This is a revision of the previous joint Policy Statement titled "Guidelines for Care of Children in the Emergency Department." Children have unique physical and psychosocial needs that are ...heightened in the setting of serious or life-threatening emergencies. The majority of children who are ill and injured are brought to community hospital emergency departments (EDs) by virtue of proximity. It is therefore imperative that all EDs have the appropriate resources (medications, equipment, policies, and education) and capable staff to provide effective emergency care for children. In this Policy Statement, we outline the resources necessary for EDs to stand ready to care for children of all ages. These recommendations are consistent with the recommendations of the Institute of Medicine (now called the National Academy of Medicine) in its report "The Future of Emergency Care in the US Health System." Although resources within emergency and trauma care systems vary locally, regionally, and nationally, it is essential that ED staff, administrators, and medical directors seek to meet or exceed these recommendations to ensure that high-quality emergency care is available for all children. These updated recommendations are intended to serve as a resource for clinical and administrative leadership in EDs as they strive to improve their readiness for children of all ages.
Pediatric patients cared for in emergency departments (EDs) are at high risk of medication errors for a variety of reasons. A multidisciplinary panel was convened by the Emergency Medical Services ...for Children program and the American Academy of Pediatrics Committee on Pediatric Emergency Medicine to initiate a discussion on medication safety in the ED. Top opportunities identified to improve medication safety include using kilogram-only weight-based dosing, optimizing computerized physician order entry by using clinical decision support, developing a standard formulary for pediatric patients while limiting variability of medication concentrations, using pharmacist support within EDs, enhancing training of medical professionals, systematizing the dispensing and administration of medications within the ED, and addressing challenges for home medication administration before discharge.
Pediatric Readiness in the Emergency Department Remick, Katherine; Gausche-Hill, Marianne; Joseph, Madeline M. ...
Annals of emergency medicine,
December 2018, 2018-12-00, 20181201, Volume:
72, Issue:
6
Journal Article
ABSTRACTThis article provides recommendations for pediatric readiness, scope of services, competencies, staffing, emergency preparedness, and transfer of care coordination for urgent care centers ...(UCCs) and retail clinics that provide pediatric care. It also provides general recommendations for the use of telemedicine in these establishments. With continuing increases in wait times and overcrowding in the nationʼs emergency departments and the mounting challenges in obtaining timely access to primary care providers, a new trend is gaining momentum for the treatment of minor illness and injuries in the form of UCCs and retail clinics. As pediatric visits to these establishments increase, considerations should be made for the type of injury or illnesses that can be safely treated, the required level training and credentials of personnel needed, the proper equipment and resources to specifically care for children, and procedures for safe transfer to a higher level of care, when needed. When used appropriately, UCCs and retail clinics can be valuable and convenient patient care resources.
Background
Emergency care in the United States faces notable challenges with regard to children. In some jurisdictions, available resources are not sufficient to meet local needs. Physicians with ...specialty training in pediatric emergency care are largely concentrated in children's medical centers within larger urban areas. Rural emergency facilities, which are more likely to face ongoing staffing shortages in all specialties, are particularly deficient in pediatric emergency medicine (PEM) physicians. This paper addresses challenges in distribution of pediatric emergency care specialists into suburban and rural health care facilities, and proposes potential local and regional solutions to improve pediatric emergency care capabilities as well as to enhance disaster response in children.
Objectives
The American College of Emergency Physicians (ACEP) committee on PEM generated the objective to study and explore methods and strategies to address current challenges and shortcomings in the distribution of pediatric emergency physicians and to develop recommendations to improve access to emergency pediatric expertise in all care settings. A sub‐committee was formed to generate a written report followed by full committee input. The content was reviewed by the ACEP Board of Directors.
Discussion
Pediatric emergency physicians are certified either by the American Board of Emergency Medicine or the American Board of Pediatrics (ABP) depending on whether their training occurred through the emergency medicine or a pediatric residency program. ABP‐certified PEM that account for the majority of PEM physicians, remain largely concentrated in urban tertiary pediatric care centers, primarily children's hospitals. By contrast to the resources, the majority of pediatric patients receive emergency care in emergency departments (EDs) outside this setting. The goal of our recommendations is to help regionalize PEM expertise, allowing sharing of such resources with facilities that have traditionally not had access to PEM expertise. Financial or low number of pediatric cases likely contributed to lack of PEM resources in suburban and rural EDs, although a significant factor for lack of access to ABP‐certified PEM physicians may be local privilege and practice restrictions. Expanding the scope of practice for ABP‐certified PEM physicians beyond traditionally assigned arbitrary age limits to include selective adult patients has the potential to alleviate credentialing barriers and offset the financial and volume concerns while enhancing preparedness efforts, resource utilization, and access to specialized pediatric emergency care.
Conclusion
Recognition that the training of ABP‐certified PEM physicians allows for these individuals to safely care for selective adult patients with common disease patterns that extend beyond traditionally assigned arbitrary pediatric age limits has the potential to improve resource dissemination and utilization, allowing for greater access to pediatric emergency physicians in currently underserved settings.
Reviews the book, The Embers and the Stars: A Philosophical Inquiry into the Moral Sense of Nature by Erazim Kohák (1984). The books I read tend to be one of two kinds: stories or conceptual ...discourse. Only rarely do I come across a volume that speaks from the originary well-springs of this bifurcation; that intertwines a penetrating discussion of ideas with the evocative fullness of lived personal experience. Erazim Kohak has proffered such a work - one that is both intimate and intellectually challenging. Kohak's concern focuses on the alienation that has resulted from dwelling in a world in which nature has been largely replaced with our own technological constructs. Declining to either "condemn the works of technology or to extoll the virtues of a putative 'natural' life," his central question then becomes, "How, though, can we go about the task of recovering our vision of a living world and of our place as moral subjects therein?". Standing within the western philosophical tradition, Kohak attempts to articulate a response to this concern. Yet he also keeps faith with the spirit of his quest, remaining close to the refreshing impulse of the poet's awareness. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
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CEKLJ, FFLJ, NUK, ODKLJ, PEFLJ
SUMMARY Septoria nodorum blotch (SNB), caused by Parastagonospora nodorum, is a disease of durum and common wheat initiated by the recognition of pathogen‐produced necrotrophic effectors (NEs) by ...specific wheat genes. The wheat gene Snn1 was previously cloned, and it encodes a wall‐associated kinase that directly interacts with the NE SnTox1 leading to programmed cell death and ultimately the development of SNB. Here, sequence analysis of Snn1 from 114 accessions including diploid, tetraploid, and hexaploid wheat species revealed that some wheat lines possess two copies of Snn1 (designated Snn1‐B1 and Snn1‐B2 ) approximately 120 kb apart. Snn1‐B2 evolved relatively recently as a paralog of Snn1‐B1 , and both genes have undergone diversifying selection. Three point mutations associated with the formation of the first SnTox1‐sensitive Snn1‐B1 allele from a primitive wild wheat were identified. Four subsequent and independent SNPs, three in Snn1‐B1 and one in Snn1‐B2 , converted the sensitive alleles to insensitive forms. Protein modeling indicated these four mutations could abolish Snn1 –SnTox1 compatibility either through destabilization of the Snn1 protein or direct disruption of the protein–protein interaction. A high‐throughput marker was developed for the absent allele of Snn1 , and it was 100% accurate at predicting SnTox1‐insensitive lines in both durum and spring wheat. Results of this study increase our understanding of the evolution, diversity, and function of Snn1‐B1 and Snn1‐B2 genes and will be useful for marker‐assisted elimination of these genes for better host resistance.
Significance Statement Alleles of the wheat Snn1 gene that confer septoria nodorum blotch susceptibility through direct interaction with the pathogen‐produced necrotrophic effector SnTox1 arose through three point mutations and a gene duplication event, and four subsequent point mutations led to the formation of lack‐of‐function (resistance) alleles. Knowledge of the evolution, selection, and structural and functional nature of Snn1 alleles allowed for the development of an efficient marker‐based elimination assay for the development of disease resistant wheat.
Key message
Two stem rust resistance genes identified on chromosome arms 2BL and 6AL of the cultivated emmer wheat accession PI 193883 can be used for protecting modern varieties against Ug99 ...strains.
The wheat research community consistently strives to identify new genes that confer resistance to stem rust caused by the fungal pathogen
Puccinia graminis
f. sp
. tritici
Eriks & E. Henn (
Pgt
). In the current study, our objective was to identify and genetically characterize the stem rust resistance derived from the cultivated emmer accession PI 193883. A recombinant inbred line population developed from a cross between the susceptible durum wheat line Rusty and PI 193883 was genotyped and evaluated for reaction to
Pgt
races TTKSK, TRTTF, and TMLKC. Two QTLs conferring resistance were identified on chromosome arms 2BL (
QSr.fcu
-
2B
) and 6AL (
QSr.fcu
-
6A
). The stem rust resistance gene (
Sr883
-
2B
) underlying
QSr.fcu
-
2B
was recessive, and based on its physical location it is located proximal to the
Sr9
region.
QSr.fcu
-
6A
was located in the
Sr13
region, but PI 193883 is known to carry the susceptible haplotype S4 for
Sr13
, indicating that the gene underlying
QSr.fcu
-
6A
(
Sr883
-
6A
) is likely a new allele of
Sr13
or a gene residing close to
Sr13
. Three IWGSC scaffold-based simple sequence repeat (SSR) and two SNP-based semi-thermal asymmetric reverse PCR (STARP) markers were developed for the
Sr883
-
2B
region, and one STARP marker was developed for
Sr883
-
6A
.
Sr883
-
2B
was epistatic to
Sr883
-
6A
for reaction to TTKSK and TRTTF, and the two genes had additive effects for TMLKC. These two genes and the markers developed in this research provide additional resources and tools for the improvement in stem rust resistance in durum and common wheat breeding programs.
High-dose-rate (HDR) brachytherapy is an alternative treatment to electron external beam radiation therapy (EBRT) of superficial skin lesions. The purpose of this study was to establish the selection ...criteria for HDR brachytherapy technique (HDR-BT) and EBRT in cutaneous oncology for various clinical scenarios.
The study consists of two parts: a) EBRT and HDR-BT treatment plans comparison analyzing clinical target volumes (CTVs) with different geometries, field sizes, and topologies, and b) development of a prediction model capable of characterization of dose distributions in HDR surface brachytherapy for various geometries of treatment sites.
A loss of CTV coverage for the electron plans (D
, D
) was recorded up to 45%, when curvature of the applicator increased over 30°. Values for D2 cm
for both plans were comparable, and they were in range of ±8% of prescription dose. An increase in higher doses (D0.5 cm
and D0.1 cm
) was observed in HDR-BT plans, and it was greater for larger lesions. The average increase was 3.8% for D0.5 cm
and 12.3% for D0.1 cm
. When CTV was approximately flat, electron plans were comparable with HDR-BT plans, having lower average D2 cm
, D0.5 cm
, and D0.1 cm
of 7.7%. Degradation of quality of electron plans was found to be more dependent on target curvature than on CTV size.
Both EBRT and HDR-BT could be used in treatments of superficial lesions. HDR-BT revealed superior CTV coverage when the surface was very large, complex, curvy, or rounded, and when the topology was complicated. The prediction model can be used for an approximate calculation and quick assessment of radiation dose to organs-at-risk (OARs), at a depth or at a lateral distance from CTV.
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