Bronchiolitis Simulation Module in the Pediatric Preclerkship Educational Exercises (PRECEDE) Curriculum.

Introduction: Acute bronchiolitis is a viral infection infecting 90% of children under the age of 2 years, with approximately 200,000 deaths per year. The current standard of care remains largely respiratory support and prevention. Therefore, understanding how to assess and escalate respiratory supportive care is paramount for health care providers taking care of children.

Diabetic ketoacidosis after the treatment of anaphylaxis.

Summary: Anaphylaxis is a rapidly progressive potentially lethal condition, and epinephrine is the most crucial medication in its treatment. In this study, we present a case of diabetic ketoacidosis in a young woman that was precipitated by the administration of epinephrine to treat anaphylaxis. This patient had diabetes mellitus and poor glycemic control and developed ketoacidosis despite having evidence of ongoing endogenous insulin production and having been treated with exogenous long-acting insulin less than 24 h prior to the event.

The Structured Oral Examination: A Method to Improve Formative Assessment of Fellows in Pediatric Endocrinology.

Objective: A structured oral exam (SOE) can be utilized as a formative assessment to provide high-quality formative feedback to trainees, but has not been adequately studied in graduate medical education. We obtained fellow and faculty perspectives on: 1) educational effectiveness, 2) feasibility/acceptability, and 3) time/cost of a SOE for formative feedback.

Methods: Four pediatric endocrinology cases were developed and peer-reviewed to generate a SOE.

Otitis Media Module in the Pediatric Preclerkship Educational Exercises (PRECEDE) Curriculum.

Introduction: The Johns Hopkins Pediatrics Clerkship developed the PRECEDE (preclerkship educational exercises) curriculum with the primary goal of offering students formative instruction in essential pediatric clinical skills to prepare them for their clerkship. PRECEDE sessions occur at the beginning of each basic clerkship for new clinical clerkship students. The otitis media module is one in a series of modules presented in the curriculum and consists of a lecture and four short skills-development stations, each with a faculty facilitator.

Growth Module in the Pediatric Preclerkship Educational Exercises (PRECEDE) Curriculum.

Introduction: The Johns Hopkins Pediatrics Clerkship developed this growth module as part of the PRECEDE (preclerkship educational exercises) curriculum, with the primary goal of providing students with experiential, explicit, and standardized instruction in essential pediatric clinical skills to better prepare them to utilize these skills during their clerkship.

Methods: This 2-hour growth module begins with a 45-minute didactic overview of growth, including discussion of normal growth, normal variants of growth, and disorders that affect growth, and contains interactive elements to engage the students. Students then divide into groups of four to six, each with a faculty facilitator to work through three cases in a guided discussion to explore specific aspects of growth that may be encountered in a pediatric evaluation.

Dexmedetomidine infusion associated with transient adrenal insufficiency in a pediatric patient: a case report.

Dexmedetomidine is a highly selective α 2-adrenoceptor agonist used for sedation due to its anxiolytic and analgesic properties without respiratory compromise. Due to its structural similarity to etomidate, there has been concern that dexmedetomidine may cause adrenal insufficiency. This concern was initially supported by animal studies, but subsequent human studies demonstrated mixed results.

Electron-mediated ferromagnetic behavior in CoO/ZnO multilayers.

CoO/Al-doped ZnO (AZO) multilayers exhibit ferromagnetism up to ~300 K. The magnetic behavior oscillates with odd vs even number of Co layers in the insulating antiferromagnetic CoO and (separately) with the thickness of the AZO layers and vanishes if AZO is replaced by intrinsic ZnO. Magnetization is due to uncompensated (111) ferromagnetic planes of insulating CoO for odd numbers of atomic planes per layer that are coupled together via RKKY exchange mediated by electron carriers in the nonmagnetic AZO layers.

Thermodynamic measurements of Fe-Rh alloys.

FeRh undergoes an unusual antiferromagnetic-to-ferromagnetic (AFM-FM) transition just above room temperature (T(AFM>FM)) that can be tuned or even completely suppressed with small changes in composition. The underlying temperature-dependent entropy difference between the competing AFM and FM states that drives this transition is measured by specific heat as a function of temperature from 2 to 380 K on two nearly equiatomic epitaxial Fe-Rh films, one with a ferromagnetic ground state (Fe-rich) and the other with an antiferromagnetic ground state (Rh-rich). The FM state shows an excess heat capacity near 100 K associated with magnetic excitations that are not present in the AFM state.

Fe spin reorientation across the metamagnetic transition in strained FeRh thin films.

A spin reorientation accompanying the temperature-induced antiferromagnetic (AFM) to ferromagnetic (FM) phase transition is reported in strained epitaxial FeRh thin films. (57)Fe conversion electron Mössbauer spectrometry showed that the Fe moments have different orientations in FeRh grown on thick single-crystalline MgO and in FeRh grown on ion-beam-assist-deposited (IBAD) MgO. It was also observed, in both samples, that the Fe moments switch orientations at the AFM to FM phase transition.

Electronic structure changes across the metamagnetic transition in FeRh via hard X-ray photoemission.

Stoichiometric FeRh undergoes a temperature-induced antiferromagnetic (AFM) to ferromagnetic (FM) transition at ~350 K. In this Letter, changes in the electronic structure accompanying this transition are investigated in epitaxial FeRh thin films via bulk-sensitive valence-band and core-level hard x-ray photoelectron spectroscopy with a photon energy of 5.95 keV.

Heat transfer simulation and thermal measurements of microfabricated x-ray transparent heater stages.

A microfabricated amorphous silicon nitride membrane-based nanocalorimeter is proposed to be suitable for an x-ray transparent sample platform with low power heating and built-in temperature sensing. In this work, thermal characterization in both air and vacuum are analyzed experimentally and via simulation. Infrared microscopy and thermoreflectance microscopy are used for thermal imaging of the sample area in air.

Calorimetry of epitaxial thin films.

Thin film growth allows for the manipulation of material on the nanoscale, making possible the creation of metastable phases not seen in the bulk. Heat capacity provides a direct way of measuring thermodynamic properties of these new materials, but traditional bulk calorimetric techniques are inappropriate for such a small amount of material. Microcalorimetry and nanocalorimetry techniques exist for the measurements of thin films but rely on an amorphous membrane platform, limiting the types of films which can be measured.

Cyclophosphamide for rapid-onset obesity, hypothalamic dysfunction, hypoventilation, and autonomic dysregulation syndrome.

Patients with rapid-onset obesity, hypothalamic dysfunction, hypoventilation, autonomic dysregulation, and neural crest tumor syndrome have poor long-term outcomes. We report a patient who was treated successfully with high-dose cyclophosphamide immunoablation. This experience offers a novel therapeutic approach and an indirect insight into the underlying pathogenesis of this syndrome.

Type 2 diabetes mellitus in children and adolescents.

The rising prevalence of obesity in the United States has resulted in an increased incidence of T2DM in children and adolescents. T2DM now accounts for up to 45% of new cases of diabetes in the pediatric population. Many new medications have been developed for the treatment of T2DM, although few have been investigated in children.

Management of diabetic ketoacidosis in children and adolescents.

* Based on some research evidence, DKA is a significant contributor to morbidity and mortality in children who have type 1 diabetes, and cerebral edema is responsible for most of the deaths during DKA in children. (Dunger, 2004). * Based on strong research evidence, treatment of DKA requires replacement of water and electrolytes and correction of the insulin deficiency.

Thermodynamic measurements of submilligram bulk samples using a membrane-based "calorimeter on a chip".

Calorimetry offers a direct measurement of thermodynamic properties of materials, including information on the energetics of phase transitions. Many materials can only be prepared in thin film or small crystal (submilligram) form, negating the use of traditional bulk techniques. The use of micromachined, membrane-based calorimeters for submilligram bulk samples is detailed here.

Adipocyte gene expression is altered in formerly obese mice and as a function of diet composition.

In the development of obesity, the source of excess energy may influence appetite and metabolism. To determine the effects of differences in diet composition in obesity, mice were fed either a high-carbohydrate diet (HC; 10% fat energy) or a high-fat energy-restricted diet (HFR; 60% fat energy) over 18 wk in weight-matched groups of mice. To identify obesity-associated genes with persistently altered expression following weight reduction, mice were fed either a standard low-fat diet (LF; 10% fat energy), an unrestricted high-fat diet (HF; 60% fat energy), or a HF diet followed by weight reduction (WR).

Repression of GLUT4 expression by the endoplasmic reticulum stress response in 3T3-L1 adipocytes.

Expression of GLUT4 is decreased in adipocytes in obesity and type 2 diabetes, contributing to the insulin resistance of these states. Recent investigations suggest a role for activation of the ER stress response in the pathophysiology of type 2 diabetes. We investigated activation of the ER stress response in 3T3-L1 adipocytes.

Application of calorimetry on a chip to high-pressure materials.

Silicon micromachined calorimeters ("calorimeter on a chip") are used to measure heat capacities and phase transition enthalpies for thin film, single crystal, and powder samples (5-500 mug). The technology is thus compatible with the small samples produced in multianvil and large diamond anvil cells. Techniques for handling small samples and attaching them to the calorimetric devices have been developed.

Reduction in Gsalpha induces osteogenic differentiation in human mesenchymal stem cells.

We hypothesized that a decrease in Gsalpha expression occurs with osteogenic differentiation and that when Gsalpha expression was decreased by antisense oligonucleotides or direct inhibition of protein kinase A there was a concomitant increase in Runx2/Cbfa1. We also investigated the mechanism involved in the change in Runx2/Cbfa1 levels and whether the expression of other genes known to be involved in bone formation was altered. There was a decrease in Gsalpha expression with osteogenic differentiation and antisense oligonucleotides, and protein kinase A inhibition led to increased expression and DNA binding of the osteoblast-specific Runx2/Cbfa1.

GLUT4 expression in 3T3-L1 adipocytes is repressed by proteasome inhibition, but not by inhibition of calpains.

Because of recent studies showing linkage of type 2 diabetes with the calpain 10 gene, we investigated the ability of calpains to regulate GLUT4 expression in 3T3-L1 adipocytes. Treatment of 3T3-L1 adipocytes with the calpain inhibitor ALLN significantly decreased the mRNA and protein expression of GLUT4. GLUT4 expression was not affected by treatment with the more selective calpain inhibitors PD150606, calpeptin, or a calpastatin peptide.

Olanzapine-induced diabetes in a seven-year-old boy.

The atypical antipsychotics have been recognized to induce diabetes mellitus and ketoacidosis in the adult psychiatric population. This report notes the onset of weight gain, diabetes, and apparent ketosis in a prepubertal boy diagnosed with bipolar disorder and treated with olanzapine. The hyperglycemia rapidly normalized after discontinuation of the olanzapine.

Nuclear factor 1 regulates adipose tissue-specific expression in the mouse GLUT4 gene.

Previous studies demonstrated that an adipose tissue-specific element(s) (ASE) of the murine GLUT4 gene is located between -551 and -506 in the 5'-flanking sequence and that a high-fat responsive element(s) for down-regulation of the GLUT4 gene is located between bases -701 and -552. A binding site for nuclear factor 1 (NF1), that mediates insulin and cAMP-induced repression of GLUT4 in 3T3-L1 adipocytes is located between bases -700 and -688. To examine the role of NF1 in the regulation of GLUT4 gene expression in white adipose tissues (WAT) in vivo, we created two types of transgenic mice harboring mutated either 5' or 3' half-site of NF1-binding sites in GLUT4 minigene constructs.