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To determine whether a brief leadership curriculum including high-fidelity simulation can improve leadership skills among resident physicians.This was a double-blind, randomized controlled trial among obstetrics-gynecology and emergency medicine (EM) residents across 5 academic medical centers from different geographic areas of the United States, 2015-2017. Participants were assigned to 1 of 3 study arms: the Leadership Education Advanced During Simulation (LEADS) curriculum, a shortened Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) curriculum, or as active controls (no leadership curriculum). Active controls were recruited from a separate site and not randomized to limit any unintentional introduction of materials from leadership curricula. The LEADS curriculum was developed in partnership with the Council on Resident Education in Obstetrics and Gynecology and Council of Residency Directors in Emergency Medicine as a novel way to provide a leadership toolkit. Both LEADS and the abbreviated TeamSTEPPS were designed as six 10-minute interactive web-based modules.The primary outcome of interest was the leadership performance score from the validated Clinical Teamwork Scale instrument measured during standardized high-fidelity simulation scenarios. Secondary outcomes were 9 key components of leadership from the detailed leadership evaluation measured on 5-point Likert scales. Both outcomes were rated by a blinded clinical video reviewer.One hundred ten obstetrics-gynecology and EM residents participated in this 2-year trial. Participants in both LEADS and TeamSTEPPS had statistically significant improvement in leadership scores from "average" to "good" ranges both immediately and at the 6-month follow-up, while controls remained unchanged in the "average" category throughout the study. There were no differences between LEADS and TeamSTEPPS curricula with respect to the primary outcome.Residents who participated in a brief structured leadership training intervention had improved leadership skills that were maintained at 6-month follow-up.

Neurodegenerative lysosomal storage disorders (LSDs) are severe and untreatable, and mechanisms underlying cellular dysfunction are poorly understood. We found that toxic lipids relevant to three different LSDs disrupt multiple lysosomal and other cellular functions. Unbiased drug discovery revealed several structurally distinct protective compounds, approved for other uses, that prevent lysosomal and cellular toxicities of these lipids. Toxic lipids and protective agents show unexpected convergence on control of lysosomal pH and re-acidification as a critical component of toxicity and protection. In twitcher mice (a model of Krabbe disease [KD]), a central nervous system (CNS)-penetrant protective agent rescued myelin and oligodendrocyte (OL) progenitors, improved motor behavior, and extended lifespan. Our studies reveal shared principles relevant to several LSDs, in which diverse cellular and biochemical disruptions appear to be secondary to disruption of lysosomal pH regulation by specific lipids. These studies also provide novel protective strategies that confer therapeutic benefits in a mouse model of a severe LSD., Different structurally related lipids from three genetically distinct lysosomal storage disorders are sufficient to cause multiple dysfunctions that converge on disruption of lysosomal pH as a core pathogenic mechanism., Author Summary Neurodegenerative lysosomal storage disorders (LSDs) are severe and untreatable recessive genetic disorders that cause devastating damage to the nervous system. These diseases exhibit severe disruption of lysosomes (a cellular organelle that breaks down lipids and proteins) and other aspects of cell function. However, the means by which mutations cause these dysfunctions are poorly understood. By studying different lipids that accumulate in three different LSDs, we found that lipids with specific shared structures are sufficient to cause multiple lysosomal and cellular dysfunctions, including an abnormal alkalization of the lysosomal pH. We prevented all of these dysfunctions by promoting lysosomal re-acidification and discovered several drugs—already approved for other purposes—with unexpected abilities to restore lysosomal pH and rescue cells. In a genetic mouse model of a severe LSD, one of these compounds decreased tissue damage, improved quality of life, and extended survival. In contrast with previous studies on individual disorders, our study provides novel shared principles relevant to several LSDs and uncovers relevant compounds able to provide multiple benefits in a disease-relevant model in vivo.

The American Academy of Pediatrics and the American Academy of Family Physicians believe that infants, children, and adolescents benefit from having a medical home, characterized by accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective care. Several studies suggest that patients with asthma benefit from having a medical home. However, no national study has been conducted examining the relationships between having a medical home and asthma control in school-aged children with asthma. The purpose of this study was to examine the hypothesis that having an adequate medical home is protective against uncontrolled asthma in children.To test this hypothesis, cross-sectional data from the 2003-2004 National Survey of Children's Health were analyzed. Analyses entailed creating the variables "medical home" as well as "uncontrolled asthma" from multiple variables. Multivariate analysis was performed using children with uncontrolled asthma as the dependent variable.The logistic regression model performed yielded that school-aged children with uncontrolled asthma were more likely to: speak a primary language other than English (OR, 1.069; 95% CI, 1.045-1.093); live in households with incomes100% of the federal poverty level (FPL) (OR, 1.826; 95% CI, 1.810-1.842); not have health insurance (OR, 2.296; 95% CI, 2.263-2.330); live in rural rather than metropolitan areas (OR, 1.275; 95% CI, 1.262-1.287); and be non-Caucasian (OR, 2.067; 95% CI, 2.050-2.085). Multivariate analysis also yielded that children with uncontrolled asthma were more likely to have a medical home (OR, 1.138; 95% CI, 1.128-1.148).After controlling for possible confounding variables, this study did not detect an association between having a medical home and asthma control for children with asthma aged 5 to 17 years. Additional research should examine the relationship between variables, such as poverty, place of residence, health insurance status, and the medical home, not only in the instance of uncontrolled asthma, but for other childhood health conditions.

Background A patient with a suspected cervical spine injury may be at risk for secondary neurologic injury when initially placed and repositioned to the center of the spine board. Objectives We sought to determine which centering adjustment best limits cervical spine movement and minimizes the chance for secondary injury. Methods Using five lightly embalmed cadaveric specimens with a created global instability at C5–C6, motion sensors were anchored to the anterior surface of the vertebral bodies. Three repositioning methods were used to center the cadavers on the spine board: horizontal slide, diagonal slide, and V-adjustment. An electromagnetic tracking device measured angular (degrees) and translation (millimeters) motions at the C5–C6 level during each of the three centering adjustments. The dependent variables were angular motion (flexion-extension, axial rotation, lateral flexion) and translational displacement (anteroposterior, axial, and medial-lateral). Results The nonuniform condition produced significantly less flexion-extension than the uniform condition ( p = 0.048). The horizontal slide adjustment produced less cervical flexion-extension ( p = 0.015), lateral bending ( p = 0.003), and axial rotation ( p = 0.034) than the V-adjustment. Similarly, translation was significantly less with the horizontal adjustment than with the V-adjustment; medial-lateral ( p = 0.017), axial ( p p = 0.006). Conclusions Of the three adjustments, our team found that horizontal slide was also easier to complete than the other methods. The horizontal slide best limited cervical spine motion and may be the most helpful for minimizing secondary injury based on the study findings.

Although it is essential to maintain a secure airway in a trauma patient, it is also critical to protect the potentially injured cervical spine. It has previously been suggested that the jaw thrust maneuver be used in place of the head tilt-chin lift in the suspected spine-injured patient.We sought to examine whether the jaw thrust was in fact safer to use in the setting of an unstable upper cervical spine injury.Unstable, dissociative C1-C2 injuries were surgically created in nine fresh, lightly embalmed human cadaver specimens. An electromagnetic motion analysis device was used to assess the amount of angular and linear motion with sensors placed above and below the injured segment. Measurements were recorded during execution of the two airway maneuvers. Trials were performed both with and without a cervical immobilization collar in place.There was almost twice as much angular motion in all planes when performing a head tilt-chin lift as compared with the jaw thrust, and this was statistically significant (p.013). In addition, there was more displacement at the injured level with a head tilt-chin lift as compared with the jaw thrust. This was statistically significant for axial displacement and anteroposterior translation (p=.003 for both), and approached significance for mediolateral translation (p=.056).The jaw thrust maneuver results in less motion at an unstable C1-C2 injury as compared with the head tilt-chin lift maneuver. We therefore recommend the use of the jaw thrust to improve airway patency in the trauma patient with suspected cervical spine injury.