Strategic Surge Responses in the COVID-19 era: Operational Themes, Innovative Solutions and Lessons Learned by Three Freestanding Pediatric Emergency Departments.

The prolonged COVID-19 pandemic has created unique and complex challenges in operational and capacity planning for pediatric emergency departments, as initial low pediatric patient volumes gave way to unpredictable patient surges during Delta and Omicron variants. Compounded by widespread hospital supply chain issues, staffing shortages due to infection and attrition, and a concurrent pediatric mental health crisis, the surges have pushed pediatric emergency department leaders to re-examine traditionally defined clinical processes, and adopt innovative operational strategies. This study describes the strategic surge response and lessons learned by 3 major freestanding academic pediatric emergency departments in the western United States to help inform current and future pediatric pandemic preparedness.

High purity Sc production using high-energy photons and natural vanadium targets.

Scandium-47 (Sc) is of high value for targeted radiotherapy and theranostics; we report a novel, cost-effective approach to produce high-purity Sc via photonuclear reactions with natural vanadium. Irradiation at 20 MeV photon end-point energy produces >99.998% pure Sc, while irradiation at 38 MeV produces 98.

Rapid Separation of Photofissioned Uranium Products via a Single-Pass Multiplexed Chromatographic Fission Product Separation System.

Current state-of-the-art fission product separations frequently involve multiple independent separation columns and sample manipulation processes; to couple these processes together, multiple evaporation and transposition steps are often required. The addition of these steps results in lengthy separation times, increased analysis costs, the potential for sample loss, and release of radioactive contamination. We report a new semiautomated method for the rapid separation of U, Zr, Mo, Ba, Sr, Te, and lanthanide fission products from irradiated uranium samples.

Guiding therapeutic plasma exchange for antibody-mediated rejection treatment in lung transplant recipients - a retrospective study.

Antibody-Mediated Rejection (AMR) due to donor-specific antibodies (DSA) is associated with poor outcomes after lung transplantation. Currently, there are no guidelines regarding the selection of treatment protocols. We studied how DSA characteristics including titers, C1q, and mean fluorescence intensity (MFI) values in undiluted and diluted sera may predict a response to therapeutic plasma exchange (TPE) and inform patient prognosis after treatment.

A Front-end Redesign With Implementation of a Novel "Intake" System to Improve Patient Flow in a Pediatric Emergency Department.

Introduction: Children's Hospital Colorado is an academic, tertiary-care Level 1 Trauma Center with an emergency department (ED) that treats >70,000 patients/year. Patient volumes continue to increase, leading to worsening wait times and left-without-being-seen (LWBS) rates. In 2015, the ED's median door-to-provider time was 49 minutes [interquartile range (IQR) = 26-90], with a 3.

Lung Transplant for the Critical Care Nurse.

Lung transplantation is an established treatment of select patients with end-stage pulmonary disease. Lung transplantation should be considered for patients with end-stage pulmonary disease who have an expected 2-year survival of less than 50% without lung transplant and an expected 5-year survival of greater than 80% after transplant. This article reviews routine postsurgical intensive care unit management, along with management of complications such as acute kidney injury, atrial arrhythmias, deep vein thrombosis, primary graft dysfunction, hyperammonemia syndrome, and thrombocytopenia.

Development of a Quality Improvement Curriculum in a Pediatric Emergency Medicine Fellowship.

Quality improvement (QI) is a science of systematic analysis and improvement of health care delivery systems. Working knowledge of QI models is imperative to professional development of future pediatric emergency medicine practitioners. The Accreditation Council for Graduate Medical Education has established a list of QI and patient safety expectations for trainees.

A composite position independent monitor of reactor fuel irradiation using Pu, Cs, and Ba isotope ratios.

When post-irradiation materials from the nuclear fuel cycle are released to the environment, certain isotopes of actinides and fission products carry signatures of irradiation history that can potentially aid a nuclear forensic investigation into the material's provenance. In this study, combinations of Pu, Cs, and Ba isotope ratios that produce position (in the reactor core) independent monitors of irradiation history in spent light water reactor fuel are identified and explored. These position independent monitors (PIMs) are modeled for various irradiation scenarios using automated depletion codes as well as ordinary differential equation solutions to approximate nuclear physics models.

High power narrow linewidth discrete mode laser diode integrated with a curved semiconductor optical amplifier emitting at 2051 nm.

We report on a 2.051 μm InGaAs/InP-based discrete mode laser diode monolithically integrated with a curved tapered semiconductor optical amplifier for CO sensing applications. At a heat-sink temperature of 0°C, the laser emits a record InP value of more than 35 mW continuous-wave output power in a single longitudinal mode.

A reference material for evaluation of Cs radiochronometric measurements.

A new nuclear forensic reference material has been characterized as a standard for radiochronometric determination of the model purification date for Cs sources. The purification date of a radioactive source is a potentially diagnostic nuclear forensic signature for determining the provenance of a radioactive material. Reference values have been measured for the attributes needed to use the Cs/Ba chronometer: the molality (reported here as nmol g) of Cs and of the radiogenic portion of Ba in the material (hereafter referred to as Ba*).

Synthesis and Crystal Structures of Volatile Neptunium(IV) β-Diketonates.

Production of certified reference materials in support of domestic nuclear forensics programs require volatile precursors for introduction into electromagnetic isotopic separation instruments. β-Diketone chelates of tetravalent actinides are known for their high volatility, but previously developed synthetic approaches require starting material (NpCl) that is prohibitively difficult and hazardous to prepare. An alternative strategy was developed here that uses controlled potential electrolysis to reduce neptunium to the tetravalent state in submolar concentrations of hydrochloric acid.

Extraction chromatographic separations of tantalum and tungsten from hafnium and complex matrix constituents.

Tantalum (Ta), hafnium (Hf), and tungsten (W) analyses from complex matrices require high purification of these analytes from each other and major/trace matrix constituents, however, current state-of-the-art Ta/Hf/W separations rely on traditional anion exchange approaches that show relatively similar distribution coefficient (Kd) values for each element. This work reports an assessment of three commercially available extraction chromatographic resins (TEVA, TRU, and UTEVA) for Ta/Hf/W separations. Batch contact studies show differences in Ta/Hf and Ta/W Kd values of up to 10 and 10 (respectively), representing an improvement of a factor of 100 and 300 in Ta/Hf and Ta/W Kd values (respectively) over AG1×4 resin.

Massive donor transfusion potentially increases recipient mortality after lung transplantation.

Objective: Donor blood transfusion has been identified as a potential risk factor for primary graft dysfunction and by extension early mortality. We sought to define the contributing risk of donor transfusion on early mortality for lung transplant.

Methods: Donor and recipient data were abstracted from the Organ Procurement and Transplantation Network database updated through June 30, 2014, which included 86,398 potential donors and 16,255 transplants.

Method to improve the noise figure and saturation power in multi-contact semiconductor optical amplifiers: simulation and experiment.

The consequences of tailoring the longitudinal carrier density along the active layer of a multi-contact bulk semiconductor optical amplifier (SOA) are investigated using a rate equation model. It is shown that both the noise figure and output power saturation can be optimized for a fixed total injected bias current. The simulation results are validated by comparison with experiment using a multi-contact SOA.

Impact of bias current distribution on the noise figure and power saturation of a multicontact semiconductor optical amplifier.

We present an experimental investigation of a multicontact semiconductor optical amplifier. This first-generation device allows for direct control of the carrier density profile along the length of the waveguide. This is used to control the device noise figure, with a minimum value of 5 dB observed at a gain of 15 dB for an optimum carrier density profile.

Relationship of race to sudden cardiac death in competitive athletes with hypertrophic cardiomyopathy.

Objectives: The goal of this study was to determine the impact of race on identification of hypertrophic cardiomyopathy (HCM).

Background: Sudden death in young competitive athletes is due to a variety of cardiovascular diseases (CVDs) and, most commonly, HCM. These catastrophes have become an important issue for African Americans, although HCM has been previously regarded as rare in this segment of the U.