Using cognitive load theory to develop an emergency airway management curriculum: the Queen's University Mastery Airway Course (QUMAC).

Emergency airway management requires the simultaneous coordination of clinical reasoning and therapeutic interventions in the complex and time-sensitive setting of emergency resuscitation. The cognitive demand associated with these situations is invariably high and must be taken into consideration when designing training programs for this core professional competency. The four-component instructional design model (4C/ID), based on cognitive load theory, was used to develop a 1-year longitudinal airway management curriculum for Emergency Medicine residents. The simulation-based curriculum was designed with the goal of facilitating the construction and automation of schemas by individual residents in preparation for the high cognitive demand associated with emergency airway management in the clinical environment.

RéSUMé: La gestion des voies aériennes en urgence nécessite la coordination simultanée du raisonnement clinique et des interventions thérapeutiques dans le cadre complexe et sensible au temps de la réanimation d'urgence. La demande cognitive associée à ces situations est invariablement élevée et doit être prise en considération lors de la conception des programmes de formation pour cette compétence professionnelle essentielle. Le modèle de conception pédagogique à quatre composantes (4C/ID), fondé sur la théorie de la charge cognitive, a été utilisé pour élaborer un programme longitudinal de gestion des voies aériennes d'un an à l'intention des résidents en médecine d'urgence.

Dye-sensitized photooxygenation of the C=N bond. 5. substituent effects on the cleavage of the C=N bond of C-aryl-N-aryl-N-methylhydrazones.

The title compounds are cleaved cleanly at the C=N bond by singlet oxygen ((1)O(2), (1)Delta(g)) yielding arylaldehydes and N-aryl-N-methylnitrosamines. These reactions take place more rapidly at -78 degrees C than at room temperature. The effects of substituent variation at both the C-aryl and N-aryl groups were studied using a competitive method. Good correlations of the resulting rate ratios with substituent constants (sigma(-) or sigma(+)) were obtained yielding small to very small rho values indicative of small to very small changes in charge distribution between the reactant and the rate determining transition state. Electron withdrawing groups on the C-aryl moiety retard reaction somewhat by preferential stabilization of the hydrazone. Electron donors on the other hand slightly stabilize the rate determining transition state. Substituents on the N-aryl group have almost no effect. Inhibition by 3,5-di-tert-butylphenol was not observed showing that free (uncaged) radical intermediates are not involved in the mechanism. We postulate a mechanism in which the initial event is exothermic electron transfer from the hydrazone to (1)O(2) leading to an ion-radical caged pair. Subsequent covalent bond formation between the hydrazone carbon and an oxygen atom is rate controlling. The transition state for this step also has a lower enthalpy than the starting reactants, but the free energy of activation is dominated by a large negative TDeltaS++term leading to the negative temperature dependence. Direct formation of a C-O bond in the initial step is not unambiguously ruled out. Subsequent steps lead to C-N cleavage.