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Random tilings of very large domains will typically lead to a solid, a liquid, and a gas phase. In the two-phase case, the solid–liquid boundary (arctic curve) is smooth, possibly with singularities. At the point of tangency of the arctic curve with the domain boundary, for large-sized domains, the tiles of a certain shape form a singly interlacing set, fluctuating according to the eigenvalues of the principal minors of a Gaussian unitary ensemble-matrix. Introducing non-convexities in large domains may lead to the appearance of several interacting liquid regions: They can merely touch, leading to either a split tacnode (hard tacnode), with two distinct adjacent frozen phases descending into the tacnode, or a soft tacnode. For appropriate scaling of the non-convex domains and probing about such split tacnodes, filaments, evolving in a bricklike sea of dimers of another type, will connect the liquid patches. Nearby, the tiling fluctuations are governed by a discrete tacnode kernel—i.e., a determinantal point process on a doubly interlacing set of dots belonging to a discrete array of parallel lines. This kernel enables us to compute the joint distribution of the dots along those lines. This kernel appears in two very different models: (i) domino tilings of skew-Aztec rectangles and (ii) lozenge tilings of hexagons with cuts along opposite edges. Soft tacnodes appear when two arctic curves gently touch each other amid a bricklike sea of dimers of one type, unlike the split tacnode. We hope that this largely expository paper will provide a view on the subject and be accessible to a wider audience. [ABSTRACT FROM AUTHOR]

Background: To provide optimal care, medical students should understand that the social determinants of health (SDH) impact their patients' well-being. Those charged with teaching SDH to future physicians, however, face a paucity of curricular guidance.Objective: This review's objective is to map key characteristics from publications about teaching SDH to students in undergraduate medical education (UME).Methods: In 2016, the authors searched PubMed, Embase, Web of Science, the Cochrane and ERIC databases, bibliographies, and MedEdPORTAL for articles published between January 2010 and November 2016. Four reviewers screened articles for eligibility then extracted and analyzed data descriptively. Scoping review methodology was used to map key concepts and curricular logistics as well as educator and student characteristics.Results: The authors screened 3571 unique articles of which 22 were included in the final review. Many articles focused on community engagement (15). Experiential learning was a common instructional strategy (17) and typically took the form of community or clinic-based learning. Nearly half (10) of the manuscripts described school-wide curricula, of which only three spanned a full year. The majority of assessment was self-reported (20) and often related to affective change. Few studies objectively assessed learner outcomes (2).Conclusions: The abundance of initial articles screened highlights the growing interest in SDH in medical education. The small number of selected articles with sufficient detail for abstraction demonstrates limited SDH curricular dissemination. A lack of accepted tools or practices that limit development of robust learner or program evaluation was noted. Future research should focus on identifying and evaluating effective instructional and assessment methodologies to address this gap, exploring additional innovative teaching frameworks, and examining the specific contexts and characteristics of marginalized and underserved populations and their coverage in medical education. [ABSTRACT FROM AUTHOR]

We examine the current state of readiness of aerocapture at several destinations of interest, to identify what technologies are needed and to determine if a technology demonstration mission is required, before the first use of aerocapture for a science mission. The study team concluded that the current state of readiness is destination dependent, with aerocaptured missions feasible at Venus, Mars, and Titan with current technologies. The use of aerocapture for orbit insertion at the ice giant planets Uranus and Neptune requires at least additional study to assess the expected performance of new guidance, navigation, and control algorithms and possible development of new hardware, such as a mid-lift-to-drag entry vehicle shape or new thermal protection system materials. A variety of near-term activities could contribute to risk reduction for missions proposing the use of aerocapture, but an end-to-end, system-level technology demonstration mission is not deemed necessary before the use of aerocapture for a NASA science mission. [ABSTRACT FROM AUTHOR]

This paper studies random lozenge tilings of general non-convex polygonal regions. We show that the pairwise interaction of the non-convexities leads asymptotically to new kernels and thus to new statistics for the tiling fluctuations. The precise geometrical figure here consists of a hexagon with cuts along opposite edges. For this model, we take limits when the size of the hexagon and the cuts tend to infinity, while keeping certain geometric data fixed in order to guarantee sufficient interaction between the cuts in the limit. We show in this paper that the kernel for the finite tiling model can be expressed as a multiple integral, where the number of integrations is related to the fixed geometric data above. The limiting kernel is believed to be a universal master kernel. [ABSTRACT FROM AUTHOR]

In this paper, we study random lozenge tilings of non-convex polygonal regions. The interaction of the non-convexities (cuts) leads to new kernels and thus new statistics for the tiling fluctuations near these regions. This paper gives new probability distributions and joint probability distributions for the fluctuation of tiles along lines in between the cuts. [ABSTRACT FROM AUTHOR]

This paper deals with two Gaussian unitary ensemble (GUE)-matrices, coupled together through some inequalities between the spectra of the first few (small) principal minors. The main results of the paper is to show that the spectra of the principal minors of these coupled matrices behave statistically as the domino tilings of finitely overlapping Aztec diamonds when their sizes become very large, with horizontal and vertical dominos being equally likely. This extends naturally a result of Johansson and Nordenstam [20], stating that the spectra of the principal minors of a GUE-matrix behave statistically as domino tilings of an Aztec diamond, near the middle of its edge. Given the spectra of the two coupled matrices, the joint spectra of the underlying principal minors of the two GUE-matrices are uniformly distributed in a certain "double cone". In particular, this leads to two GUE-matrices, whose spectra share the same real line, with one spectrum being completely to the left of the other spectrum; this gives a new and simple extension of GUE. Also note that all statements concerning these coupled random matrices have a domino tiling counterpart. [ABSTRACT FROM AUTHOR]

We study determinantal point processes arising in random domino tilings of a double Aztec diamond, a region consisting of two overlapping Aztec diamonds. At a turning point in a single Aztec diamond where the disordered region touches the boundary, the natural limiting process is the GUE-minor process. Increasing the size of a double Aztec diamond while keeping the overlap between the two Aztec diamonds finite, we obtain a new determinantal point process which we call the tacnode GUE-minor process. This process can be thought of as two colliding GUE-minor processes. As part of the derivation of the particle kernel whose scaling limit naturally gives the tacnode GUE-minor process, we find the inverse Kasteleyn matrix for the dimer model version of the Double Aztec diamond. [ABSTRACT FROM AUTHOR]

The number of adults with congenital heart disease is rapidly increasing, resulting in more emergency care needs of this unique population. Concomitantly, the number of physicians trained in adult congenital heart disease (ACHD) care is insufficient, leading to physicians with limited experience assuming primary responsibility for the management of acute illness. We developed a simulation-based curriculum consisting of three cases and linked assessment instruments for fellows in multiple training programs to enhance their experience in this growing field. A 40-min asynchronous didactic presentation on ACHD emergencies was provided between pretests and posttests. Each participant was given checklist, global, and timeliness scores, and a second rater scored a subset to assess inter-rater reliability. Twenty-two participants across multiple disciplines completed the study. Our results demonstrate a significant and meaningful improvement in checklist scores, as well as a significant improvement in the secondary measures of global and efficiency performance from the first simulation to the second. Comfort levels for trainees improved significantly on post-test surveys. Inter-rater reliability was greater than 0.6 for all assessments. In conclusion, our novel simulation-based educational curriculum improved trainee performance in managing emergencies in adults with congenital heart disease, and we provide validity evidence for use of our checklist in training fellows for formative feedback. [ABSTRACT FROM AUTHOR]

Human babesiosis co-infected with Lyme disease in a young patient is an important condition. Here, we describe a case of a 39-year-old male patient with concurrent babesiosis and Lyme disease. Co-infections of tick borne diseases are often difficult to diagnose and underreported, and resulting in significant morbidity and mortality to patients. While co-infections have been infrequently described, it is of paramount importance that clinicians should be able to diagnose early and treat them effectively according to the patient geographical area and history of tick bite. [ABSTRACT FROM AUTHOR]

Abstract: In 1962, Dyson (1962) introduced dynamics in random matrix models, in particular into GUE (also for and 4), by letting the entries evolve according to independent Ornstein–Uhlenbeck processes. Dyson shows the spectral points of the matrix evolve according to non-intersecting Brownian motions. The present paper shows that the interlacing spectra of two consecutive principal minors form a Markov process (diffusion) as well. This diffusion consists of two sets of Dyson non-intersecting Brownian motions, with a specific interaction respecting the interlacing. This is revealed in the form of the generator, the transition probability and the invariant measure, which are provided here; this is done in all cases: . It is also shown that the spectra of three consecutive minors ceases to be Markovian for . [Copyright &y& Elsevier]

Abstract: Discrete and continuous non-intersecting random processes have given rise to critical “infinite-dimensional diffusions”, like the Airy process, the Pearcey process and variations thereof. It has been known that domino tilings of very large Aztec diamonds lead macroscopically to a disordered region within an inscribed ellipse (arctic circle in the homogeneous case), and a regular brick-like region outside the ellipse. The fluctuations near the ellipse, appropriately magnified and away from the boundary of the Aztec diamond, form an Airy process, run with time tangential to the boundary. This paper investigates the domino tiling of two overlapping Aztec diamonds; this situation also leads to non-intersecting random walks and an induced point process; this process is shown to be determinantal. In the large size limit, when the overlap is such that the two arctic ellipses for the single Aztec diamonds merely touch, a new critical process will appear near the point of osculation (tacnode), which is run with a time in the direction of the common tangent to the ellipses: this is the tacnode process. It is also shown here that this tacnode process is universal: it coincides with the one found in the context of two groups of non-intersecting random walks or also Brownian motions, meeting momentarily. [Copyright &y& Elsevier]

Introduction: Temporary transvenous cardiac pacing (TVP) is a critical intervention that emergency physicians perform infrequently in clinical practice. Prior simulation studies revealed that emergency medicine (EM) residents and board-certified emergency physicians perform TVP poorly during checklist-based assessments. Our objective in this report was to describe the design and implementation of a simulation-based mastery learning (SBML) curriculum and evaluate its impact on EM residents' ability to perform TVP. Methods: An expert panel of emergency physicians and cardiologists set a minimum passing standard (MPS) for a previously developed 30-item TVP checklist using the Mastery Angoff approach. Emergency medicine residents were assessed using this checklist and a high-fidelity TVP task trainer. Residents who did not meet the MPS during baseline testing viewed a procedure video and completed a 30-minute individual deliberate practice session before retesting. Residents who did not meet the MPS during initial post-testing completed additional deliberate practice and assessment until meeting or exceeding the MPS. Results: The expert panel set an MPS of correctly performing 28 (93.3%) checklist items. Fifty-seven EM residents participated. Mean checklist scores improved from 13.4 (95% CI 11.8-15.0) during baseline testing to 27.5 (95% CI 26.9-28.1) during initial post-testing (P < 0.01). No residents met the MPS at baseline testing. The 21 (36.8%) residents who did not meet the MPS during initial post-testing all met or exceeded the MPS after completing one additional 30-minute deliberate practice session. Conclusion: Emergency medicine residents demonstrated significantly improved TVP performance with reduced variability in checklist scores after completing a simulation-based mastery learning curriculum. [ABSTRACT FROM AUTHOR]

Background: A variety of approaches to defining sepsis using administrative datasets have been previously reported. We aimed to compare estimates, demographics, treatment factors, outcomes and longitudinal trends of patients identified with sepsis in United States emergency departments (EDs) using differing sets of sepsis criteria. Methods: We performed a cross-sectional study using the National Healthcare Ambulatory Medical Care Survey, a complex survey of nonfederal US ED encounters between 2002 to 2018. We obtained survey-weighted population-adjusted encounters of sepsis using the following criteria: explicit sepsis, severe sepsis, and quick Sequential Organ Failure Assessment (qSOFA) score combined with the presence of infection. Results: Age-adjusted for US adults, 18.6, 16.1 and 8.9 encounters per 10 000 population were identified when using the explicit, severe sepsis and qSOFA definitions, respectively. A higher proportion of the explicit cohort was hospitalized and had blood cultures performed, compared to cohorts ascertained using severe sepsis and qSOFA criteria, though confidence intervals overlapped. Antibiotic use was highest in encounters meeting qSOFA criteria. When inspecting unweighted encounters meeting each set of criteria, there was minimal overlap, with only 3% meeting all three. Encounters meeting the explicit and severe sepsis criteria were increasing over time. Conclusion: The explicit, severe sepsis and qSOFA criteria generated similar annual rates of presentation when applied to US ED encounters, with some evidence of the explicit sepsis cohort being higher acuity. There was minimal overlap of cases and instability in estimates when assessed longitudinally. Our findings inform research efforts to accurately identify sepsis among ED encounters using administrative data. [ABSTRACT FROM AUTHOR]

Abstract: Consider non-intersecting Brownian motions on , depending on time , with particles forced to leave from at time , , and particles forced to end up at at time , . For arbitrary and , it is not known if the distribution of the positions of the non-intersecting Brownian particles at a given time , is the same as the joint distribution of the eigenvalues of a matrix ensemble. This paper proves the existence, for general and , of a partial differential equation (PDE) satisfied by the log of the probability to find all the particles in a disjoint union of intervals at a given time . The variables are the coordinates of the starting and ending points of the particles, and the boundary points of the set . The proof of the existence of such a PDE, using Virasoro constraints and the multicomponent KP hierarchy, is based on the method of elimination of the unwanted partials; that this is possible is a miracle! Unfortunately we were unable to find its explicit expression. The case will be discussed in the last section. [Copyright &y& Elsevier]

Abstract: Consider non-intersecting Brownian motions on the real line, starting from the origin at , with particles forced to reach p distinct target points at time , with . This can be viewed as a diffusion process in a sector of . This work shows that the transition probability, that is the probability for the particles to pass through windows at times , satisfies, in a new set of variables, a non-linear PDE which can be expressed as a near-Wronskian; that is a determinant of a matrix of size , with each row being a derivative of the previous, except for the last column. It is an interesting open question to understand those equations from a more probabilistic point of view. As an application of these equations, let the number of particles forced to the extreme points and tend to infinity; keep the number of particles forced to intermediate points fixed (inliers), but let the target points themselves go to infinity according to a proper scale. A new critical process appears at the point of bifurcation, where the bulk of the particles forced to depart from those going to . These statistical fluctuations near that point of bifurcation are specified by a kernel, which is a rational perturbation of the Pearcey kernel. This work also shows that such equations are an essential tool in obtaining certain asymptotic results. Finally, the paper contains a conjecture. [Copyright &y& Elsevier]

Abstract: Consider non-intersecting Brownian motions on the line leaving from the origin and forced to two arbitrary points. Letting the number of Brownian particles tend to infinity, and upon rescaling, there is a point of bifurcation, where the support of the density of particles goes from one interval to two intervals. In this paper, we show that at that very point of bifurcation a cusp appears, near which the Brownian paths fluctuate like the Pearcey process. This is a universality result within this class of problems. Tracy and Widom obtained such a result in the symmetric case, when the two target points are symmetric with regard to the origin. This asymmetry enabled us to improve considerably a result concerning the non-linear partial differential equations governing the transition probabilities for the Pearcey process, obtained by Adler and van Moerbeke. [Copyright &y& Elsevier]

OBJECTIVE: There is significant variation in the literature regarding the characteristics that are associated with pediatric ovarian torsion and its management. National data regarding the demographics and management of pediatric ovarian torsion are lacking. Our objective was to describe the epidemiology of pediatric ovarian torsion and the rate of oophorectomy by using nationally representative data. Demo- graphic factors and hospital characteristics that are associated with rates of oophorectomy were also explored. METHODS: This was a cohort analysis of the Healthcare Cost and Utilization Project Kids' Inpatient Database (KID) 2000, 2003, and 2006. All females aged 1 to 20 years who were hospitalized with ovarian torsion in states participating in KID 2000, KID 2003, and KID 2006 representing 900, 1224, and 1232 ovarian torsion-related hospitalizations, respectively, were included. Primary outcome measures included the incidence of ovarian torsion and rate of associated oophorectomy. Multivariable regression was used to control for patient and hospital characteristics. RESULTS: Among females aged 1 to 20 years, there were 1232 cases of ovarian torsion in KID 2006, an estimated incidence of 4.9 per 100 000. A total of 713 (58%) were treated with oophorectomy. The rate of ovarian torsion-associated oophorectomy remained unchanged from 2000 to 2006. The adjusted odds of having an oophorectomy decreased by 0.95 for every increasing year of age. Residing in a lower quartile of household income by zip code increased the adjusted odds of oophorectomy. A diagnosis of benign neoplasm increased the adjusted odds of oophorectomy by 2.16. Fewer than 0.5% of ovarian torsion hospitalizations were associated with malignant neoplasm. CONCLUSIONS: Nationally representative hospital data indicate that ovarian torsion is uncommon but occurs in all ages and is typically associated with normal ovaries or benign lesions. Improved awareness of the epidemiology may help to guide management. Ongoing analysis to identify factors that are associated with successful conservative management is warranted. [ABSTRACT FROM AUTHOR]

Questions on random matrices and non-intersecting Brownian motions have led to the study of moment matrices with regard to several weights. The main result of this paper is to show that the determinants of such moment matrices satisfy, upon adding one set of “time” deformations for each weight, the multi-component KP-hierarchy: these determinants are thus “tau-functions” for these integrable hierarchies. The tau-functions, so obtained, with appropriate shifts of the time-parameters (forward and backwards) will be expressed in terms of multiple orthogonal polynomials for these weights and their Cauchy transforms. The main result is a vast generalization of a known fact about infinitesimal deformations of orthogonal polynomials: it concerns an identity between the orthogonality of polynomials on the real line, the bilinear identity in KP theory and a generating functional for the full KP theory. An additional fact not discussed in this paper is that these τ-functions satisfy Virasoro constraints with respect to these time parameters. As one of the many examples worked out in this paper, we consider N non-intersecting Brownian motions in $${\mathbb R}$$ leaving from the origin, with n i particles forced to reach p distinct target points b i at time t = 1; of course, $${\sum_{i=1}^p n_i = N}$$ . We give a PDE, in terms of the boundary points of the interval E, for the probability that the Brownian particles all pass through an interval E at time 0 < t < 1. It is given by the determinant of a ( p + 1) × ( p + 1) matrix, which is nearly a wronskian. This theory is also applied to biorthogonal polynomials and orthogonal polynomials on the circle. [ABSTRACT FROM AUTHOR]

Given uniform probability on words of length M = Np + k, from an alphabet of size p, consider the probability that a word (i) contains a subsequence of letters p, p − 1, ..., 1 in that order and (ii) that the maximal length of the disjoint union of p − 1 increasing subsequences of the word is ⩽ M − N. A generating function for this probability has the form of an integral over the Grassmannian of p-planes in ℂ n. The present paper shows that the asymptotics of this probability, when N → ∞, is related to the kth moment of the χ2-distribution of parameter 2 p2. This is related to the behavior of the integral over the Grassmannian Gr( p, ℂ n) of p-planes in ℂ n, when the dimension of the ambient space ℂ n becomes very large. A dierent scaling limit for the Poissonized probability is related to a new matrix integral, itself a solution of the Painlevé IV equation. This is part of a more general set-up related to the Painlevé V equation. [ABSTRACT FROM AUTHOR]

Dear Editor, We are very appreciative of the enthusiastic response to our article, "Teaching the Social Determinants of Health in Undergraduate Medical Education: A Scoping Review,"[1] and thank Drs. Specifically, the NCEAS education collection invites submissions of detailed curricula, like the one that Drs. We welcome other passionate educators and healthcare providers to submit to the education collection, join the NCEAS network, and work collectively to promote SDH education in research and practice. [Extracted from the article]

Classically, it is well known that a single weight on a real interval leads to orthogonal polynomials. In Generalized orthogonal polynomials, discrete KP and Riemann-Hilbertproblems, Comm. Math. Phys. 207 (1999), 589–620, we have shown that m-periodic sequences of weights lead to “moments,” polynomials dened by determinants of matrices involving these moments and 2m + 1-step relations between them, thus leading to 2m + 1-band matrices L. Given a Darboux transformations on L, which effect does it have on the m-periodic sequence of weights and on the associated polynomials? These questions will receive a precise answer in this paper. The methods are based on introducing time parameters in the weights, making the band matrix L evolve according to the so-called discrete KP hierarchy. Darboux transformations on that L translate into vertex operators acting on the τ-function. [ABSTRACT FROM PUBLISHER]

AbstractSimulation-based mastery learning is a powerful educational paradigm that leads to high levels of performance through a combination of strict standards, deliberate practice, formative feedback, and rigorous assessment. Successful mastery learning curricula often require well-designed checklists that produce reliable data that contribute to valid decisions. The following twelve tips are intended to help educators create defensible and effective clinical skills checklists for use in mastery learning curricula. These tips focus on defining the scope of a checklist using established principles of curriculum development, crafting the checklist based on a literature review and expert input, revising and testing the checklist, and recruiting judges to set a minimum passing standard. While this article has a particular focus on mastery learning, with the exception of the tips related to standard setting, the general principles discussed apply to the development of any clinical skills checklist. [ABSTRACT FROM AUTHOR]

Reports on the development of potential nutritional prophylactic for the reduction of feline hairball symptoms by researchers from Australia. Role of the routine activity of grooming on the formation of hairball in cats; Incapability of the gastric mucosa to move the strands of ingested hair by peristalsis; Advantages of nutritional prophylactics over surgery to treat severe cases of hairball intestinal obstruction.

Demonstrates the evolution of messenger ribonucleic acids (MRNA) between plant cells and their developmental functions within cells. Effects of transported RNA on distinct phenotypic consequences; Promotion of MRNA from the role of an intracellular to an intercellular information; Transfer of acquired traits to the genome.

Assessment and evaluation guidelines inform programmatic changes necessary for educational effectiveness. Presently, no widely accepted guidelines exist for educators to assess learners and evaluate programs regarding social determinants of health (SDOH) during physician and physician assistant (PA) education. We sought to garner expert consensus about effective SDOH learner assessment and program evaluation, so as to make recommendations for best practices related to SDOH education. We used a Delphi approach to conduct our study (September 2019 to December 2020). To administer our Delphi survey, we followed a three-step process: 1) literature review, 2) focus groups and semi-structured interviews, 3) question development and refinement. The final survey contained 72 items that addressed SDOH content areas, assessment methods, assessors, assessment integration, and program evaluation. Survey participants included 14 SDOH experts at US medical schools and PA programs. The survey was circulated for three rounds seeking consensus, and when respondents reached consensus on a particular question, that question was removed from subsequent rounds. The geographically diverse sample of experts reached consensus on many aspects of SDOH assessment and evaluation. The experts selected three important areas to assess learners' knowledge, skills, and attitudes about SDOH. They identified assessment methods that were "essential", "useful, but not essential", and "not necessary." The essential assessment methods are performance rating scales for knowledge and attitudes and skill-based assessments. They favored faculty and patients as assessors, as well as learner self-assessment, over assessments conducted by other health professionals. Questions about separation versus incorporation of SDOH assessment with other educational assessment did not yield consensus opinion. The experts reached consensus on priority outcome measures to evaluate a school's SDOH program which included student attitudes toward SDOH, Competence-Based Assessment Scales, and the percentage of graduates involved in health equity initiatives. Based on the Delphi survey results, we make five recommendations that medical and PA educators can apply now when designing learner assessments and evaluating SDOH programming. These recommendations include what should be assessed, using what methods, who should do the assessments, and how they should be incorporated into the curriculum. This expert consensus should guide future development of an assessment and evaluation toolkit to optimize SDOH education and clinical practice. Supplemental data for this article is available online at https://doi.org/10.1080/10401334.2022.2045490. [ABSTRACT FROM AUTHOR]

Background: Vomiting limits the success of oral rehydration in children with gastroenteritis. We conducted a double-blind trial to determine whether a single oral dose of ondansetron, an antiemetic, would improve outcomes in children with gastroenteritis. Methods: We enrolled 215 children 6 months through 10 years of age who were treated in a pediatric emergency department for gastroenteritis and dehydration. After being randomly assigned to treatment with orally disintegrating ondansetron tablets or placebo, the children received oral-rehydration therapy according to a standardized protocol. The primary outcome was the proportion who vomited while receiving oral rehydration. The secondary outcomes were the number of episodes of vomiting and the proportions who were treated with intravenous rehydration or hospitalized. Results: As compared with children who received placebo, children who received ondansetron were less likely to vomit (14 percent vs. 35 percent; relative risk, 0.40; 95 percent confidence interval, 0.26 to 0.61), vomited less often (mean number of episodes per child, 0.18 vs. 0.65; P<0.001), had greater oral intake (239 ml vs. 196 ml, P=0.001), and were less likely to be treated by intravenous rehydration (14 percent vs. 31 percent; relative risk, 0.46; 95 percent confidence interval, 0.26 to 0.79). Although the mean length of stay in the emergency department was reduced by 12 percent in the ondansetron group, as compared with the placebo group (P=0.02), the rates of hospitalization (4 percent and 5 percent, respectively; P=1.00) and of return visits to the emergency department (19 percent and 22 percent, P=0.73) did not differ significantly between groups. Conclusions: In children with gastroenteritis and dehydration, a single dose of oral ondansetron reduces vomiting and facilitates oral rehydration and may thus be well suited for use in the emergency department. N Engl J Med 2006;354:1698-705. [ABSTRACT FROM AUTHOR]

Invasive non-native species (INS) are found in every city around the globe, but their impacts in urban settings as biological agents of visual pollution that block views of natural landscapes and disconnect citizens from nature are not as often addressed as comprehensively as their impacts in natural areas or agricultural settings. The multiple impacts of INS in cities make them ideal candidates for aspects of Civic Ecology Practice, where local environmental stewardship action is taken to enhance green infrastructure and community well-being in urban and other human-dominated systems. We present details of a community driven program focused on removal of an INS, Amur bush honeysuckle (Lonicera maackii), from banks of a creek in Indianapolis, Indiana, in the midwestern USA. Unlike many civic ecology practices, this project was motivated by community response to the long-developing environmental, social, and economic impacts of an INS and includes involvement of a major corporation. In response to local residents' concerns and following months of planning, over 2,000 volunteers removed more than 760 m3 of Amur bush honeysuckle from 30 acres of land along Fall Creek during a single day. The honeysuckle removal served ecological and environmental goals of removing an invasive species, but it also helped foster in citizens a sense of place and connection with Indianapolis' waterways, reflecting local history and culture. Aspects of the project can serve as a model for action in other cities. [ABSTRACT FROM AUTHOR]

Background: Social determinants of health (SDOH) curricular content in medical schools and physician assistant programs are increasing. However, there is little understanding of current practice in SDOH learner assessment and program evaluation, or what the best practices are. Objective: Our study aim was to describe the current landscape of assessment and evaluation at US medical schools and physician assistant programs as a first step in developing best practices in SDOH education. Design: We conducted a national survey of SDOH educators from July to December 2020. The 55-item online survey covered learner assessment methods, program evaluation, faculty training, and barriers to effective assessment and evaluation. Results were analyzed using descriptive statistics. Participants: One hundred six SDOH educators representing 26% of medical schools and 23% of PA programs in the USA completed the survey. Key Results: Most programs reported using a variety of SDOH learner assessment methods. Faculty and self were the most common assessors of learners' SDOH knowledge, attitudes, and skills. Common barriers to effective learner assessment were lack of agreement on "SDOH competency" and lack of faculty training in assessment. Programs reported using evaluation results to refine curricular content, identify the need for new content, and improve assessment strategies. Conclusions: We identified a heterogeneity of SDOH assessment and evaluation practices among programs, as well as gaps and barriers in their educational practices. Specific guidance from accrediting bodies and professional organizations and agreement on SDOH competency as well as providing faculty with time, resources, and training will improve assessment and evaluation practice and ensure SDOH education is effective for students, patients, and communities. [ABSTRACT FROM AUTHOR]

Introduction: In this paper, we explored the utility and value of the METRICS model for modeling scholarship in healthcare simulation by: (1) describing the distribution of articles in four healthcare simulation journals across the seven areas of METRICS scholarship; and (2) appraising patterns of scholarship expressed in three programs of simulation scholarship and reflecting on how these patterns potentially influence the pursuit of future scholarly activities. Methods: Two raters reviewed abstracts of papers published between January 2015 and August 2017 in four healthcare simulation journals and coded them using METRICS. Descriptive statistics were calculated for scholarship type and distribution across journals. Twenty-eight articles from three scholars were reviewed, with patterns of scholarship within articles mapped to METRICS. Descriptive synthesis was constructed through discussion between two reviewers. Results: A total of 432 articles from four journals were reviewed. The three most commonly published areas of scholarship were: 32.2% (139/432) evaluation, 18.8% (81/432) innovation, and 15.3% (66/432) conceptual. The METRICS model was able to represent different kinds of scholarship expressed in all of the papers reviewed and across programs of research. Reflecting on patterns of scholarship within their scholarly programs was helpful for research in planning future directions. Conclusions: The METRICS model for scholarship can describe a wide range of patterns of simulation scholarship within individual articles, programs of research, or across journals. [ABSTRACT FROM AUTHOR]

The article presents a study which examined the skills of senior pediatrics residents in communication and acute resuscitation and measured logistical factors like staffing and program costs with an aim to develop an objective structured clinical examination (OSCE) in the U.S.

Prompt diagnosis of malrotation and midgut volvulus in infants with bilious emesis is critical. However because of the limited frequency of pediatric upper gastrointestinal (UGI) fluoroscopic procedures in neonates, many diagnostic radiology residents complete their training never having seen or performed a UGI on a baby for evaluation of malrotation and midgut volvulus. A UGI simulation model for infants with bilious emesis was created to supplement the hands-on fluoroscopic experience of residents in training. We are now studying the addition of simulated UGI studies to our pediatric radiology curriculum. [ABSTRACT FROM AUTHOR]

The article discusses a study on the benefits of a simulation-based mastery learning program designed to teach pediatrics resident about the management of status epilepticus (SE).

Aim Many healthcare providers rely on visual perception to guide cardiopulmonary resuscitation (CPR), but little is known about the accuracy of provider perceptions of CPR quality. We aimed to describe the difference between perceived versus measured CPR quality, and to determine the impact of provider role, real-time visual CPR feedback and Just-in-Time (JIT) CPR training on provider perceptions. Methods We conducted secondary analyses of data collected from a prospective, multicenter, randomized trial of 324 healthcare providers who participated in a simulated cardiac arrest scenario between July 2012 and April 2014. Participants were randomized to one of four permutations of: JIT CPR training and real-time visual CPR feedback. We calculated the difference between perceived and measured quality of CPR and reported the proportion of subjects accurately estimating the quality of CPR within each study arm. Results Participants overestimated achieving adequate chest compression depth (mean difference range: 16.1–60.6%) and rate (range: 0.2–51%), and underestimated chest compression fraction (0.2–2.9%) across all arms. Compared to no intervention, the use of real-time feedback and JIT CPR training (alone or in combination) improved perception of depth ( p < 0.001). Accurate estimation of CPR quality was poor for chest compression depth (0–13%), rate (5–46%) and chest compression fraction (60–63%). Perception of depth is more accurate in CPR providers versus team leaders (27.8% vs. 7.4%; p = 0.043) when using real-time feedback. Conclusion Healthcare providers’ visual perception of CPR quality is poor. Perceptions of CPR depth are improved by using real-time visual feedback and with prior JIT CPR training. [ABSTRACT FROM AUTHOR]

Background Pediatrics residents have few opportunities to perform cardiopulmonary resuscitation (CPR). Enhancing the quality of CPR is a key factor to improving outcomes for cardiopulmonary arrest in children and requires effective training strategies. Objective To evaluate the effectiveness of a simulationbased intervention to reduce first-year pediatrics residents' time for 3 critical actions in CPR: (1) call for help, (2) initiate bag-mask ventilation, and (3) initiate chest compressions. Methods A prospective study involving 31 first-year pediatrics residents at a children's hospital assigned to an early or late (control) intervention group. Residents underwent baseline assessment followed by repeat evaluations at 3 and 6 months. Time to critical actions was scored by video review. A 90-minute educational intervention focused on skill practice was conducted following baseline evaluation for the early-intervention group and following 3-month evaluation for the lateintervention group. Primary outcome was change in time to initiating the 3 critical actions. Change in time was analyzed by comparison of Kaplan-Meier curves, using the log-rank test. A 10% sample was timed by a second rater. Agreement was assessed using intraclass correlation (ICC). Results There was a statistically significant reduction in time for all 3 critical actions between baseline and 3- month evaluation in the early intervention group; this was not observed in the late (control) group. Rater agreement was excellent (ICC ≽ 0.99). Conclusions A simulation-based educational intervention significantly reduced time to initiation of CPR for first-year pediatrics residents. Simulation training facilitated acquisition of critical CPR skills that have the potential to impact patient outcome. [ABSTRACT FROM AUTHOR]

B Introduction/Hypothesis: b Acute care pediatrics teams face ambiguous, dynamic patient care situations that demand adaptability to avoid patient harm. Teams received verbal handoff about a patient with imminent arrival in their clinical space and are instructed to plan collectively for aspects of patient care they deem important. Our project seeks to describe how teams experience pre-action TR before patients arrive and active hands-on patient care begins. [Extracted from the article]