East Tennessee Children's Hospital is a private, independent, not-for-profit, 152-bed pediatric medical center in Knoxville, Tennessee. The hospital's primary service area includes 16 counties in East Tennessee, and its secondary service area includes counties in southwest Virginia, southeast Kentucky and western North Carolina.It is certified by the state as a Comprehensive Regional Pediatric Center (CRPC), Tennessee's highest level of certification for pediatric hospital care. The hospital is accredited by the Joint Commission for the Accreditation of Healthcare Organizations and is a member of Child Health Corporation of America, Hospital Alliance of Tennessee, Children's Hospital Alliance of Tennessee, Tennessee Hospital Association and National Association of Children's Hospitals and Related Institutions (NACHRI).The hospital and its affiliates, including numerous pediatric physician practices, employ about 1,800 individuals in full-time, part-time and as-needed positions.
This review aims to summarize the common clinical presentations of renal tubular acidosis (RTA) in children and present a simplified, practical approach for differentiating between the various types of RTA. Emphasis is placed on the integration of genetic testing, particularly next-generation sequencing (NGS), to identify hereditary forms of RTA accurately. Recent advances underscore the value of combining genetic and biochemical testing in routine clinical practice. This article highlights key genetic variants commonly associated with RTA and reviews the role of NGS in diagnosis. Additionally, we examine long-term outcomes in pediatric RTA and review emerging treatment strategies, including Veverimer and ADV7103, which have shown enhanced metabolic control of acidosis. We provide an up-to-date overview of the diagnostic and therapeutic advancements in RTA, with a focus on genetic insights and long-term management. This review emphasizes the importance of early identification and individualized treatment in mitigating the chronic effects of metabolic acidosis.
OBJECTIVE:To describe the feasibility and perceived value of a diagnostic timeout (DT) across a national pediatric learning network. METHODS:The DT was implemented during unplanned transfers from general care to the pediatric intensive care unit (PICU) from April 2024 through June 2024 at 4 children's hospitals. One health care team member filled out a survey immediately after the DT to assess participant roles, the time required, and the perceived value. Responses were stratified by which team members participated and compared using chi-square tests. RESULTS:Overall, a DT was performed in 43% (78 of 182) of unplanned transfers with notable heterogeneity in its use across sites (site A, 75% [18 of 24]; site B, 56% [22 of 39]; site C, 53% [36 of 68]; site D, 4% [2 of 51]). Over 90% of DTs took 5 minutes or less. The value statement "Improved interdisciplinary team understanding of the priorities and plan of care" received the highest number of "Agree/Strongly Agree" responses (47%; 37 of 78), and the statement "Changed or added to the differential diagnosis" received the fewest (28%; 22 of 78). There was a statistically higher percentage of "Agree/Strongly Agree" responses to most survey statements when the bedside nurse or patient and/or family were present. CONCLUSIONS:The adoption of a DT during unplanned PICU transfers varied considerably across sites but was feasible in under 5 minutes. The perceived value was greatest when the patient and/or family or bedside nurse were present. Future studies are needed to better understand how best to implement a DT and how it impacts diagnostic error.
This paper studies the impact of precursor temperature and carrier gas flow rates on low-temperature atomic layer deposition process SiO2 using bis(diethylamino)silane (BDEAS) and O2-plasma as the oxidant. The deposition behavior of BDEAS under varying flow conditions—particularly in relation to carrier gas dynamics— remains underexplored. Experiments were conducted across Ar-carrier flow rates from 400 to 2000 sccm and precursor bottle temperatures from 50°C to 65°C, while maintaining all other process conditions constant. Film thickness (THK), growth per cycle (GPC), and wet etch rate (WER) were measured to assess the sensitivity of SiO2 deposition behavior to precursor delivery dynamics. Results show an inverse relationship between carrier gas flow and both THK and GPC, consistent with precursor dilution and reduced BDEAS partial pressure. Higher precursor temperatures increased vapor pressure and correspondingly elevated growth rates at all flow conditions. WER decreased with increased carrier gas flow, indicating a change in film characteristics under reduced precursor availability. These findings demonstrate the importance of balancing precursor temperature and carrier gas flow to maintain stable film growth, density, and etch characteristics—parameters essential for optimizing SiO2 hard mask deposition in advanced semiconductor manufacturing.
This study outlines the development and instructional rationale behind a serious game designed to strengthen emergency nurses’ clinical prioritization skills through mechanics-driven learning. Drawing on principles from cognitive load theory, motivational psychology, and serious game design, we present a blueprint-style guide for aligning mechanics with educational outcomes. We describe how core mechanics such as countdown timers, scoring systems, and progress indicators function not just as game elements, but as instructional tools that support decision-making under pressure in healthcare settings. Implementation strategies, design lessons, and practical considerations are shared to assist other educators and developers seeking to build meaningful, scalable training experiences for clinical environments. The game was developed through interdisciplinary collaboration between a children’s hospital and a university’s digital media department.
