High-Fidelity Simulation With Debriefing: Best Practice Education for Flight Nurses?

OBJECTIVE: High-fidelity simulation with debriefing has been shown to be effective in maintaining high-risk, low-volume proficiencies in nursing. The purpose of this evidence-based practice project was to implement high-fidelity simulation with debriefing to measure improvements in flight nurse skill acuity and retention when performing intubations. METHODS: This was a prospective evidence-based project conducted before and after a debriefing intervention that took place at HealthNet Aeromedical Services, Charleston, WV. Participants were flight nurses who were asked to intubate during a high-fidelity simulation session and participate in a debriefing session to reflect on their performance. They were then tested on 7-month skill retention. Eight subjects completed all stages of the study and were included in the analysis. RESULTS: The mean ± standard deviation time to successful intubation predebriefing was 26.9 ± 11.9 seconds; for postdebriefing, it was 24.8 ± 5.8 seconds. The mean ± standard deviation checklist score before debriefing was 7.9 ± 0.4 points, whereas for postdebriefing it was 9.4 ± 0.7 points. CONCLUSION: The implementation of debriefing after simulation improved the time to intubation and produced better clinical judgment and mastery while performing the intubation.

How Prometheus creates structure in Saturn's F ring.

Images of Saturn's narrow and contorted F ring returned by the Cassini spacecraft have revealed phenomena not previously detected in any planetary ring system. The perturbing effect of the inner shepherding satellite, Prometheus, seems to introduce channels through the F ring and a 'streamer'--a line of particles that link the ring to the satellite. The detailed mechanism for the formation of these features has been lacking an explanation. Here we show that these phenomena can be understood in terms of a simple gravitational interaction as Prometheus approaches and recedes from the F ring every 14.7 hours. Our numerical models show that as Prometheus recedes from its closest approach to the F ring, it draws out ring material; one orbital period later, this affected region has undergone keplerian shear and is visible as a channel, in excellent agreement with structures seen in the Cassini images. Prometheus' periodic disruption of the F ring will become more pronounced as the two orbits approach their minimum separation in 2009. The model predicts that the appearance of streamers and the associated channels will vary in a regular fashion on a timescale of one orbital period.

Imaging of Titan from the Cassini spacecraft.

Titan, the largest moon of Saturn, is the only satellite in the Solar System with a substantial atmosphere. The atmosphere is poorly understood and obscures the surface, leading to intense speculation about Titan's nature. Here we present observations of Titan from the imaging science experiment onboard the Cassini spacecraft that address some of these issues. The images reveal intricate surface albedo features that suggest aeolian, tectonic and fluvial processes; they also show a few circular features that could be impact structures. These observations imply that substantial surface modification has occurred over Titan's history. We have not directly detected liquids on the surface to date. Convective clouds are found to be common near the south pole, and the motion of mid-latitude clouds consistently indicates eastward winds, from which we infer that the troposphere is rotating faster than the surface. A detached haze at an altitude of 500 km is 150-200 km higher than that observed by Voyager, and more tenuous haze layers are also resolved.

Rates of decline distinguish Alzheimer's disease and mild cognitive impairment relative to normal aging: integrating cognition and brain function.

AIMS: Increasing age is the strongest risk factor for Alzheimer's disease (AD). Yet, departure from normal age-related decline for established markers of AD including memory, cognitive decline and brain function deficits, has not been quantified. METHODS: We examined the cross-sectional estimates of the "rate of decline" in cognitive performance and psychophysiological measures of brain function over age in AD, preclinical (subjective memory complaint-SMC, Mild Cognitive Impairment-MCI) and healthy groups. Correlations between memory performance and indices of brain function were also conducted. RESULTS: The rate of cognitive decline increased between groups: AD showed advanced decline, and SMC/MCI groups represented intermediate stages of decline relative to normal aging expectations. In AD, advanced EEG alterations (excessive slow-wave/reduced fast-wave EEG, decreased working memory P450 component) were observed over age, which were coupled with memory decline. By contrast, MCI group showed less severe cognitive changes but specific decreases in the working memory N300 component and slow-wave (delta) EEG, associated with decline in memory. DISCUSSION AND INTEGRATIVE SIGNIFICANCE: While the cognitive data suggests a continuum of deterioration associated with increasing symptom severity across groups, integration with brain function measures points to possible distinct compensatory strategies in MCI and AD groups. An integrative approach offers the potential for objective markers of the critical turning point, with age as a potential factor, from mild memory problems to disease.

Does community-based point of care HIV testing reduce late HIV diagnosis? A retrospective study in England and Wales.

The objective of this study was to investigate if patients diagnosed in community clinics have higher baseline CD4 cell counts than those diagnosed in Genitourinary medicine (GUM)/HIV clinics. We undertook a retrospective review of baseline CD4 cell counts for patients receiving a reactive HIV test in community-testing clinics. Eleven local HIV clinics were contacted to determine the baseline CD4 cell counts of these patients. Baseline CD4 cell counts of those diagnosed in the community were compared with mean local GUM/HIV clinic and median national baseline CD4 cell count for their year of diagnosis. Clients diagnosed in community settings had a mean baseline CD4 cell count of 481 cells/mm3 (SD 236 cells/mm3) and median baseline of 483 cells/mm3 (interquartile range 311-657 cells/mm3). This was significantly higher than those diagnosed in the GUM/HIV clinic local to the community-testing site (mean baseline CD4 397 cells/mm3, p = 0.014) and the national median for that year (336 cells/mm3, p < 0.001). HIV testing in community settings identifies patients at an earlier stage of infection than testing in clinical settings.

Fine mapping of type 1 diabetes susceptibility loci and evidence for colocalization of causal variants with lymphoid gene enhancers.

Genetic studies of type 1 diabetes (T1D) have identified 50 susceptibility regions, finding major pathways contributing to risk, with some loci shared across immune disorders. To make genetic comparisons across autoimmune disorders as informative as possible, a dense genotyping array, the Immunochip, was developed, from which we identified four new T1D-associated regions (P < 5 × 10(-8)). A comparative analysis with 15 immune diseases showed that T1D is more similar genetically to other autoantibody-positive diseases, significantly most similar to juvenile idiopathic arthritis and significantly least similar to ulcerative colitis, and provided support for three additional new T1D risk loci. Using a Bayesian approach, we defined credible sets for the T1D-associated SNPs. The associated SNPs localized to enhancer sequences active in thymus, T and B cells, and CD34(+) stem cells. Enhancer-promoter interactions can now be analyzed in these cell types to identify which particular genes and regulatory sequences are causal.

The effect of training distinct neurofeedback protocols on aspects of cognitive performance.

The use of neurofeedback as an operant conditioning paradigm has disclosed that participants are able to gain some control over particular aspects of their electroencephalogram (EEG). Based on the association between theta activity (4-7 Hz) and working memory performance, and sensorimotor rhythm (SMR) activity (12-15 Hz) and attentional processing, we investigated the possibility that training healthy individuals to enhance either of these frequencies would specifically influence a particular aspect of cognitive performance, relative to a non-neurofeedback control-group. The results revealed that after eight sessions of neurofeedback the SMR-group were able to selectively enhance their SMR activity, as indexed by increased SMR/theta and SMR/beta ratios. In contrast, those trained to selectively enhance theta activity failed to exhibit any changes in their EEG. Furthermore, the SMR-group exhibited a significant and clear improvement in cued recall performance, using a semantic working memory task, and to a lesser extent showed improved accuracy of focused attentional processing using a 2-sequence continuous performance task. This suggests that normal healthy individuals can learn to increase a specific component of their EEG activity, and that such enhanced activity may facilitate semantic processing in a working memory task and to a lesser extent focused attention. We discuss possible mechanisms that could mediate such effects and indicate a number of directions for future research.

Seeing triggers acting, hearing does not trigger saying: evidence from children's weak inhibition.

There is evidence to suggest action imitation is automatic in adults and children. Children's weak inhibitory control means that automatic activation can have dramatic effects on behaviour. In three developmental studies, we investigated whether verbal imitation, like action imitation, is automatic. In Experiment 1 (n=96), 3-year-olds' accuracy was investigated on three well-established inhibitory tasks, and on a novel task which required the suppression of verbal imitation. Experiment 2 (n=48) compared 3-year-olds' accuracy on well-matched action and verbal tasks. In Experiment 3 (n=96), 5-, 7- and 11-year-olds reaction times were compared on verbal and action tasks using conditions that enabled the tasks' inhibitory demands to be assessed. Consistent support was found for verbal imitation being less automatic than action imitation. We suggest that this difference may reflect the greater complexity of speech, and has consequences for children's behaviour and learning.

Mind mapping as a teaching resource.

BACKGROUND: Modern mind mapping has been around since the mid-1970s, having been developed in its current form by Tony Buzan. It works by taking information from several sources and displaying this information as key words in a bright, colourful manner. Mind maps have been described as an effective study technique when applied to written material. CONTEXT: This paper looks at how to use mind mapping as a teaching resource, and was written as a result of the recent undergraduate 'Doctors as Teachers' conference at The Peninsula Medical School. INNOVATION: Mind mapping is a technique not often used or considered by many teachers. This paper looks at how a busy clinical teacher can apply this technique in a practical, useable way. This allows topics to be more interesting to students and makes both learning and teaching more enjoyable. IMPLICATIONS: Mind mapping has many potential applications to clinical education, and can be adapted to many situations. It can be used as a teaching resource, as an aid to preparing and reviewing lectures, and the technique allows notes to be written and reviewed quickly, and most importantly enables information to be easily updated. Mind mapping can be used in many situations including problem-based learning, small-group teaching, in a one-to-one context, as an examination tool and for personal revision.

Explicit identification and implicit recognition of facial emotions: II. Core domains and relationships with general cognition.

Both general and social cognition are important in providing endophenotypic markers and predicting real-world functional outcomes of clinical psychiatric disorders. However, to date, focus has been on general cognition, rather than on core domains of social/emotional cognition. This study sought to determine core domains of emotion processing for both explicit identification and implicit recognition and their relationships with core domains of general cognition. Age effects and sex differences were also investigated. A sample of 1,000 healthy individuals (6 to 91 years, 53.5% female) undertook the WebNeuro tests of emotion identification and recognition and tests of general cognitive function. Factor analysis revealed seven core domains of emotion processing: speed of explicit emotion identification, speed of implicit emotion recognition, implicit emotion recognition accuracy, "threat" processing, sadness-disgust identification, "positive emotion" processing, and general "face perception." Seven corresponding core domains of general cognition were identified: information-processing speed, executive function, sustained attention/vigilance, verbal memory, working-memory capacity, inhibition/impulsivity, and sensorimotor function. Factors of emotion processing generally showed positive associations with those of general cognitive function, suggesting commonality in processing speed in particular. Moreover, age had a consistent nonlinear impact on both emotion processing and general cognitive factors, while sex differences were more specific. These findings contribute to a normative and standardized structure for assessment of emotional and general cognition in clinical groups.