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Objective Task-oriented role assignment (TORA) is the assignment of a specific role, a list of tasks, and a location to stand to each resuscitation team member. We performed this study to examine the impact of TORA training during a Neonatal Resuscitation Program (NRP) course on neonatal resuscitation team technical performance and behavioral skills.Study Design Participants were cluster randomized into either a standard NRP course (control) or an NRP course with TORA training. Both technical and behavioral skills were evaluated using standardized simulations. The simulations were video recorded and then scored by two blinded reviewers using previously validated instruments.Results A total of 65 participants (62 resident physicians and 3 nurses) participated in 108 simulations (48 controls, 60 TORA). Technical skill scores were similar between the two groups (control = 77.6% [±8.4] vs. TORA = 78.1% [±8.1]; p = 0.74). The TORA group had higher behavior skill scores in 8 of the 10 NRP key behavioral skills and had higher overall behavioral skill scores (control = 30.1 [±7.2] vs. TORA = 34.9 [±4.8]; p Conclusion In resuscitation teams comprising mostly resident physicians, TORA training resulted in better behavioral skills during simulated neonatal resuscitation. Further study on the impact of TORA training on actual resuscitation performance in interdisciplinary teams is warranted.

Background Simulation is widely used in graduate medical education. A prior survey showed that 80% of Neonatal-Perinatal Medicine (NPM) fellowship programs in the U.S. use simulation. There are multiple ways to provide simulation-based education. One such method is through intensive simulation-based education sessions held at the beginning of a training program, common called 'boot camps'. The aim of this study was to describe the use of simulation-based boot camps in NPM fellowship programs. Methods Survey study of Accreditation Council for Graduate Medical Education (ACGME) accredited NPM fellowships in the U.S. Results Fifty-nine of 98 programs (60%) responded. Thirty six (61%) participated in 1st year fellow boot camps, which focused on procedural skills and newborn resuscitation. Nearly half of programs participated in regional boot camps. Most boot camps were one or two days long. Eleven programs (19%) held 2nd or 3rd year fellow boot camps, which focused on advanced resuscitation and communication. Barriers included lack of faculty protected time (57%), funding (39%), and lack of faculty experience (31%). Conclusions A majority of ACGME accredited NPM fellowships participate in 1st year fellows' boot camps. Many participate in regional boot camps. A few programs have 2nd or 3rd year fellow boot camps. Lack of time, funding, and faculty experience were common barriers.

Introduction As part of an international response to the Ebola virus disease (EVD) outbreak, the US Department of Defense has deployed thousands of personnel to help train and augment international health care workers. The transmission risk of this deadly virus to health care workers has been extreme, demonstrating the importance of safe practices while caring for these patients. Medical simulation training is well recognized as an integral component for disease outbreak preparedness. Therefore, the US Government created a program of instruction that outlines a formalized EVD training program, using high-fidelity simulation, which projects both an understanding of the disease and its transmission risks. Methods Two 5-day training courses were established to provide training to the 65-member Department of Defense Ebola Response Team, which would be activated during a stateside Ebola outbreak. This training consisted of Ebola-specific protocols, personal protective equipment familiarization, and scenario-based certification for physicians, nurses, and public health trainers. Simulation was used to replicate the work environment inside an Ebola treatment unit. Results Three comprehensive clinical scenarios covering a wide spectrum of EVD presentations were designed around details of published cases to provide the most realistic and relevant EVD training available. The authors conducted 10 iterations of the 3 EVD clinical scenarios totaling more than 1100 hours of simulation training. Conclusions Quality practical exercises to include specialized task performance and collective teamwork training relied heavily on dedicated facilities and realistic medical simulation resulting in valuable lessons learned. In future iterations, these characteristics would be imperative to a successful training course.

Objective: To evaluate Staphylococcus aureus surveillance, prophylaxis, and decolonization practices among US

In 1990, an 18-month-old Micronesian girl was initially diagnosed with a right adrenocortical carcinoma. More than a decade later (2003), she was diagnosed with metastatic osteosarcoma with the primary in her right proximal fibula. Given this child's remarkable history of malignancy, she underwent testing for a genetic mutation that is associated with increased cancer formation. One such cancer syndrome is called Li-Fraumeni syndrome where approximately 70% of patients carry a genetic mutation in the p53 tumor suppressor gene. Patients with LFS are at risk for developing cancers of the breast, soft tissues, brain, bone, adrenal gland, and blood cells. Mutational analysis of our patient did reveal the presence of a germline mutation of the p53 tumor suppressor gene. She was found to have a base pair change (A-->C) at nucleotide 394 resulting in a lysine to glutamine amino acid change at codon 132 (K132Q), which remarkably has never been described in association with either adrenocortical carcinoma or osteosarcoma.

The synthesis of neutral [Cu(dpm)2] and [Cu(dpm)(acac)] (dpm = dipyrromethene, acac = acetylacetonato) complexes is presented. The formation of the asymmetric metal complexes was monitored by electronic absorption and infrared spectroscopy. Two of the complexes investigated, containing pyrdpm ligands (pyrdpm = pyridyldipyrromethene), form 1-dimensional coordination polymers. The coordination polymers formed by these complexes have been characterized by single-crystal X-ray diffraction, differential scanning calorimetry, and thermogravimetric analysis. The complexes possess square pyramidal coordination geometries with the apical position occupied by the meso-pyridyl donor of a neighboring complex in the crystal lattice. The features of these coordination complexes that facilitate formation of extended solids have been probed. Symmetric [Cu(pyrdpm)2] complexes are unable to form coordination solids due to steric hindrance at the metal center. Use of cyano donors in complexes such as [Cu(cydpm)(acac)] (cydpm = cyanodipyrromethene) in lieu of pyridyl donors also fail to form network solids. Through these systematic studies, both the basic coordination chemistry of these complexes and the fundamental design requirements for synthesizing this novel class of coordination polymers have been defined.

To examine the use of long-term prophylactic mupirocin as part of a comprehensive strategy in reducing Staphylococcus aureus colonization and infection in a neonatal intensive care unit (NICU).Twice daily mupirocin was applied to all infants admitted to the NICU throughout hospitalization starting in 2004. S. aureus surveillance was implemented in 2008. The efficacy of these practices was evaluated with a retrospective review of infants admitted from 2004 to 2010 found to be colonized or infected with S. aureus.During the study period, 66 of 6283 NICU infants had a S. aureus infection with 67% methicillin resistance. There were three distinctive S. aureus outbreaks, the first being a methicillin-resistant strain July 2004. After implementation of daily mupirocin, the outbreak was eradicated and the rate of S. aureus infection significantly decreased (1.82 to 0.40/1000 patient-days-at-risk, P=0.0049). Mupirocin was discontinued March 2005 followed by a methicillin-sensitive S. aureus outbreak November 2005. In December 2005, mupirocin was reinstituted and has continued to present day, again significantly reducing S. aureus infections (1.42 to 0.33/1000 patient-days-at-risk, P0.0001) with zero isolates resistant to mupirocin. In the pre-mupirocin period, S. aureus colonization was upwards of 60% now with rates typically5%. S. aureus colonization strongly predicted later invasive infection (P0.0001).Although controversial, prophylactic mupirocin in all NICU infants has acted as a barrier to colonization and markedly decreased S. aureus infection rates over a 5-year period.

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disorder characterized by mucocutaneous telangiectases and arteriovenous malformations (AVMs). The disease rarely presents in the neonatal period, primarily manifesting with epistaxis and gastrointestinal bleeding in adulthood. Occasionally, HHT can also present with symptoms related to AVMs in the cerebral, pulmonary or gastrointestinal vasculature. In prior reports, intracranial hemorrhage (ICH) secondary to cerebral AVM in neonates with HHT has been catastrophic and uniformly fatal. Here we report a case of a newborn with HHT and ICH from a suspected AVM who survived with aggressive medical management and surgical intervention, and provide a comprehensive review of the literature on ICH in neonates with HHT.