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We present a proof-of-concept for the adaptive mesh refinement method applied to atmospheric boundary-layer simulations. Such a method may form an attractive alternative to static grids for studies on atmospheric flows that have a high degree of scale separation in space and/or time. Examples include the diurnal cycle and a convective boundary layer capped by a strong inversion. For such cases, large-eddy simulations using regular grids often have to rely on a subgrid-scale closure for the most challenging regions in the spatial and/or temporal domain. Here we analyze a flow configuration that describes the growth and subsequent decay of a convective boundary layer using direct numerical simulation (DNS). We validate the obtained results and benchmark the performance of the adaptive solver against two runs using fixed regular grids. It appears that the adaptive-mesh algorithm is able to coarsen and refine the grid dynamically whilst maintaining an accurate solution. In particular, during the initial growth of the convective boundary layer a high resolution is required compared to the subsequent stage of decaying turbulence. More specifically, the number of grid cells varies by two orders of magnitude over the course of the simulation. For this specific DNS case, the adaptive solver was not yet more efficient than the more traditional solver that is dedicated to these types of flows. However, the overall analysis shows that the method has a clear potential for numerical investigations of the most challenging atmospheric cases.

Simulation Modeling and Analysis with Arena is a highly readable textbook which treats the essentials of the Monte Carlo discrete-event simulation methodology, and does so in the context of a popular Arena simulation environment.\" It treats simulation modeling as an in-vitro laboratory that facilitates the understanding of complex systems and experimentation with what-if scenarios in order to estimate their performance metrics. The book contains chapters on the simulation modeling methodology and the underpinnings of discrete-event systems, as well as the relevant underlying probability, statistics, stochastic processes, input analysis, model validation and output analysis. All simulation-related concepts are illustrated in numerous Arena examples, encompassing production lines, manufacturing and inventory systems, transportation systems, and computer information systems in networked settings. · Introduces the concept of discrete event Monte Carlo simulation, the most commonly used methodology for modeling and analysis of complex systems· Covers essential workings of the popular animated simulation language, ARENA, including set-up, design parameters, input data, and output analysis, along with a wide variety of sample model applications from production lines to transportation systems· Reviews elements of statistics, probability, and stochastic processes relevant to simulation modeling* Ample end-of-chapter problems and full Solutions Manual* Includes CD with sample ARENA modeling programs

The target audience for this simulation is third-year medical students, specifically those in an emergency medicine clerkship. This topic is critically important in emergency medicine due to the ongoing opioid epidemic, which has led to a dramatic rise in overdose cases and deaths across the United States. Overdose deaths involving opioids numbered nearly 50,000 in 2019, a nearly six-fold increase since 1999.1 Over 70% of drug overdose deaths in 2019 involved opioids. Emergency department visits for opioid overdoses rose 30% from 2016 to 2017 in all parts of the United States. 2 Emergency departments often serve as the front line in treating opioid overdoses, where rapid recognition and timely administration of Naloxone can be lifesaving. Training medical students to recognize and manage opioid overdoses is essential to prepare them for real-world scenarios, ensuring they are equipped with the skills and confidence to respond effectively in emergencies. Educating future healthcare providers on this topic could ultimately reduce opioid-related mortality and improve patient outcomes in these high-stakes situations. By the end of the simulation session, learners will be able to: 1) accurately identify the three key clinical signs of opioid overdose (respiratory depression, pinpoint pupils, unresponsiveness), 2) identify and administer the correct dose and route of Naloxone within five minutes of recognizing an opioid overdose, 3) perform at least two basic life support (BLS) interventions, such as airway management and bag-valve mask ventilation, 4) communicate effectively with team members by providing clear instructions and patient status updates at least three times during the simulation. In this study, high-fidelity simulation was implemented by creating a patient scenario of an opioid overdose, where students were required to recognize the symptoms and administer appropriate treatment, specifically Naloxone. The simulation was a component of the third-year emergency medicine clerkship curriculum. Learners completed pre- and post-simulation surveys assessing confidence in recognizing and managing opioid overdose, administering Naloxone, and performing airway interventions. The surveys used 5-point Likert scales to evaluate perceived competence and simulation effectiveness. The simulation significantly improved learners' confidence and knowledge in recognizing, managing, and treating opioid overdoses. Post-simulation surveys demonstrated marked gains across all domains of assessment, confirming the educational effectiveness of the scenario. Overall, the educational content was highly effective. The significant increase in students' confidence and knowledge regarding the recognition and treatment of opioid overdoses demonstrates that the hands-on, high-fidelity simulation successfully met its objectives. By immersing students in a realistic scenario and allowing them to practice administering Naloxone, the simulation prepared them to handle real-life cases with greater confidence and competence.From its implementation, we learned that simulation-based education is a powerful tool for teaching critical skills in emergency medicine, particularly for life-threatening situations like opioid overdose. The overwhelmingly positive feedback from students further reinforced that they found the simulation valuable and informative. Opioid overdose recognition and treatment, emergency medicine education, high-fidelity simulation, Naloxone administration, recognition of overdose symptoms, treatment of opioid overdose, clinical confidence, patient-simulated experience, opioid epidemic, mu-opioid receptor antagonism, knowledge and confidence assessed via pre- and post-simulation surveys.

This article discusses the problem of finding the optimal design using SolidWorks simulation. A number of solutions to the problem using simulation are proposed. Flexible and rigid computational models for solving the problem are described; the disadvantages and advantages of the plow’s body are indicated when calculating automated SolidWorks modeling programs.

The aim of this simulation case is to educate medical students, interns, junior residents, senior residents, nurses, and faculty on how to identify victims of human trafficking in the healthcare setting. This scenario is adaptable for emergency medicine, outpatient clinic settings, and prehospital settings, including EMS personnel as learners. Human trafficking is a profound violation of human rights and a pressing local, national, and global health problem. Victims are reduced to objects for commerce, fueling a $150 billion-dollar industry and representing the second largest source of income for organized crime.1,2,3,4 Globally, an estimated 40.3 million people are victims of modern slavery, with more than 70% being women and girls, and one in four victims being children under the age of 18.3,4 While once perceived as a mostly international problem, prevalence estimates now show 5.4 victims per 1,000 people across the world, with 1.3 victims per 1,000 in the United States for forced labor.4Healthcare providers are among the few professionals likely to encounter victims. Multiple studies show that 28-88% of victims sought medical care while being trafficked.6-9 These victims are most likely to seek medical care from emergency departments (63.3%), Planned Parenthood clinics (29.6%), private practices (22.5%), urgent care clinics (21.4%), women's health clinics (19.4%), and neighborhood clinics (19.4%).8 Despite this, only a small fraction of emergency physicians report receiving formal training on human trafficking. This highlights the critical need for enhanced education in emergency medicine, where providers are frequently the first point of contact for victims. At the conclusion of this case, learners should be able to: 1) review red flags of identifying victims of human trafficking in healthcare settings, 2) identify common indicators and injuries associated with human trafficking, 3) demonstrate a trauma-informed care approach when interviewing potential victims, 4) list and provide patients with national resources for human trafficking,5) understand federal and state mandatory reporting laws and the role of the healthcare provider, 6) determine best treatment options in patients with limited healthcare access, including counseling on empiric treatment of sexually transmitted infection (STI), 7) review management options for an undesired pregnancy according to local institutional policies and state laws for the senior case. This simulation was designed to assess and improve the level of knowledge on identifying victims of human trafficking in the healthcare setting. This session was conducted using standardized patients portraying both the patient and father/trafficker, a faculty member in the nursing role, and a second faculty member in the control booth. The control booth faculty adjusted the displayed vitals, facilitated case progression, and could call in as registration if needed to progress the case. Each case included approximately four to five learners. A pre-brief was provided to the residents prior to the start of the case, explaining the expectations for interacting with standardized patients (SPs) and emphasizing the importance of safety and professionalism. After each scenario concluded, a post-simulation debriefing was held focusing on the presentation, differential diagnosis, physical exam findings, and management of the targeted social and medical issues. This case scenario can also be adapted for use as an oral board examination case. The authors performed a knowledge assessment of the case using both pre-simulation and post-simulation surveys designed specifically for this project. These surveys measured participants' knowledge of human trafficking prior to training and their knowledge after the session. Facilitators also provided informal feedback to the scenario developers after the case was piloted. These evaluations were reviewed after implementation. This case was trialed with emergency medicine residents across all training levels (PGY-1 through PGY-4). Linear mixed models were used to compare pre-session to post-session knowledge of human trafficking, with means reported as descriptive statistics and Cohen's standardized difference (d) used as a measure of effect size. For ordinal questions, a chi-square test compared pre- and post-session responses. Residents' post-session perceptions of effectiveness were analyzed using frequency distributions. Statistical analyses were conducted using SPSS v29. Open-ended feedback responses were analyzed qualitatively using content analysis, with each author independently reviewing and categorizing key themes.Participants reported gaining a deeper understanding of the complexities of human trafficking and greater confidence in their ability to recognize and intervene. A total of 29 residents participated across all four years of training (PGY-1 = 9, PGY-2 = 4, PGY-3 = 11, PGY-4 = 5; 51% female). Only 24% reported prior training, while 94% believed they would benefit from training on human trafficking. Knowledge scores improved significantly (Pre: 59.2 → Post: 65.1; Cohen's d = 0.39, p < .05). Self-reported comfort recognizing victims increased from 35% to 64% (p < .05), and comfort managing victims increased from 28% to 69% (p < .05), with no differences by PGY level or gender. On the post-survey, 100% of participants agreed the simulation enhanced their knowledge.Qualitative comments were gathered digitally through a QR code linked to Smartsheet as part of the standard process for resident didactic feedback. Resident responses were provided to case authors without any identifying information, except for PGY year. Prompts for qualitative comments were open-ended response questions of feedback for presenters and their most valuable learning points. Qualitative feedback (n = 27) emphasized increased awareness, the Human Trafficking Hotline as a valuable resource, and strategies for investigating concerns and providing medical management. Many also suggested smaller groups, additional pre-simulation training, and clearer integration of social work. Overall, residents highlighted that this simulation not only improved their base of knowledge but also provided practical tools to support victims in real-world clinical settings. Simulation-based training on human trafficking in emergency medicine is a vital tool for preparing providers to recognize and respond to these complex cases. By engaging in highly interactive, standardized patient scenarios, learners can practice recognizing subtle red flags, applying trauma-informed communication, and balancing confidentiality with mandated reporting requirements. The debriefing sessions allow further reflection, knowledge integration, and discussion of best practices. Although standardized patients may be cost-prohibitive, faculty can serve as role players to reduce barriers to implementation. Through such training, healthcare providers enhance preparedness, empathy, and effectiveness in addressing the needs of trafficking survivors and contribute to broader efforts to combat exploitation. Medical simulation, emergency medicine, human trafficking, sex trafficking, sexually transmitted diseases, abuse, non-accidental trauma, domestic abuse.

How do you get students to engage in a historical episode or era? How do you bring the immediacy and contingency of history to life? Michael A. Barnhart shares the secret to his award-winning success in the classroom with Can You Beat Churchill? , which encourages role-playing for immersive teaching and learning. Combating the declining enrollment in humanities classes, this innovative approach reminds us how critical learning skills are transmitted to students: by reactivating their curiosity and problem-solving abilities. Barnhart provides advice and procedures, both for the use of off-the-shelf commercial simulations and for the instructor who wishes to custom design a simulation from scratch. These reenactments allow students to step into the past, requiring them to think and act in ways historical figures might have. Students must make crucial or dramatic decisions, though these decisions need not align with the historical record. In doing so, they learn, through action and strategic consideration, the impact of real individuals and groups of people on the course of history. There is a quiet revolution underway in how history is taught to undergraduates. Can You Beat Churchill? hopes to make it a noisy one.

The target audience for the key learning objectives of this Left-Ventricular Assist Device (LVAD) simulation are emergency medicine residents. Other team members such as attendings, nurses, pharmacists, and technicians could potentially be integrated. Left ventricular assist devices (LVADs) are common bridge therapy for patients suffering from severe heart failure to cardiac transplant or destination therapy for non-transplant candidates.1 Emergency medicine physicians must be prepared for a variety of device complications that may result in an acute care presentation, such as drive-line infections, suction events, arrhythmias, and cardiac arrest with device failure. In a review investigating ED presentations for patients with LVADs, device-specific complaints were among the fewest, with the most common presentations involving bleeding, infection, and arrythmias.2 The present case involves a suction event that is precipitated by a gastrointestinal (GI) bleed, which has an incidence of 30% for LVAD patients.3 This case was developed for a technology failure-themed resident simulation competition during the Western Society for Academic Emergency Medicine (SEAM) conference held on April 1, 2022. By the end of this simulation session, learners will be able to: 1) assess the hemodynamics of an LVAD patient by using a Doppler to determine mean arterial pressure, 2) Manage an arrhythmia in an LVAD patient with a suction event by addressing preload, 3) Identify and treat the source of hypovolemia (a massive lower gastrointestinal hemorrhage), 4) Perform clear closed-loop communication with other team members. This high-fidelity simulation case aims to train emergency medicine residents on recognition and management of an LVAD suction event, a rare but serious presentation encountered in the emergency department. This simulation can be successfully implemented either , in an immersive simulation center, or off-site. This case could be represented by lower fidelity mannequins without the capabilities to provide learner tactile feedback of hemodynamics or airway, with a separate monitor device such as SimMon to display vital signs and digital media to demonstrate needed clinical images. The audio file of the low-flow alarm can be accessed and played by any device with internet access. The simulation benefits from embedded simulation participants to act as the bedside nurse and wife to provide history. This simulation included debriefing focused on a critical action checklist. A working group of two simulation-trained faculty, a simulation fellow, and three senior emergency medicine residents chose and developed the simulation case. Two simulation-trained faculty implemented the pilot case series to gather feedback on performance against the critical action checklist. One simulation-trained faculty then facilitated two additional sessions, again evaluating performance on the critical actions as well as content of the debrief discussion. That data was used to iteratively edit the presentation and dynamics of the case in preparation for the SIMposium case competition. During March 2022, in a three-case pilot series, a total of 15 residents (five EM PGY4, four EM PGY3, five EM PGY2, one off-service PGY1) and two medical students (MS3) participated in the simulation case. Participant reactions were overwhelmingly positive, particularly from senior residents. The final version of the SIMposium case was held for a team of four emergency medicine residents from an alternate institution, all critical actions were met, and a discussion point arose regarding the reversal of anticoagulation in LVAD patients with acute GI bleed. Overall, this simulation was well received, effective, and easy to implement and translate to immersive, , or offsite locations for the training of emergency medicine residents on the management of a high acuity, low-frequency event of LVAD device complication. Each debrief stimulated an excellent discussion regarding the general management of LVAD patients regarding initial assessment, arrhythmia, and distinguishing pathologies from device alarms. Our main takeaway from this simulation was the power of a case involving a critical and high acuity patient with LVAD which stimulated residents to engage in more robust discussions during debriefing, leading to broader clinical learning. simulation, simulation competition, LVAD, left ventricular assist device.

This simulation is designed for critical care transport providers but can be easily adapted for the inpatient setting. It is applicable to an interdisciplinary team including nurses, respiratory therapists, medical students, emergency medicine residents, and emergency medicine attendings. Cardiogenic shock carries an incredibly high burden of morbidity and mortality. Acute myocardial infarction accounts for 81% of cardiogenic shock patients and is a common indication for transfer to a tertiary care facility.1 Hypotension due to cardiogenic shock is often refractory to volume resuscitation and often requires pharmacologic intervention. Additionally, the resultant end organ dysfunction frequently requires advanced ventilatory support.1-6 This simulation aims to educate critical care transport providers on the best practices for management of the cardiogenic shock patients requiring resuscitation and intubation prior to transport. By the end of this simulation session, learners will be able to: 1) recognize the need for intubation in an unstable patient in cardiogenic shock who requires transport, 2) appropriately titrate bi-Level non-invasive ventilatory support (BiPAP) to optimize oxygenation and ventilation in preparation for intubation, 3) choose appropriate vasoactive medications to support the hemodynamics of a patient in cardiogenic shock, 4) perform rapid sequence intubation using appropriate induction and paralytic agents and dosing for a patient in cardiogenic shock, 5) choose appropriate initial lung-protective ventilator settings, and 6) implement an adequate analgesia and sedation plan for transport of an intubated patient in cardiogenic shock. This session was conducted using high-fidelity simulation, allowing learners to manage a patient in cardiogenic shock and respiratory distress requiring intubation. Each session was followed by a debriefing and discussion. Qualitative feedback provided by participants during the discussion session was utilized to adjust the simulation between each session. In addition, participants were surveyed using a five-point Likert scale (strongly disagree to strongly agree) on if the simulation met their professional and educational needs, its efficacy and appropriateness for Level, and whether it would change future practice. A total of 36 learners, including 20 physicians and 16 nurses, participated in the simulation over a total of nine sessions. Twenty out of the thirty-six participants completed the survey (both RNs and MDs) and 100% responded \"strongly agree\" to all four prompts (top response out of a five Likert scale). Feedback provided by participants was used after each session to adjust the simulation. Changes implemented included the addition of a nurse confederate, greater emphasis on management and titration of non-invasive ventilation for optimal preoxygenation, and initiation of post intubation sedation and analgesia. Cardiogenic shock is a common cause of mortality, often requires transport, and is particularly challenging to manage. This simulation was overall effective at educating learners on the resuscitation of cardiogenic shock, including appropriate use of vasopressors and ventilatory support. Cardiogenic shock, hypoxic respiratory failure, vasopressor management, airway management, intubation, non-invasive positive pressure ventilation management, ventilatory management, emergency medicine, critical care transport medicine.

This study evaluates the impact of high-fidelity simulation on the acquisition and retention of competencies in nursing students. High-fidelity simulation provides a realistic and risk-free environment allowing students to practice, which potentially enhances the acquisition and retention of required competencies. A blinded, randomised clinical trial with three arms was conducted with a pretest and a follow-up at 6 months (post-test 1) and 12 months (post-test 2). This study was conducted with 105 s-year nursing students, divided into three groups: control (6 low-fidelity simulations), intervention 1 (3 high-fidelity and 3 low-fidelity) and intervention 2 (6 high-fidelity simulations). Competencies were assessed using the Objective Structured Clinical Examination at baseline, 6 and 12 months. Student satisfaction was measured with the Simulated Clinical Experiences Scale. Initial competency scores were similar across groups. At 6 months, both intervention groups showed significant improvements in critical thinking (6.2 and 6.0, p < 0.05), clinical skills (6.8 and 6.6, p < 0.05), communication (8.0 and 8.3, p < 0.05) and ethics (7.6 and 7.5, p < 0.05) compared with the control group. Intervention group 1 demonstrated better competency retention at 12 months. Overall satisfaction with highfidelity simulation was high (9.13/10), with particular praise for the practical dimension (8.95/10), realism (8.02/10) and the cognitive dimension (9.43/10). High-fidelity simulation has the potential to enhance nursing competencies effectively. This approach supports long-term skill retention, highlighting the importance of a well-structured curriculum that integrates different simulation levels for optimal student preparation for clinical practice.