Rapid cycle deliberate practice improves resident performance during ELBW resuscitation.

BACKGROUND: Neonatal Resuscitation is a required competency for pediatric and family medicine residency programs. Simulation-based training can be used to supplement clinical experience. Rapid Cycle Deliberate Practice (RCDP) has been validated as an effective education model and is gaining favor over traditional simulation models. The aim of this study was to evaluate the effectiveness of a simulation-based rapid cycle deliberate practice (RCDP) intervention on extremely low birth weight (ELBW) infant resuscitation. METHODS: Pediatric and family practice residents were randomized to control and intervention groups and participated in pre- and post-NICU rotation simulations. The intervention group received one RCDP session. Simulations were scored by blinded video review for overall performance, positive pressure ventilation (PPV), endotracheal intubation and behavioral skills. Surveys assessed confidence in ELBW resuscitation. RESULTS: Forty-one residents participated in the study. The RCDP group performed better than the control group at post-rotation evaluation for overall resuscitation performance (65% vs 87%, p = 0.004), administering PPV (63% vs 88%, p = 0.006), and validated behavior skills (1.4 vs 2.0, p = 0.019). Residents in the RCDP group reported greater confidence with ELBW resuscitation. CONCLUSION: An educational intervention using RCDP was associated with improved resident performance and confidence in ELBW resuscitation. RCDP should be considered for NRP and ELBW resuscitation training.

Clinical and neurodevelopmental outcomes in premature infants exposed to intravenous fish- and soybean oil-based lipid emulsions.

BACKGROUND: The optimal composition of lipid emulsions in parenteral nutrition (PN) for premature infants remains controversial. This study examined the effects of a combination of soybean oil-based (SoyLE) and fish oil-based (FishLE) lipid emulsions compared to FishLE as monotherapy on the lipid and fatty acid profiles and clinical outcomes of premature infants requiring prolonged PN. METHODS: 42 premature infants received FishLE+SoyLE or FishLE. Serum concentrations of lipoproteins and 29 fatty acids (FA) were measured at baseline, 4, and 8 weeks of PN and growth and neurodevelopmental outcomes were measured at 3, 6, 12, 18, and 24 months of life. RESULTS: Lipid profiles were similar between groups. Plasma concentrations of ω-6 fatty acids tended to decrease over time in both groups. Concentrations of most ω-3 fatty acids, in particular docosapentaenoic acid, eicosapentaenoic acid, and docosahexaenoic acid, were significantly increased over time in the FishLE+SoyLE group whereas they did not change in the FishLE alone group. However, serum concentrations of almost all fatty acids were similar between groups at the end of the study period. No differences in growth parameters including weight, height, fronto-occipital circumference (FOC), and body mass index (BMI) were observed up to two years of age. Similarly, there were no differences in neurodevelopmental test scores at 6, 12, 18, and 24 months of age. CONCLUSIONS: No substantial differences in lipid profiles and short clinical outcomes were found in infants exposed to FishLE+SoyLE when compared to FishLE.

Clinical practice guidelines on nutrition management in head and neck cancer: a systematic quality appraisal using the Appraisal of Guidelines for Research and Evaluation 2nd edition instrument.

OBJECTIVE: Several guidelines have been produced for the management of nutrition in patients with head and neck cancer. However, no systematic evaluation of the quality of these guidelines has been performed to date. METHOD: A comprehensive search was conducted up to August 2020. The quality of guidelines was assessed by four independent reviewers using the Appraisal of Guidelines for Research and Evaluation, 2nd edition. RESULTS: Nine guidelines were assessed for critical evaluation. Only two guidelines were classified as 'high quality'. The 'scope and purpose' domain achieved the highest mean score (75.5 ± 17.0 per cent), and the lowest domain mean score was 'applicability' (37.6 ± 23.0 per cent). CONCLUSION: These findings highlight the variability in the methodological quality of guidelines for the management of nutrition in head and neck cancer. These results may help to improve the reporting of future guidelines and guide the selection for use in clinical practice.

First Report of Tomato chlorosis virus Infecting Tomato Crops in Brazil.

During 2006 and 2007 in the region of Sumaré, state of São Paulo, Brazil, surveys were done on tomato (Solanum lycopersicum L.) virus diseases in three open field-grown crops. The data revealed low incidence (0.25 to 3.42%) of randomly distributed plants exhibiting interveinal chlorosis and some necrosis on the basal leaves. Symptoms were only observed on old fruit-bearing plants. Preliminary analysis of thin sections of symptomatic leaves from one plant by transmission electron microscopy revealed the presence of aggregates of thin, flexible, and elongated particles in some phloem vessels, suggesting infection with a member of the genus Crinivirus, family Closteroviridae. Total RNA was extracted separately from leaves of 10 symptomatic plants and used for one-step reverse transcription (RT)-PCR using the HS-11/HS-12 primer pair, which amplifies a fragment of 587 bp from the highly conserved region of the heat shock protein (HSP-70) homolog gene reported for Tomato infectious chlorosis virus (TICV) and Tomato chlorosis virus (ToCV) (1). The RT-PCR product was subsequently tested by nested-PCR for single detection of TICV and ToCV using primer pairs TIC-3/TIC-4 and ToC-5/ToC-6, respectively (1). Only one fragment of approximately 463 bp was amplified from 7 of the 10 plants with the primer pair specific for ToCV. No amplification was obtained with the primers specific for TICV. Two amplicons of 463 bp were purified and directly sequenced in both directions. Sequence comparisons of the 463-bp consensus sequence (GenBank Accession No. EU868927) revealed 99% identity with the reported sequence of ToCV from the United States (GenBank Accession No. AY903448) (3). Virus-free adults of Bemisia tabaci biotype B confined on symptomatic tomato leaves for a 24-h acquisition access period were able to transmit the virus to healthy tomato plants, which reproduced the original symptoms on the bottom leaves 65 days after inoculation under greenhouse conditions. Infection from transmission was confirmed by RT-PCR using the HS-11/HS-12 primer pair. In addition to B. tabaci biotype B, the greenhouse whitefly, Trialeurodes vaporariorum, has also been reported as a vector of ToCV, although it is less efficient than the B. tabaci biotype B in transmission of this virus (4). T. vaporariorum, which was previously considered limited to greenhouses, was recently reported in tomato and green bean (Phaseolus vulgaris L.) crops under field conditions in São Paulo State (2). Therefore, it might also contribute to the spread of ToCV in tomato crops in São Paulo. To our knowledge, this is the first report of ToCV in Brazil and South America. References: (1) C. I. Dovas et al. Plant Dis.86:1345, 2002. (2) A. L. Lourenção et al. Neotrop. Entomol. 37:89, 2008. (3) W. M. Wintermantel et al. Arch. Virol. 15:2287, 2005. (4) W. M. Wintermantel and G. C. Wisler. Plant Dis. 90:814, 2006.

Simulations of counterions at charged plates.

Using Monte Carlo simulations, we study the counterion distribution close to planar charged walls in two geometries: i) when only one charged wall is present and the counterions are confined to one half-space, and ii) when the counterions are confined between two equally charged walls. In both cases the surface charge is smeared out and the dielectric constant is the same everywhere. We obtain the counterion density profile and compare it with both the Poisson-Boltzmann theory (asymptotically exact in the limit of weak coupling, i.e. low surface charge, high temperature and low counterion valence) and the strong-coupling theory (valid in the opposite limit of high surface charge, low temperature and high counterion valence) and with previously calculated correction terms to both theories for different values of the coupling parameter, thereby establishing the domain of validity of the asymptotic limits. Gaussian corrections to the leading Poisson-Boltzmann behavior (obtained via a systematic loop expansion) in general perform quite poorly: At coupling strengths low enough so that the Gaussian (or one-loop) correction does describe the numerical deviations from the Poisson-Boltzmann result correctly, the leading Poisson-Boltzmann term by itself matches the data within high accuracy. This reflects the slow convergence of the loop expansion. For a single charged plane, the counterion pair correlation function indicates a behavioral change from a three-dimensional, weakly correlated counterion distribution (at low coupling) to a two-dimensional, strongly correlated counterion distribution (at high coupling), which is paralleled by the specific-heat capacity which displays a rounded hump at intermediate coupling strengths. For the case of counterions confined between two equally charged walls, we analyze the inter-wall pressure and establish the complete phase diagram, featuring attraction between the walls for large enough coupling strength and at intermediate wall separation. Depending on the thermodynamic ensemble, the phase diagram exhibits a discontinuous transition where the inter-wall distance jumps to infinity (in the absence of a chemical potential coupling to the inter-wall distance, as for charged lamellae in excess solvent) or a critical point where two coexisting states with different inter-wall distance become indistinguishable (in the presence of a chemical potential, as for charged lamellae with a finite fixed solvent fraction). The attractive pressure decays with the inter-wall distance as an inverse cube, similar to analytic predictions, although the amplitude differs by an order of magnitude from previous theoretical results. Finally, we discuss in detail our simulation methods and compare the finite-size scaling behavior of different boundary conditions (periodic, minimal image and open).

Binding of similarly charged plates with counterions only.

Similarly and highly charged plates in the presence of multivalent counterions attract each other and form electrostatically bound states. Using Monte-Carlo simulations, we obtain the interplate pressure in the global parameter space. The equilibrium plate separation, where the pressure changes from attractive to repulsive, exhibits a novel unbinding transition. A systematic and asymptotically exact strong-coupling field theory yields the bound state from a competition between counterion entropy and electrostatic attraction, in agreement with simple scaling arguments and simulations.