The new 6-unit individualized curriculum for pediatric residents: the perspective of neonatology fellowship program directors.

OBJECTIVE: Starting in 2013, all pediatric residents entering fellowship must be provided six educational units whose structure is to be determined by their individual career plans. We sought to determine whether (1) neonatology fellowship program directors (PDs) consistently identify certain weaknesses among incoming fellows and (2) neonatology fellowship PDs agree on the most beneficial activities in which pediatric residents should participate to improve preparation for entry into neonatology fellowships. STUDY DESIGN: We sent a 21-question survey focused on the structure and implementation of the 6-unit curriculum to all members of the Organization of Neonatology Training Program Directors. RESULTS: Sixty-seven percent of PDs responded. Seventy-five percent cited insufficient procedural skills as the primary weakness of incoming fellows. More than 80% rated additional training in clinical neonatology, including procedural and resuscitation training, as 'beneficial' or 'highly beneficial'. In contrast, fewer than 40% of PDs gave the same positive ratings to activities broadly focused on scholarship. CONCLUSIONS: The results of the survey may help guide pediatric residency programs as they undertake development of these new curricular initiatives for individual residents entering neonatology.

A delivery room-focused education and deliberate practice can improve pediatric resident resuscitation training.

OBJECTIVE: To determine if deliberate practice and simulation would improve pediatric residents' neonatal resuscitation abilities. STUDY DESIGN: Prospective cohort with pre-post-intervention design. Senior residents from 2008 to 2009 were evaluated and served as controls (C-Senior, N=23). Interns (PL-1, N=28) from 2008 to 2009 received the education and evaluation at the beginning (I-Pre) and end of their NICU rotation (I-Post) and again when they were seniors (I-Senior, N=24). The education, based on deliberate practice, included scored assessments of a resident's ability to assemble delivery room equipment and lead a simulated resuscitation. RESULT: PL-1 equipment score increased by 30% (I-Pre; 53%, I-Post; 83%) and was not different 1 to 2 years later (I-Senior; 87%). I-Senior equipment score was 22% higher than the C-Senior group (C-Senior; 65%). The PL-1's ability to lead a resuscitation improved after the education (I-Pre; 76%, I-Post; 85%) and was maintained as senior residents (I-Senior; 85%), but was not superior to the C-Senior group (C-Senior; 81%). CONCLUSION: The use of deliberate practice and simulation can improve a residents' resuscitation training, particularly for equipment.

Comparison of 4% articaine and 0.5% levobupivacaine/2% lidocaine mixture for sub-Tenon's anaesthesia in phacoemulsification cataract surgery: a randomised controlled trial.

BACKGROUND/AIMS: [corrected] The aim of this study was to compare the efficacy and safety of 4% articaine with a mixture containing equal volumes of 2% lidocaine and 0.5% levobupivacaine without hyaluronidase for sub-Tenon's anaesthesia in phacoemulsification cataract surgery. METHODS: The study was a prospective, randomised double-masked clinical trial of 65 patients allocated to receive either 4% articaine or a mixture containing equal parts of 2% lidocaine and 0.5% levobupivacaine. All patients had pre- and postoperative Hess charting to document ocular motility dysfunction. Ocular and eyelid movements were scored at 2 min intervals from 2 to 10 min after injection of the anaesthetic agent, and at the end of surgery. Complications related to injection, including pain, chemosis and subconjunctival haemorrhage, were recorded. Patients rated pain (none/mild/moderate/severe) during surgery. The operating surgeon masked to the anaesthetic agent assessed proptosis/chemosis at the start of the operation and the degree of ocular akinesia and analgesia at the end of surgery. RESULTS: The articaine group demonstrated a rapid onset of ocular akinesia with a mean time to readiness for surgery (achieving a score of

The pregnant sheep as a model for human pregnancy.

Successful outcome of human pregnancy not only impacts the quality of infant life and well-being, but considerable evidence now suggests that what happens during fetal development may well impact health and well-being into adulthood. Consequently, a thorough understanding of the developmental events that occur between conception and delivery is needed. For obvious ethical reasons, many of the questions remaining about the progression of human pregnancy cannot be answered directly, necessitating the use of appropriate animal models. A variety of animal models exist for the study of both normal and compromised pregnancies, including laboratory rodents, non-human primates and domestic ruminants. While all of these animal models have merit, most suffer from the inability to repetitively sample from both the maternal and fetal side of the placenta, limiting their usefulness in the study of placental or fetal physiology under non-stressed in vivo conditions. No animal model truly recapitulates human pregnancy, yet the pregnant sheep has been used extensively to investigate maternal-fetal interactions. This is due in part to the ability to surgically place and maintain catheters in both the maternal and fetal vasculature, allowing repeated sampling from non-anesthetized pregnancies. Considerable insight has been gained on placental oxygen and nutrient transfer and utilization from use of pregnant sheep. These findings were often confirmed in human pregnancies once appropriate technologies became available. The purpose of this review is to provide an overview of human and sheep pregnancy, with emphasis placed on placental development and function as an organ of nutrient transfer.

Coherent synthesis using carrier-envelope phase-controlled pulses from a dual-color femtosecond optical parametric oscillator.

By using a dual-color femtosecond optical parametric oscillator (OPO), a coherent waveform was synthesized from two coresonant near-infrared signal pulses whose center wavelengths had a separation of 100 nm. Immediately after the OPO cavity the pulses had independent carrier-envelope phase-slip frequencies, and synthesis was achieved by shifting these frequencies using an acousto-optic modulator driven by an internally generated difference frequency. Soliton self-frequency shifted pulses from a photonic crystal fiber and a cross-correlation frequency-resolved optical gating (XFROG) measurement were used to analyze the result of the synthesis experiment and revealed that the synthesized waveform was a train of high-contrast 30 fs pulses.

Short burst oxygen therapy after activities of daily living in the home in chronic obstructive pulmonary disease.

BACKGROUND: Short burst oxygen therapy (SBOT) is widely prescribed in the UK with little evidence of benefit. A study was performed to examine whether SBOT benefits patients when undertaking normal activities at home among those who already use it. METHODS: Twenty-two patients with chronic obstructive pulmonary disease (COPD) were included in the study. All regularly used SBOT at home and claimed that it helps them. Each patient chose two daily living activities for which they used SBOT for relief of breathlessness. Patients were then randomised to use either an air or oxygen gas cylinder. At least 15 min later the same activity was performed using the other gas cylinder. The same process was then repeated for the second chosen activity. The main endpoints were subjective and objective times to recovery, analysed for each activity separately or taking the average over the two activities. A paired statistical analysis was performed. RESULTS: All patients used SBOT with nasal prongs after exercise. Using the average recovery time over two activities for each patient, the mean objective recovery time was 38 s lower (95% CI -81 to +5) using oxygen and the mean subjective recovery time was 34 s lower (95% CI -69 to +2). Five patients were correctly able to distinguish oxygen from air after both activities and there was a suggestion that their recovery times were shorter than those who did not correctly identify the gases (91 s vs 20 s using objective recovery times, and 80 s vs 22 s using subjective recovery times), although this was a subgroup analysis based on only five patients with non-significant results. CONCLUSIONS: There is some evidence that SBOT shortens recovery time after activities of daily living in a selected group of patients with COPD, but the effect is small. There appears to be a subgroup of patients who may benefit to a much greater degree.

Testing the energy conservation law in an optical parametric oscillator using phase-controlled femtosecond pulses.

An experimental verification of energy conservation in a parametric oscillator is reported with an optical frequency precision of approximately 200 kHz (< 10(-6) nm). This high precision is made possible by simultaneously measuring the frequency offsets of the pump, signal and idler frequency combs in a singly-resonant femtosecond optical parametric oscillator system.

Refractive outcomes after cataract surgery with primary lens implantation in infants.

AIMS: To show the refractive outcomes, accuracy of intraocular lens power selection, and visual outcomes and complications in infants undergoing cataract surgery. METHODS: The refraction (spherical equivalent) of 14 operated eyes in 8 children aged <1 year was plotted over time. Preoperative and final recorded visual acuities were assessed. RESULTS: The median follow-up was 37.25 months. The median initial postoperative refraction was (+)6.75 dioptres. CONCLUSIONS: Refractive outcomes for each eye were not entirely predictable and were variable between infants. However, there was a consistent pattern in each infant who underwent bilateral surgery, with both eyes following a similar pattern of refractive change with time: a decreasing myopic shift was seen in 8 eyes, possibly demonstrating emmetropisation. The two unilateral cases appeared to show a linear myopic shift. 4 eyes in 2 patients did not follow a myopic shift curve and one of these patients showed an early trend towards increased hyperopia. Definite causes for this erratic refractive change were not identified. A postoperative refraction >4.5 dioptres avoided early onset myopia. The range of difference between postoperative and predicted refraction using SRK-T was (-)2.85 to 2.97 dioptres. Most of the visual results are encouraging compared with historical data in older children.

Dual-color operation of a femtosecond optical parametric oscillator exhibiting stable relative carrier-envelope phase-slip frequencies.

A femtosecond optical parametric oscillator is demonstrated that can operate in a regime where two signal pulses with well-separated center wavelengths are simultaneously resonant. Measurements show that the oscillator output contains a stable modulation at a frequency corresponding to the difference in the carrier-envelope phase-slip frequencies of the co-resonant pulses. The physical origin of this internal beat signal is attributed to second-order mixing effects, and its frequency is shown to be consistent with theory.

X-ray diffraction testing for weak-binding crossbridges in relaxed bony fish muscle fibres at low ionic strength.

Equatorial X-ray diffraction patterns from single skinned fibres from bony fish muscle (turbot) were obtained with the fibres at 6 degrees C bathed in relaxing solutions of 170 down to 26 mM ionic strength. Diffraction patterns from rigor fibres were also obtained as controls. Unlike fibres from rabbit muscle, which show very clear evidence of substantial crossbridge formation at low ionic strength in what is mechanically a rapid equilibrium ("weak-binding") state (Brenner et al., 1982), diffraction patterns from bony fish fibres showed only a small change in relative peak intensities at low ionic strength (26 mM) compared with normal (170 mM) ionic strength. However, there was a slight ordering of the filament lattice at low ionic strength. The specimen temperature used (about 6 degrees C) was not far from the normal physiological temperature of the fish. Likewise, only a small change was seen by Xu et al. (1987) in patterns from frog fibres at low ionic strength at 2 to 6 degrees C. (Rabbit fibres previously studied, where large changes were seen at temperatures of 5 to 20 degrees C, were about 17 to 32 degrees C below physiological.) The I11/I10 ratio for fish fibres at 26 mM ionic strength was actually lower than that for rabbit even at normal ionic strength. This may be associated with an intrinsic structural difference between these muscles or alternatively with the disordering of the crossbridge helix in rabbit muscle found at low temperature by Wray (1987), and could support the view that rabbit fibres at 5 degrees C and normal ionic strength may already have a significant population of weak-binding crossbridges.