Institution of a difficult airway response team for emergency department patients with anticipated or encountered difficult airways: Descriptive analysis of a 5-year experience at an academic teaching hospital.

Objectives: This study aimed to describe characteristics and outcomes associated with difficult airway response team (DART) encounters in the emergency department (ED). Methods: We performed a descriptive analysis of a prospective, single-center database of DART encounters in the ED from April 1, 2016 to March 31, 2021 cross-referenced with retrospective chart review. Adult ED patients ≥18 years old for whom a DART was activated were eligible. We prospectively collected activation characteristics, intubation indications, operator characteristics, and intubation methods used for DART encounters. Retrospective chart review was conducted to obtain patient demographics and outcome variables. Descriptive analyses were computed for all outcomes. Results: We analyzed 89 DART encounters. No intubation attempts were made prior to DART activation in 52 cases (58.4%). The most common indications for intubation were angioedema (n = 17, 19.1%) or other airway obstruction (n = 15, 16.9%). A definitive airway was established by anesthesiology (n = 46, 51.7%), emergency medicine (n = 25, 28.1%), trauma surgery (n = 9, 10.1%), and ENT (n = 5, 5.6%). The most common method of intubation used to establish a definitive airway was video laryngoscopy with a bougie or D-blade (n = 29, 32.6%) followed by flexible fiberoptic intubation (n = 19, 21.3%). A surgical airway was required in eight encounters (cricothyrotomy [n = 4, 4.5%]; tracheostomy [n = 4, 4.5%]). Cases were managed in the ED (n = 73, 82%), operating room (OR) (n = 10, 11.2%), and intensive care unit (ICU) (n = 1, 1.1%). All patients requiring intubation had an endotracheal or surgical airway established. Conclusion: Our findings provide important insights regarding ED DART utilization and have implications when considering institution of a DART in the ED.

Trainee burnout: Are there modifiable factors?

BACKGROUND: Burnout is a complex phenomenon and a major concern in graduate medical education as it directly impacts trainee well-being. Identifying modifiable lifestyle factors over which trainees have immediate control could support timely, actionable, individual and programme-level interventions to combat it. OBJECTIVE: The objective of this pilot study is to describe modifiable lifestyle factors that may limit the development of burnout in medical residents and fellows. METHODS: We performed a cross-sectional survey of residents and fellows at academic medical centre from September 2017 to October 2017. Participants completed the Maslach Burnout Inventory and a questionnaire designed to identify factors hypothesised to be protective against burnout. FINDINGS: A total of 205/805 (25%) trainees completed the survey with a mean (SD) age of 29.7 (2.6) years. 52% (n = 107) were female. Averaging at least 7 h of sleep per night was found to have a significant association with lower scores for the emotional exhaustion (24.8 [11, p = 0.04]) and depersonalisation (11.1 [6.4, p = 0.02]) dimensions of burnout. Additionally, self-identifying as a healthy eater was found to have a significant association with lower scores for emotional exhaustion (25 [11.5, p = 0.03]) and depersonalisation (11.5 [6.6, p = 0.04]) as well. Workouts, hobbies, identifying with organised religion, praying, meditation and mindfulness activities were not associated with a difference. CONCLUSIONS: Adequate sleep (7 or more hours per night) and healthy eating are modifiable individual-level lifestyle factors associated with lower burnout scores in trainees. These items could be a target for trainee education and programme level support initiatives.

"My wellbeing-their wellbeing "- An eHealth intervention for managing obesity in early care and education: Protocol for the Go NAPSACC Cares cluster randomized control trial.

BACKGROUND: To fully leverage the potential of the early care and education (ECE) setting for childhood obesity prevention, initiatives must not intervene solely at the organizational level, but rather they should also address the health needs of the ECE workers. Workers suffer disproportionately high rates of obesity, and have reported low confidence in modeling and promoting healthy eating and activity behaviors. However, information regarding the effectiveness of improving ECE workers' health behaviors or whether such improvements elicit meaningful change in the ECE environment and/or the children in their care is limited. METHOD: The proposed study will integrate a staff wellness intervention into a nationally recognized, ECE obesity prevention initiative (Go NAPSACC). Go NAPSACC+ Staff Wellness program will be assessed using a clustered randomized controlled trial including 84 ECE centers, 168 workers, and 672 2-5-year-old children. Centers will be randomly assigned to 1) standard "Go NAPSACC" or 2) Go NAPSACC+ Staff Wellness. Outcome measures will assess impact on dietary intake and PA behaviors of 2-5-year-old children at 6 months (primary aim) and 12 months. Secondarily, we will compare the impact of the intervention on centers' implementation of healthy weight practices and the effect on ECE workers' diet quality and PA at 6- and 12 months. DISCUSSION: This trial expects to increase our understanding of how ECE worker's personal health behaviors impact the health behaviors of the children in their care and the ECE environment. TRIAL REGISTRATION: ClinicalTrials.gov: NCT05656807, registered on 19 December 2022. Protocol version 1.0, 22 March 2023.

A National Survey of Job Satisfaction and Workload Among Emergency Medicine (EM) Residency Faculty.

INTRODUCTION:  Faculty workload, and its relation to job satisfaction, has not been well studied in Emergency Medicine (EM).  Methods: A cross-sectional survey was conducted among EM physician faculty at 49 residency programs across the United States. We collected information on clinical and non-clinical (education, administration, and research) workload, demographics, and EM department characteristics, as well as job satisfaction measured using the Global Job Satisfaction (GJS) scale. Comparisons were made using Wilcox signed rank tests. Multivariable associations with job satisfaction were assessed in a regression model. RESULTS:  Of 1,791 surveys sent, 265 were completed. The quantity of contracted clinical and non-clinical hours was lower than the actual clinical (difference (95% confidence interval (CI)): 2.7 (1.5-4.1)) and non-clinical hours (6.0 (3.8-8.8)) worked. Respondents preferred a distribution of 50% clinical work. However, the actual percentage was 62% (difference (95% CI): 14.4% (10.8%-17.6%)). Identifying as core faculty and required logging of non-clinical hours were associated with improved job satisfaction while increased percentage of time spent in the clinical and administrative domains were associated with significant declines. CONCLUSIONS:  The estimated actual work performed by EM physician faculty is greater than contracted and misaligned with their preferred type of work, the latter of which is associated with decreased job satisfaction. Improved job satisfaction and faculty retention might be achieved by increasing the percentage of time devoted to education and research, by increasing the core faculty contingent and by implementing tracking of non-clinical efforts.

Eliciting Learner Knowledge: Enabling Focused Practice through an Open-Source Online Tool.

Eliciting and interpreting students' ideas are essential skills in teaching, yet pre-service teachers (PSTs) rarely have adequate opportunities to develop these skills. In this study, we examine PSTs' patterns of discourse and perceived learning through engaging in an interactive digital simulation called Eliciting Learner Knowledge (ELK). ELK is a seven-minute, chat-based virtual role play between a PST playing a "teacher" and a PST playing a "student" where the goal is for the teacher to find out what the student knows about a topic. ELK is designed to be a practice space where pre-service and in-service teachers can learn strategies for effectively eliciting their students' knowledge. We review the implementation of ELK in eight teacher education courses in math or science methods at six different universities and assess (a) patterns of interaction during ELK and (b) PSTs' perceptions of ELK and their learning from the simulation. Our findings suggest that PSTs engage in effective practices such as eliciting and probing more often than less effective practices such as evaluating and telling. Results suggest that PSTs gain experience in practicing talk moves and having empathy for students' perspectives through using ELK.

Authenticity, Interactivity, and Collaboration in VR Learning Games.

Decreasing cost and increasing technology access in schools places 3D immersive virtual reality (VR) within the reach of K-12 classrooms (Korbey, 2017). Educators have great interest in incorporating VR into classrooms because they are engaging and often novel experiences. However, long-term curriculum development must be positioned on how to best leverage the unique affordances of VR, be informed by theory and research, and integrate VR in meaningful ways that continue to motivate students even after experiences are no longer novel. We propose the theoretical framework of embodied learning and discuss how VR and reflect on current research findings to outline effective applications of VR and provide guidelines in developing educational materials using those tools. We discuss two particular examples: spatial awareness and collaboration. We share our perspectives on the benefits and challenges of applying these principles in a learning game about cellular biology.

A hierarchy of endothelial colony-forming cell activity displayed by bovine corneal endothelial cells.

PURPOSE: To test the hypothesis that the robust expansion of bovine corneal endothelial cells (BCECs) in vitro is due to the presence of individual endothelial cells with various levels of proliferative potential. METHODS: BCECs and bovine vascular endothelial cells (ECs) derived from aorta, coronary artery, and pulmonary artery were cultivated in optimized medium. These cell populations were confirmed by morphologic features, functional assays, and gene expression profiles. Moreover, ECs were plated in a single-cell clonogenic assay to evaluate colony-forming ability. RESULTS: Both corneal and vascular ECs were confirmed to be pure populations of endothelium uncontaminated with hematopoietic cells. A complete hierarchy of endothelial colony-forming cells (ECFCs) was identified in BCECs by a single-cell clonogenic assay. The distribution of the various types of ECFCs was similar to the control ECs removed from the systemic vessels. CONCLUSIONS: Cultured BCECs display clonal proliferative properties similar to those of vascular ECs.

A Novel Contrast for DTI Visualization for Thalamus Delineation.

It has been recently shown that thalamic nuclei can be automatically segmented using diffusion tensor images (DTI) under the assumption that principal fiber orientation is similar within a given nucleus and distinct between adjacent nuclei. Validation of these methods, however, is challenging because manual delineation is hard to carry out due to the lack of images showing contrast between the nuclei. In this paper, we present a novel gray-scale contrast for DTI visualization that accentuates voxels in which the orientations of the principal eigenvectors are changing, thus providing an edge map for the delineation of some thalamic nuclei. The method uses the principal fiber orientation computed from the diffusion tensors computed at each voxel. The three-dimensional orientations of the principal eigenvectors are represented as five dimensional vectors and the spatial gradient (matrix) of these vectors provide information about spatial changes in tensor orientation. In particular, an edge map is created by computing the Frobenius norm of this gradient matrix. We show that this process reveals distinct edges between large nuclei in the thalamus, thereby making manual delineation of the thalamic nuclei possible. We briefly describe a protocol for the manual delineation of thalamic nuclei based on this edge map used in conjunction with a registered T1-weighted MR image, and present a preliminary multi-rater evaluation of the volumes of thalamic nuclei in several subjects.

RNAi knockdown of transcription factor Pu.1 in the differentiation of mouse embryonic stem cells.

Murine embryonic stem (mES) cells are pluripotent cells derived from the inner cell mass of the preimplantation blastocyst. These cells are primitive and undifferentiated and have the potential to become a wide variety of specialized cell types. Mouse ES cells can be regarded as a versatile biological tool that has led to major advances in our understanding of cell and developmental biology. To study specific gene function in early developmental events, gene knockout approaches have been traditionally used, however, this is a time-consuming and expensive approach. Recently, we have shown that small interfering RNA is an effective strategy to knockdown target gene expression, during ES cell differentiation, and consequently, one can alter cell fates in ES-derived differentiated cells. This method will be useful to test the function of a wide variety of gene products using the ES cell differentiation system.

Acute myocardial infarction in swine rapidly and selectively releases highly proliferative endothelial colony forming cells (ECFCs) into circulation.

We have recently identified endothelial colony forming cells (ECFCs) in human blood and blood vessels, and ECFC are elevated in patients with coronary artery disease. Because pigs are a favored model for studying myocardial ischemia, we questioned whether ECFCs also exist in swine and whether myocardial ischemia would alter the number of ECFC in circulation. ECFCs were present in circulating blood and aortic endothelium of healthy pigs. In pigs with an acute myocardial infarction (AMI) (n = 9), the number of circulating ECFC was markedly increased compared to sham control pigs (15 +/- 6 vs. 1 +/- 1 colonies/100 cc blood, p < 0.05). Moreover, the percentage of circulating high proliferative potential ECFCs (HPP-ECFCs) was significantly increased following AMI induction compared to sham control (38.4 +/- 5.8% vs. 0.4 +/- 0.4%, p < 0.05) and to baseline (38.4 +/- 5.8% vs. 2.4 +/- 2.4%, p < 0.05) blood samples. This is the first study to report that ECFCs are present in blood and aorta in healthy pigs and that the number and distribution of circulating ECFCs is altered following AMI. Because circulating ECFC are also altered in human subjects with severe coronary artery disease, the pig model of AMI may be an excellent preclinical model to test the role of ECFC in the pathophysiology of AMI.