This research focuses on modeling heat transfer in heterogeneous media composed of stacked spheres of paraffin as a perspective polymeric phase-change material. The main goal is to study the requirements of the numerical scheme to correctly predict the thermal conductivity in a periodic system composed of an indefinitely repeated configuration of spherical particles subjected to a temperature gradient. Based on OpenFOAM, a simulation platform is created with which the resolution requirements for accurate heat transfer predictions were inferred systematically. The approach is illustrated for unit cells containing either a single sphere or a configuration of two spheres. Asymptotic convergence rates confirming the second-order accuracy of the method are established in case the grid is fine enough to have eight or more grid cells covering the distance of the diameter of a sphere. Configurations with two spheres can be created in which small gaps remain between these spheres. It was found that even the under-resolution of these small gaps does not yield inaccurate numerical solutions for the temperature field in the domain, as long as one adheres to using eight or more grid cells per sphere diameter. Overlapping and (barely) touching spheres in a configuration can be simulated with high fidelity and realistic computing costs. This study further extends to examine the effective thermal conductivity of the unit cell, particularly focusing on the volume fraction of paraffin in cases with unit cells containing a single sphere. Finally, we explore the dependence of the effective thermal conductivity for unit cells containing two spheres at different distances between them.

OBJECTIVE: To evaluate the effect of high-fidelity simulation of pediatric emergencies compared to case-based discussion on the development of self-confidence, theoretical knowledge, clinical reasoning, communication, attitude, and leadership in undergraduate medical students.
METHODS: 33 medical students were allocated to two teaching methods: high-fidelity simulation (HFS, n = 18) or case-based discussion (CBD, n = 15). Self-confidence and knowledge tests were applied before and after the interventions and the effect of HFS on both outcomes was estimated with mixed-effect models. An Objective Structured Clinical Examination activity was conducted after the interventions, while two independent raters used specific simulation checklists to assess clinical reasoning, communication, attitude, and leadership. The effect of HFS on these outcomes was estimated with linear and logistic regressions. The effect size was estimated with the Hedge\'s g.
RESULTS: Both groups had an increase in self-confidence (HFS 59.1 × 93.6, p < 0.001; CDB 50.5 × 88.2, p < 0.001) and knowledge scores over time (HFS 45.1 × 63.2, p = 0.001; CDB 43.5 × 56.7, p-value < 0.01), but no difference was observed between groups (group*time effect in the mixed effect models adjusted for the student ranking) for both tests (p = 0.6565 and p = 0.3331, respectively). The simulation checklist scores of the HFS group were higher than those of the CBD group, with large effect sizes in all domains (Hedges g 1.15 to 2.20).
CONCLUSIONS: HFS performed better than CBD in developing clinical reasoning, communication, attitude, and leadership in undergraduate medical students in pediatric emergency care, but no significant difference was observed in self-confidence and theoretical knowledge.

BACKGROUND: This case was designed to be an interprofessional scenario to assist the learner in the approach to a patient with cardiac tamponade. This resource provides information and materials for a high-fidelity simulation scenario that is appropriate for learners at multiple levels. Each learner has the opportunity to interact with embedded patient actors. This scenario includes the opportunity to conduct a bedside echocardiogram and perform an ultrasound-guided pericardiocentesis.
METHODS: A 51-year-old female presents to the emergency department with a chief complaint of shortness of breath and with a history of cancer. Her shortness of breath evolves into tachypnea, hypoxia, altered mental status, hypotension, and shock. The physical assessment reveals hypotension, muffled heart tones, and jugular vein distension. One critical action requires the recognition of pericardial effusion on a bedside echocardiogram. The learner needs to interpret the ultrasound findings in conjunction with the physical exam findings to diagnose cardiac tamponade. An emergent ultrasound-guided pericardiocentesis is to be performed. Equipment needed includes a high-fidelity adult mannequin, the low-cost ultrasound pericardiocentesis model (or pericardocentesis model of choice), bedside ultrasound, the PowerPoint presentation containing imaging, and laboratory data.
RESULTS: A survey was completed by 23 residents who participated in this simulation. Ninety-five percent of those responding felt that this simulation in conjunction with the debriefing was effective in managing a patient presenting with undifferentiated shortness of breath and pericardial tamponade.
CONCLUSIONS: This case will be incorporated into the 3-year curriculum for our emergency medicine residency program and assist with evaluation of resident performance of pericardiocentesis.

Salicylate poisoning is a serious toxicologic problem with a complex pathophysiology that requires prompt diagnosis and action for a favorable outcome. A simulated experience in the evaluation and management of an aspirin-overdose patient allows learners to construct a differential diagnosis from an array of symptoms and signs, analyze a mixed acid-base disturbance, and explore the multistep management of this disorder.
This simulation exercise was designed for second-year medical students. At the start of the session, teams received a 10-minute introduction to the activity. Upon entering a room in a simulated Emergency Department, teams had 15 minutes to complete a focused history and physical exam of the patient, interpret arterial blood gas and basic metabolic panel data, and administer treatment based on key findings and a presumptive diagnosis. The scenario was followed by a 90-minute facilitated debriefing session. An alternative 45-minute debriefing guideline is also included.
Students voluntarily completed a 13-question, 5-point Likert-scale survey about the educational exercise immediately following the session. They evaluated the preparatory materials and briefing, the simulation scenario, the usefulness of the debriefing, and their confidence in their understanding of salicylate poisoning following the session. Students reported a favorable response to the overall experience and the debriefing, as well as an increase in confidence following the session.
This simulation exercise was successful in exposing students to the clinical presentation of salicylate toxicity and giving them the opportunity to apply and synthesize basic science knowledge during the scenario.