Boot camps in neonatal-perinatal medicine fellowship programs: A national survey.

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.

Accuracy of the nasal-tragus length measurement for correct endotracheal tube placement in a cohort of neonatal resuscitation simulators.

OBJECTIVE: Nasal-tragus length (NTL) estimates of endotracheal tube (ETT) depth are replacing weight-based estimates for endotracheal tube depth in neonates requiring endotracheal intubation. Existing neonatal simulators were designed before interest in using the NTL, and may lack fidelity in this measurement. The objective of this study is to evaluate the accuracy of the adjusted NTL formula and the Neonatal Resuscitation Program (NRP) gestational age/weight-based ETT depth chart in predicting proper endotracheal tube insertion depth in a cohort of neonatal simulators. STUDY DESIGN: The NTL and appropriate intubation depth to the mid-trachea were measured for 11 commonly used neonatal intubation simulators. RESULTS: The NTL+1 cm formula incorrectly estimates the mid-tracheal depth in 82% of simulators, and the weight-based chart incorrectly estimates depth in 75% of test simulators. Only one simulator experienced a mainstem intubation with ETT insertion to the depth predicted by the NTL+1 cm formula. CONCLUSIONS: The majority of neonatal resuscitation simulations lacked physical fidelity with regard to mid-tracheal ETT insertion depth. The NRP gestational age/weight-based chart outperformed the NTL+1 cm formula but still resulted in endotracheal tube misplacement in the majority of neonatal simulators. The majority of simulators had adequate functional fidelity using either method for ETT depth estimation.

Genetic diversity and gene flow decline with elevation in montane mayflies.

Montane environments around the globe are biodiversity 'hotspots' and important reservoirs of genetic diversity. Montane species are also typically more vulnerable to environmental change than their low-elevation counterparts due to restricted ranges and dispersal limitations. Here we focus on two abundant congeneric mayflies (Baetis bicaudatus and B. tricaudatus) from montane streams over an elevation gradient spanning 1400 m. Using single-nucleotide polymorphism genotypes, we measured population diversity and vulnerability in these two species by: (i) describing genetic diversity and population structure across elevation gradients to identify mechanisms underlying diversification; (ii) performing spatially explicit landscape analyses to identify environmental drivers of differentiation; and (iii) identifying outlier loci hypothesized to underlie adaptive divergence. Differences in the extent of population structure in these species were evident depending upon their position along the elevation gradient. Heterozygosity, effective population sizes and gene flow all declined with increasing elevation, resulting in substantial population structure in the higher elevation species (B. bicaudatus). At lower elevations, populations of both species are more genetically similar, indicating ongoing gene flow. Isolation by distance was detected at lower elevations only, whereas landscape barriers better predicted genetic distance at higher elevations. At higher elevations, dispersal was restricted due to landscape effects, resulting in greater population isolation. Our results demonstrate differentiation over small spatial scales along an elevation gradient, and highlight the importance of preserving genetic diversity in more isolated high-elevation populations.

Spiral versus electron-beam CT for coronary artery calcium scoring.

PURPOSE: To determine differences in coronary artery calcium detection, quantification, and reproducibility, as measured at electron-beam computed tomography (CT) and subsecond spiral CT with retrospective electrocardiogram gating in an asymptomatic adult population. MATERIALS AND METHODS: Seventy subjects asymptomatic for coronary heart disease underwent both electron-beam CT and subsecond spiral CT. In all subjects, two images each were obtained with both scanners. Two experienced readers using three different algorithms scored each of the four scans: one score for the electron-beam CT images and two scores for the spiral CT images. RESULTS: With a 130-HU threshold for the quantification of calcium, there were no significant differences in interscan and interobserver variation in calcium scores between the electron-beam CT and spiral CT images. There was greater interobserver (P <.001) and interscan (P <.03) variation in scores when a 90-HU threshold was used for spiral CT images. With a 130-HU threshold, when calcium scores were used for clinical risk stratification, there was a significant difference between the results obtained with electron-beam CT and those obtained with spiral CT (P <.05). CONCLUSION: Spiral CT has not yet proved to be a feasible alternative to electron-beam CT for coronary artery calcium quantification. There are systematic differences between calcium scores obtained with single-detector array subsecond spiral CT and those obtained with electron-beam CT.

Overabundance of CD45RA(+) (quiescent-phenotype) cells within the involuted CD4(+) T-cell population follows initiation of immune depression in energy-deficient weanling mice and reflects involution exclusive to the CD45RA(-) subset.

Previous studies have identified an overabundance of quiescent-phenotype (CD45RA(+)) CD4(+) T cells throughout the lymphoid system of weanling mice at an advanced stage of food intake restriction mimicking marasmus. The objective of this investigation was to determine the timing of this phenomenon relative to the development of depression in cell-mediated immune competence. Two experiments were conducted in which male and female weanling C57BL/6J mice, initially 19 d of age, either were permitted free access to a complete purified diet or were subjected to restricted intake of this diet, producing loss of 1.5-2% of initial body weight daily. In the first experiment, feeding periods of 3, 6, 9, 12 and 14 d were examined, and a zero-time control group (19 d old) was also included. Expression of CD45RA was assessed by flow cytometry in CD4(+) T cells from the blood, spleen and mesenteric lymph nodes. Despite reduction in CD4(+) T-cell numbers, evident in all three lymphoid compartments of the malnourished mice by d 6, energy-restricted mice maintained the numbers of CD4(+)CD45RA(+) T cells at the level found in the zero-time control group. Consequently, the malnourished group exhibited a high percentage of CD4(+) T cells expressing CD45RA by d 9 in the blood and mesenteric nodes and by d 12 in the spleen. In the second study, malnourished and age-matched control groups were sensitized to sheep red blood cells on d 3 and energy-restricted mice exhibited depression in the delayed hypersensitivity response to this antigen when assessed on d 9 after challenge 24 h previously. Energy deficiency pathology includes a shift toward CD4(+) T cell quiescence that may contribute to ongoing immunodepression without being involved in its initiation. Remarkably, this imbalance develops because involution of the CD4(+) subset in the energy-deficient mice is confined to the CD45RA(-) population.

Changes in the percentage of 5-year-old children with no experience of decay in Dudley towns since the implementation of fluoridation schemes in 1987.

OBJECTIVE: To compare changes in dental health between non-fluoridated Stourbridge and the towns of Dudley, Sedgeley and Coseley, Brierley Hill and Kingswinford, and Halesowen that were artificially fluoridated in 1987. BASIC RESEARCH DESIGN: BASCD co-ordinated studies of total samples of 5-year-old children. CLINICAL SETTINGS: State funded primary schools in the Dudley Health Authority area. PARTICIPANTS: All 5-year-old children present on the day of examination in the years in which total population studies were conducted. INTERVENTIONS: Drinking water fluoridation commenced in 1987. MAIN OUTCOME MEASURE: The percentage of children with no experience of decay in their primary dentition. RESULTS: The percentage of children with no experience of decay in the fluoridated towns increased but remained the same in non-fluoridated Stourbridge. CONCLUSION: Drinking water fluoridation is associated with an increase in the percentage of 5-year-old children with no experience of tooth decay.

Information Technology Measurement and Testing Activities at NIST.

Our high technology society continues to rely more and more upon sophisticated measurements, technical standards, and associated testing activities. This was true for the industrial society of the 20th century and remains true for the information society of the 21st century. Over the last half of the 20th century, information technology (IT) has been a powerful agent of change in almost every sector of the economy. The complexity and rapidly changing nature of IT have presented unique technical challenges to the National Institute of Standards and Technology (NIST) and to the scientific measurement community in developing a sound measurement and testing infrastructure for IT. This measurement and testing infrastructure for the important non-physical and non-chemical properties associated with complex IT systems is still in an early stage of development. This paper explains key terms and concepts of IT metrology, briefly reviews the history of the National Bureau of Standards/National Institute of Standards and Technology (NBS/NIST) in the field of IT, and reviews NIST's current capabilities and work in measurement and testing for IT. It concludes with a look at what is likely to occur in the field of IT over the next ten years and what metrology roles NIST is likely to play.

Relative fitness of two hermaphroditic mating types in the androdioecious clam shrimp, Eulimnadia texana.

Androdioecy (populations of males and hermaphrodites) is a rare reproductive form, being described from only a handful of plants and animals. One of these is the shrimp Eulimnadia texana, which has populations comprised of three mating types: two hermaphroditic types (monogenics and amphigenics) and males. In a recent study, the amphigenic hermaphrodites were found to be in greater abundance than that predicted from a model of this mating system. Herein, we compare the relative fitness of offspring from amphigenic and monogenic siblings, attempting to understand the greater relative abundance of the former. Populations started with offspring from selfed monogenic hermaphrodites had a net reproductive rate (R) 87% that of offspring from their amphigenic siblings. Additionally, within populations of amphigenic offspring (which included males, monogenics and amphigenics), amphigenics survived longer than monogenics. These differences help to explain the increased relative abundance of amphigenics in natural populations, but amphigenics continue to be more abundant than expected.

Identifying local patterns of cross boundary flow and developing socio-economic profiles for general dental practitioners.

OBJECTIVES: The objective of this study was to assess cross-boundary flow in general dental practices in Dudley. DESIGN: Data were collected on NHS patients attending 57 general dental practitioners in Dudley Health District. Socio-economic data were attached to recognised postcodes in order to establish district of residence of patients and the socio-economic (ACORN) status of the neighbourhood in which they lived. SETTING: General dental practices in Dudley. SUBJECTS: General Dental Service patients. RESULTS: Using this methodology a profile of the patient population attending the participating practitioners was drawn up, giving an insight into patterns of dental attendance. CONCLUSION: These profiles will act as indicators of practices in which there are high levels of cross boundary flow and inform discussions on local commissioning.

An analysis of the qualitative factors which influence young people's acceptance of orthodontic care.

INTRODUCTION AND METHOD: The qualitative data volunteered as responses to open questions in a self-administered questionnaire study were analysed to identify the psychological factors influencing young people's behaviour in relation to orthodontic care and to gain an understanding of the psychological factors which influence adolescents' acceptance of orthodontic care. The study was conducted in all Walsall and Dudley secondary schools. RESULTS AND DISCUSSION: The responses of the young people who were in year 10 of education with an average age of 15.0 years demonstrated the importance of personal constructs, peer group and media influences, parental influences, conflicting messages, teasing, symptom perception, appearance and self-image, and interpersonal relationships in determining whether or not young people either seek and accept or reject orthodontic treatment. CONCLUSION: The study concluded that it is essential that clinicians involve patients fully and honestly in discussions concerning their orthodontic therapy in order to enable them to make a considered consent.

The use of a geographical information system in investigating dental services.

OBJECTIVE: To determine the value of a geographical information system (GIS) in investigating the provision of dental care. DESIGN: Information about dental need and provision of dental services was obtained from districts within the West Midlands. A Geographical Information System (Atlas GIS) was used to answer three different questions about dental services provision within the West Midlands. A GIS is an interactive system that allows data to be analysed according to regular or irregular geographical areas. Once the system is established, it is fairly simple and quick to use. However, the financial and training issues mean that it may not be viable for such a system to be available within each health trust or district, but more appropriately as a central facility which can be accessed by several users. CASE STUDIES: The way in which this system was used to answer three different questions about dental service provision within the West Midlands is demonstrated and evaluated. CONCLUSIONS: Use of a GIS presents information in a way that increases its usefulness in the planning of dental services.

Proteins that interact with PKR.

The in vitro activities of recombinant gene products of the vaccinia virus E3L and K3L genes have been compared. These proteins are both potent inhibitors of the dsRNA activated protein kinase (PKR) as assayed in cell-free translation systems or with purified PKR. The two gene products function at similar molar concentrations. Both proteins are expressed early in vaccinia virus infection suggesting that vaccinia virus maintains redundant mechanisms for the down regulation of PKR. The K3L gene product can be shown to be associated with PKR in vaccinia virus infected cells. The activities of the vaccinia virus PKR inhibitors are compared with other viral protein inhibitors of PKR. A variety of cellular proteins have also been identified by their ability to inhibit PKR activity or to prevent PKR activation. These cellular PKR interacting proteins have been uncovered from the studies of viral strategies to prevent PKR activation, as well as from studies looking at the effects of growth control, growth factors or oncogene expression on PKR activity. A picture emerges of PKR fulfilling a complex regulatory role in cell function with the regulation of its activity as part of a complex cascade interfacing with the signal transduction/cell cycle control machinery.

The relationship between caries experience in the deciduous molars at 5 years and in first permanent molars of the same child at 7 years.

The sensitivity and specificity of predictors of caries in the first permanent molars based on caries experience in the deciduous molars were tested, using longitudinal data derived from a group of 565 children examined at the ages of 5 and 7 years. The best predictor of caries experience in the first permanent molars at the age of 7 years in this group of children was found to be caries experience in three or more deciduous molars at the age of five.

Relations between early childhood care arrangements and college students' psychosocial development and academic performance.

Associations were explored between early substitute care and white middle-class college students' psychosocial development and academic performance. One set of analyses explored associations with the amount of substitute care experienced throughout early childhood (infancy and at ages 2 and 4) and college students' development; another set explored associations between amount of substitute care during infancy (none, part-time, or full-time). Substitute care experience during infancy alone did not differentiate students on the Erikson Psychosocial Inventory Scale (EPSI). There were some near-significant differences on the EPSI among students in different child care arrangements throughout early childhood, but these did not present a consistent pattern. Students' care experience also did not predict the number of extra-curricular activities in which they were presently involved or whether they chose people- or thing-oriented academic majors. However, no day care in infancy followed by full-time day care at ages 2 and 4 was the best predictor of above-average high school academic achievement, and part-time care throughout infancy and early childhood was the best predictor of average high school academic achievement.

'Idle teeth get into mischief'. The Dental Health of Walsall (UK) school children 1910-1912 and the consequent development of school dentistry in the Borough.

A Medical Inspector of Schools was appointed in Walsall Staffordshire in 1907, and her medical scrutiny of schoolchildren included a dental examination. The sections of her annual reports in 1910-12 which concerned the dental state of the 5, 7 and 14 year old children are presented. The percentage of children in these ages with one or more carious teeth was in excess of 50 per cent. The findings from these studies resulted in the appointment of the first school dental officer to Walsall Borough Corporation.

Mortality and morbidity caused by measles in children with malignant disease attending four major treatment centres: a retrospective review.

Measles is a major cause of mortality and morbidity in children receiving treatment for leukaemia. A review was made of all the documented cases of measles in children in first remission from acute lymphoblastic leukaemia at four major treatment centres in 1974-84. Over the 11 years reviewed 1043 children with acute lymphoblastic leukaemia were referred to these centres. Fifty one (4.9%) died while in first remission and 15 (29.4%) of these deaths were due to measles or its complications: 12 cases of pneumonia, 10 of them fatal; and six cases of encephalitis, five of them fatal and the sixth child left severely handicapped. These children would have had at least a 50% chance of long term survival. The severity of measles in the immunocompromised patient reinforces the need to improve the poor uptake of measles immunisation in Britain.