Designing a pediatric emergency triage and action program

BACKGROUND In Japan, non-pediatricians face many instances in which they must see children, partly due to the uneven distribution of pediatricians among urban and rural areas. We aimed to develop and examine the effect of a model simulation-based training program in pediatric primary care for non-pediatric medical and ancillary personnel who express misgivings about seeing pediatric patients in an emergency setting due to their perception of their lack of training in this area.METHODS We instituted a series of workshops on common pediatric emergency situations, first with physicians, and later also including ancillary personnel, as a form of interprofessional education. The entire program was constructed around Design-based Research.RESULTS Feedback from attendees and facilitators was mostly positive, leading us to open the workshops to ancillary personnel.CONCLUSIONS From a training point of view, this epistemological investigation was successful in mitigating anxieties in individuals about seeing pediatric emergency patients. The effects on patient care remain to be studied.

B’more Healthy Corner Stores for Moms and Kids: Identifying Optimal Behavioral Economic Strategies to Increase WIC Redemptions in Small Urban Corner Stores

Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) redemption rates have been declining in many low-income urban settings, potentially related to aspects of the food environment. B’more Healthy Corner Stores for Moms and Kids was a feasibility trial in Baltimore City that aimed to test multiple behavioral economic (BE) strategies in 10 corner stores (intervention = eight stores, comparison = two stores), to evaluate their influence on the stocking and redemptions of WIC foods. Tested strategies included in-person storeowner training, point of purchase promotion, product placement, and grouping of products in a display. All four strategies were feasible and implemented with high reach, dose delivered, and fidelity. Additionally, text messaging was found to be an acceptable form of intervention reinforcement for storeowners. Analyses to assess change in stocking of WIC foods, total sales of WIC foods, and sales of WIC foods to WIC clients, revealed consistent positive changes after implementation of the store owner training strategy, while changes after the implementation of other strategies were mixed. Furthermore, WIC food sales to WIC clients significantly increased after the simultaneous implementation of two strategies, compared to one (p > 0.05). Results suggest that store owner training was the most influential strategy and that the implementation of more BE strategies does not necessarily lead to proportional increases in stocking and sales. Selected BE strategies appear to be an effective way of increasing stocking and sales of WIC foods in small urban food stores.

The influence of cytoflavin staged therapy on dynamics of laboratory values in professional athletes during first stage of preparation for the game season.

The observation program was attended by 50 professional hockey players, divided into 2 groups, respectively, teams (25 people).The participants of the main group received step therapy with cytoflavin: first intravenously drip 10 ml of the drug diluted in 200 ml of 5% glucose solution, for 10 days, then 2 tablets 2 times a day for 25 days. Pharmacological support of participants in the comparison group were excluded the preparations of succinic acid or other metabolic means. Laboratory parameters were evaluated in dynamics: before the training (point 1), in the middle of the preparatory stage (point 2) and 35 days after the start of training (after the entire course of step therapy) (point 3). According to the results of the study revealed that the parameters of red blood (number of red blood cells, hemoglobin level, average red blood cell volume, average hemoglobin content in the red blood cell (MCH), the average concentration of hemoglobin in the red blood cell (MCHC) were more stable against the background of the use of cytoflavin, and the values of aspartataminotransferase and creatinine decreased during the observation in the main group and increased in the comparison group so that at the point 3 level aspartataminotransferase (AST) in the main group became significantly lower than in the comparison group (p=0.039*), and the level of creatinine was equal at initially higher rate in the main group (p= 0.012*). MB - fraction of creatine phosphokinase (MB-CPK) in the blood decreased in the main group of athletes (in the evaluation test of Pillai p=0,004), did not significantly change in the comparison group. There were no significant differences in the indicators of cortisol and testosterone between the groups, although the level of cortisol decreased in the athletes of the main group, and testosterone - increased, while in the comparison group the situation was the opposite. By the end of the follow-up, a statistically significant decrease in lactate levels before and after training was revealed in the group of athletes taking cytoflavin.

Adaptive Surrogate Modeling for Multidisciplinary Reliability Analysis Under Time-Dependent Uncertainty

Multidisciplinary systems will remain in transient states when time-dependent interactions are present among the coupling variables. This brings significant challenges to time-dependent multidisciplinary system reliability analysis. This paper develops an adaptive surrogate modeling approach (ASMA) for multidisciplinary system reliability analysis under time-dependent uncertainty. The proposed framework consists of three modules, namely initialization, uncertainty propagation, and three-level global sensitivity analysis (GSA). The first two modules check the quality of the surrogate models and determine when and where we should refine the surrogate models. Approaches are then proposed to estimate the potential error of the failure probability estimate and determine the location of the new training point. In the third module (i.e. three-level GSA), a method is developed to decide which surrogate model to refine, through GSA at three different levels. These three modules are integrated together systematically and enable us to adaptively allocate the computational resources to refine different surrogate models in the system and thus achieve high accuracy and efficiency in time-dependent multidisciplinary system reliability analysis. Results of two numerical examples demonstrate the effectiveness of the proposed framework.

Distance Education And Learning: An Innovative Approach to Extending Workforce Training Capacity

The mission of the Region IV (R-IV) Public Health Training Center (PHTC), headquartered at the Rollins School of Public Health at Emory University in Atlanta, Georgia, is to develop and implement programming to train public health professionals in the U.S. Department of Health and Human Services Region IV. The emphasis on public health accreditation, as well as the reality of high personnel turnover and a workforce with little formal training, point to the need for PHTCs that provide workforce training. PHTCs use distance-based education to reach those in need of training by minimizing or eliminating cost and travel barriers. However, many experienced public health trainers who are able to provide effective and engaging trainings in person lack the knowledge and skills necessary to adapt existing curricula to a distance format. Distance Education And Learning (DEAL) is an online course designed by the R-IV PHTC to increase the capacity of public health trainers to teach in the distance learning environment. The course includes four 3-hour synchronous online sessions with additional asynchronous presession and intersession activity requirements. This article describes the development and implementation of the DEAL course, including how it is used by the R-IV PHTC to increase the number of public health trainers with the skills needed to develop and implement distance-based training, which thereby builds the training capacity within the region and addresses issues of sustainability.