Pediatric Resuscitation: Evaluation of a Clinical Curriculum

Objective: To assess the impact of a 6-hour pediatric resuscitation curriculum on the comfort levels of resident physicians’ evaluation and treatment of critically ill pediatric patients. Methods: An evaluation instrument assessed resident comfort levels, measured on a seven digit Likert scale ranging from significantly uncomfortable to significantly comfortable, in 13 areas of pediatric resuscitation. To complete the curriculum, residents had to demonstrate proficiency in knowledge and procedural skills during mock resuscitation scenarios and on both written and oral examinations. Results: Thirty-one residents participated in the study: 51.6% were pediatric, 12.9% were medicine/pediatric and 35.5% were emergency medicine residents. Participants in the curriculum had little previous experience with pediatric resuscitation (83% had been involved in five or fewer pediatric resuscitations). In all 13 areas of pediatric resuscitation tested, residents reported improvement in comfort levels following the course (p<0.002; Wilcoxon Signed Rank Tests). The most significant changes were observed for the following items: resuscitation of pulseless arrest, performance of cardioversion and defibrillation, performance of intraosseous needle insertion, and drug selection and dosing for rapid sequence intubation. Fewer than 48% of learners rated themselves as comfortable in these areas prior to training, but after completion, more than 80% rated themselves in the comfortable range. All residents but one received passing scores on their written examinations (97%). During the mock resuscitation scenarios and oral examination, 100% of the residents were assessed to have ‘completely’ met the learning objectives and critical actions Conclusion: Implementation of a pediatric resuscitation curriculum improves pediatric and emergency medicine residents’ comfort with the evaluation and treatment of critically ill pediatric patients. This curriculum can be used in residency training to document the acquisition of core competencies, knowledge and procedural skills needed for the evaluation and treatment of the critically ill child. The results reported in this study support using this model of instructional design to implement educational strategies, which will meet the requirements of graduate education

Sums and differences of correlated random sets

Many fundamental questions in additive number theory (such as Goldbach's conjecture, Fermat's last theorem, and the Twin Primes conjecture) can be expressed in the language of sum and difference sets. As a typical pair of elements contributes one sum and two differences, we expect that $|A-A| > |A+A|$ for a finite set $A$. However, in 2006 Martin and O'Bryant showed that a positive proportion of subsets of $\{0, \dots, n\}$ are sum-dominant, and Zhao later showed that this proportion converges to a positive limit as $n \to \infty$. Related problems, such as constructing explicit families of sum-dominant sets, computing the value of the limiting proportion, and investigating the behavior as the probability of including a given element in $A$ to go to zero, have been analyzed extensively. We consider many of these problems in a more general setting. Instead of just one set $A$, we study sums and differences of pairs of \emph{correlated} sets $(A,B)$. Specifically, we place each element $a \in \{0,\dots, n\}$ in $A$ with probability $p$, while $a$ goes in $B$ with probability $\rho_1$ if $a \in A$ and probability $\rho_2$ if $a \not \in A$. If $|A+B| > |(A-B) \cup (B-A)|$, we call the pair $(A,B)$ a \emph{sum-dominant $(p,\rho_1, \rho_2)$-pair}. We prove that for any fixed $\vec{\rho}=(p, \rho_1, \rho_2)$ in $(0,1)^3$, $(A,B)$ is a sum-dominant $(p,\rho_1, \rho_2)$-pair with positive probability, and show that this probability approaches a limit $P(\vec{\rho})$. Furthermore, we show that the limit function $P(\vec{\rho})$ is continuous. We also investigate what happens as $p$ decays with $n$, generalizing results of Hegarty-Miller on phase transitions. Finally, we find the smallest sizes of MSTD pairs.Comment: Version 1.0, 19 pages. Keywords: More Sum Than Difference sets, correlated random variables, phase transitio

Sets Characterized by Missing Sums and Differences in Dilating Polytopes

A sum-dominant set is a finite set $A$ of integers such that $|A+A| > |A-A|$. As a typical pair of elements contributes one sum and two differences, we expect sum-dominant sets to be rare in some sense. In 2006, however, Martin and O'Bryant showed that the proportion of sum-dominant subsets of $\{0,\dots,n\}$ is bounded below by a positive constant as $n\to\infty$. Hegarty then extended their work and showed that for any prescribed $s,d\in\mathbb{N}_0$, the proportion $\rho^{s,d}_n$ of subsets of $\{0,\dots,n\}$ that are missing exactly $s$ sums in $\{0,\dots,2n\}$ and exactly $2d$ differences in $\{-n,\dots,n\}$ also remains positive in the limit. We consider the following question: are such sets, characterized by their sums and differences, similarly ubiquitous in higher dimensional spaces? We generalize the integers in a growing interval to the lattice points in a dilating polytope. Specifically, let $P$ be a polytope in $\mathbb{R}^D$ with vertices in $\mathbb{Z}^D$, and let $\rho_n^{s,d}$ now denote the proportion of subsets of $L(nP)$ that are missing exactly $s$ sums in $L(nP)+L(nP)$ and exactly $2d$ differences in $L(nP)-L(nP)$. As it turns out, the geometry of $P$ has a significant effect on the limiting behavior of $\rho_n^{s,d}$. We define a geometric characteristic of polytopes called local point symmetry, and show that $\rho_n^{s,d}$ is bounded below by a positive constant as $n\to\infty$ if and only if $P$ is locally point symmetric. We further show that the proportion of subsets in $L(nP)$ that are missing exactly $s$ sums and at least $2d$ differences remains positive in the limit, independent of the geometry of $P$. A direct corollary of these results is that if $P$ is additionally point symmetric, the proportion of sum-dominant subsets of $L(nP)$ also remains positive in the limit.Comment: Version 1.1, 23 pages, 7 pages, fixed some typo