Immediate repeat of a septic shock simulation: Nursing students’ lived experience

Background and objective: The COVID-19 pandemic has placed a significant increase for the need of high quality, high fidelity simulation practices to replace limited clinical experiences. Repetitive experiential practice is a training strategy used among professionals to bridge theoretical concepts to action. Furthermore, immediate repetitive experiential practice in a simulation environment is a novel approach that holds promise for learners to improve their response to critical conditions through increased faculty guided reflection. This study aimed to explore student attitudes regarding an immediate repeat of a simulation as a first step to explore training effectiveness.Methods: Students enrolled in a complex health baccalaureate nursing course participated in an immediate repeat of a septic shock simulation. An interpretive phenomenological approach was utilized to better understand undergraduate nursing students' lived experience of learning through a repeat septic shock simulation.Results: Three themes emerged: Appreciation of Knowledge, Awareness of Skill, and Awareness of Attitudes.Conclusions: Learners found an immediate repeat of the simulation a valuable teaching strategy. Participants described a growing sense of differentiating priorities when managing a patient in septic shock. The immediate repeat simulation was deemed impactful to the learners’ knowledge, skills, and attitudes. This is a viable option for educators to incorporate at a time when forced to utilize simulation experiences to replace limited clinical opportunities.

Microinstabilities and plasma waves at Near-Sun Solar Wind collisionless Shocks: Predictions for PSP and SO

<p><span>Microinstabilities and waves excited at perpendicular interplanetary shocks in the near-Sun solar wind are investigated by full particle-in-cell simulations. By analyzing the dispersion relation of fluctuating field components directly issued from the shock simulation, we obtain key findings concerning wave excitations at the shock front: (1) at the leading edge of the foot, two types of electrostatic (ES) waves are observed. The relative drift of the reflected ions versus the electrons triggers an electron cyclotron drift instability (ECDI) that excites the first ES wave. Because the bulk velocity of gyro-reflected ions shifts to the direction of the shock front, the resulting ES wave propagates obliquely to the shock normal. Immediately, a fraction of incident electrons are accelerated by this ES wave and a ring-like velocity distribution is generated. They can couple with the hot Maxwellian core and excite the second ES wave around the upper hybrid frequency. (2) From the middle of the foot all the way to the ramp, electrons can couple with both incident and reflected ions. ES waves excited by ECDI in different directions propagate across each other. Electromagnetic (EM) waves (X mode) emitted toward upstream are observed in both regions. They are probably induced by a small fraction of relativistic electrons. The impact of shock front rippling, Mach numbers, and dimensions on the ES wave excitation also will be discussed. Results shed new insight on the mechanism for the occurrence of ES wave excitations and possible EM wave emissions at young coronal mass ejection–driven shocks in the near-Sun solar wind.</span></p>

The effect of a repeat septic shock simulation on the knowledge and skill performance of undergraduate nursing students

Background: Prelicensure nursing students possess minimal knowledge and skill to implement sepsis protocols effectively. This article evaluates an educational project to assess the impact of a repeat septic shock simulation on pre-licensure nursing students' knowledge and skill competency. Methods: A quasi-experimental, repeated measures, pre-post design strategy was used to evaluate a repeat septic shock simulation. A convenience sample of one-hundred-forty-three (N = 143) senior baccalaureate nursing students enrolled in the study. The project consisted of a septic shock didactic session, septic shock simulation with a high-fidelity mannequin, debrief, repeat simulation followed by a second debrief as a component of a complex health nursing course. Ninety-seven (n = 97) participants were randomly assigned to groups of up to five students to participate in a repeat septic shock simulation. Forty-six (n = 46) participants were randomly assigned to up to five students and served as a control group. The control group participated in all study elements except the repeat simulation.Results: The percent change in nursing students’ knowledge scores from Pre-simulation to Post-simulation was statistically significant (p < .001). The initial and repeat simulation realized modest gains in competency scores between the initial and repeated simulation.Conclusions: Providing concurrent experiences using a screening tool in real-time while simultaneously providing an opportunity to practice and refine clinical judgment through a repeat simulation proved effective.

Improvement of Fracture Resistance Calculation Procedure for NPP Primary Equipment Components

The procedure of fracture resistance calculation for WWER primary equipment components has been improved. In particular, this refers to the reactor pressure vessel (RPV) and steam generators (SG) under normal operating conditions and emergencies. The developed calculation procedures and software make it possible to determine the significant effect of such factors as deformation stress history, residual technological heredity, analysis of temperature dependence of stress intensity factors for the postulated crack, regularity and density of the finite element mesh in the crack front on the assessment of WWER-1000 RPV fracture resistance. The paper proposes the methodology for justifying the place and orientation of the postulated crack to obtain the most conservative assessment of fracture resistance in the area of RPV inlet nozzles. It is shown that elastoplastic calculations in the thermal shock simulation can help to improve estimates of RPV strength and lifetime. It was established that not taking into account the elastoplastic deformation history, residual technological stresses after heat treatment and corrosion effects can result in non-conservative assessment of fracture resistance of coolant header welding to SG PGV-1000M shell under normal operating conditions and emergencies. The calculation methodology and software for assessing stress-strain state of in-vessel internals were improved taking into account state-of-the-art approaches to modeling of radiation-induced swelling deformations and dependence of metal mechanical peculiarities on exposure doses and temperature.

IBM POWER9 Systems, Shock Simulation and Testing Validation

At IBM Systems, developing reliable and robust designs of supercomputers is critical to IBM’s vision and continuing its leadership in our industry. Shorter development cycle time, increasingly dense product designs, along with advanced design features create real challenges in predicting structural performance of servers, such as the recently refreshed IBM Cognitive Systems’ POWER9 portfolio of servers. Both 4U and 2U versions have DDR4 RDIMM’s, POWER9 HLGA processor modules, PCIe Gen3 and Gen4 slots, blowers, hard drives, and internal storage controller slots. To meet IBM shipping standards to ensure POWER9 system’s reliability and design robustness, ANSYS Mechanical and LS-Dyna FEA models were developed and physical tests were conducted. The ability to apply accurate predictive engineering methods using simulation early in the design cycle predicted the structural performance of the servers and shortened its development time, reduced number of physical builds, and therefore, reduced development cost.

Shock Wave Characteristics of Hydraulic Shock Wave Simulator with Variable Damping

For simulating the shock wave with high peak force in a short duration, a novel variable damping hydraulic shock wave simulator was developed, and it was used for simulating the cannon recoil motion. The working principle of this simulator was explained with the assistance of established mathematical model and the flow behavior in damping channel was analyzed. The shock wave characteristics curves were obtained by using the numerical computation method. The results showed that the shock wave characteristics were directly related to the sectional area of the damping channel and the damping fluid medium characteristic; the shock wave curve can be simulated by adjusting the variable damping parameters. The computational results agreed well with the theory analysis, which meant that the proposed mathematical model can be used for supplying theoretical references for the cannon recoil motion in artillery fire shock simulation test.