Aperture Submillimeter Telescope for Polarimetry (BLASTPol). The design is based on the five-slab Pancharatnam recipe and itworks in thewavelength range 200–600 μm, making it the broadestband HWP built to date at (sub)millimetre wavelengths. The frequency behaviour of the HWP has been fully characterized at room and cryogenic temperatures with incoherent radiation from a polarizing Fourier transform spectrometer. We develop a novel empirical model, complementary to the physical and analytical ones available in the literature, that allows us to recover the HWP Mueller matrix and phase shift as a function of frequency and extrapolated to 4 K. We show that most of the HWP non-idealities can be modelled by quantifying one wavelength-dependent parameter, the position of the HWP equivalent axes, which is then readily implemented in a map-making algorithm. We derive this parameter for a range of spectral signatures of input astronomical sources relevant to BLASTPol, and provide a benchmark example of how our method can yield improved accuracy on measurements of the polarization angle on the sky at submillimetre wavelengths