PIM2, PRISM III-12, and PRISM III-24 all were found to be suitable for use in a UK PICU setting. All tools provided similar conclusions in assessing the distribution of risk-adjusted mortality in UK PICUs. It now is important that these tools be used to monitor outcome and improve the quality of pediatric intensive care within the United Kingdom.

An increasing number of global initiatives aim to address the disconnection between the increasing number of women entering medicine and the persistence of gender imbalance in the physician anaesthesiologist workforce. This commentary complements the global movement's efforts to increase women's representation in academic anaesthesiology by presenting considerations for fostering inclusion for women in academic anaesthesiology from both the faculty and departmental leadership perspectives in a US academic anaesthesiology department.The past several decades have witnessed a growing appreciation for gender diversity in medicine, 1,2 with an increasing number of women becoming physicians. 3 Despite this change, there is a persistence of specialties in which men are overrepresented, including anaesthesiology. 4,5 Global efforts to foster the inclusion of women in anaesthesiology include the British Journal of Anaesthesia symposium on Women in Anaesthesia Research (https://www.periopmedicine.org.au/index. php/2019prato), the Australian and New Zealand College of Anaesthetists Gender Equity Position Statement and Action Plan, 6 and the US Women in Anesthesiology initiative. 7 The goal of this commentary was to augment these global efforts by presenting a framework that may be useful in planning and evaluating efforts to retain and support women faculty anaesthesiologists. Using Maslow's 8 hierarchy of needs to structure the discussion, we present considerations for fostering inclusion for women in academic anaesthesiology from both faculty and departmental leadership perspectives from the University of Pennsylvania Department of Anesthesiology and Critical Care. We used the terms 'women' and 'men' to indicate gender identity, recognising that there are individuals with non-binary gender identity whose experience is not well captured by these terms.

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Background: Resident education in pediatric anesthesiology is challenging. Traditional curricula for anesthesiology residency programs have included a combination of didactic lectures and mentored clinical service, which can be variable. Limited pediatric medical knowledge, technical inexperience, and heightened resident anxiety further challenge patient care. We developed a pediatric anesthesia simulation-based curriculum to address crises related to hypoxemia and dysrhythmia management in the operating room as an adjunct to traditional didactic and clinical experiences. Aims:The primary objective of this trial was to evaluate the impact of a simulation curriculum designed for anesthesiology residents on their performance during the management of crises in the pediatric operating room. A secondary objective was to compare the retention of learned knowledge by assessment at the eight-week time point during the rotation. Methods:In this prospective, observational trial 30 residents were randomized to receive simulation-based education on four perioperative crises (Laryngospasm, Bronchospasm, Supraventricular Tachycardia (SVT), and Bradycardia) during the first week (Group A) or fifth week (Group B) of an eight-week rotation. Assessment sessions that included two scenarios (Laryngospasm, SVT) were performed in the first week, fifth week, and the eighth week of their rotation for all residents. The residents were assessed in real time and by video review using a 7-point checklist generated by a modified Delphi technique of senior pediatric anesthesiology faculty. Results: Residents in Group A showed improvement between the first week and fifthweek assessment as well as between first week and eighth week assessments without decrement between the fifth week and eighth week assessments for both the laryngospasm and SVT scenarios. Residents in Group B showed improvement between the first week and eighth week assessments for both scenarios and between the fifth week and eighth week assessment for the SVT scenario. Conclusion:This adjunctive simulation-based curriculum enhanced the learner's management of laryngospasm and SVT management and is a reasonable addition to didactic and clinical curricula for anesthesiology residents.

A 6-month-old infant, weighing 5.5 kg, was scheduled for resection of an occipital encephalocele. The patient was placed supine with his body on stacked blankets, his formed skull supported by a gel-padded Integra mayfield horseshoe headrest with the encephalocele hanging freely beneath (fig. A). mask induction maintaining spontaneous ventilation was coupled with direct laryngoscopy using a miller 1 blade. With a grade 1 view, a 3.0-mm endotracheal tube was placed orally. The patient was then positioned prone for the procedure with the head resting in the headrest (fig. B). on completion of the surgery, the patient's trachea was extubated in the operating room. Encephalocele is a rare neural tube defect, occurring in 1 in 5,000 births worldwide; 70% are occipital. 1 Up to 60% of cases are associated with other congenital anomalies such as hydrocephalus, microcephaly, micrognathia, Chiari malformation, pulmonary hypoplasia, and renal agenesis. mask ventilation may be awkward, and difficult intubation is associated with approximately 20% of cases. 1 Positioning of the patient for intubation contributes to the difficulty with airway management. 2 manual suspension of the patient's head beyond the operating table risks undesirable movement of the head during laryngoscopy. lateral positioning requires a less ideal approach for the laryngoscopist and potentiates an obscured laryngoscopic view. 2 Removal of the contents of the encephalocele by needle aspiration before induction or intubation may potentiate infection, hemodynamic instability, and possible herniation, 1,3 particularly in the neonate. Positioning any patient with an occipital encephalocele in one of the various sizes of the horseshoe headrest creates optimal conditions for induction and tracheal intubation by providing the anesthesiologist airway alignment and stability without increasing pressure on the encephalocele.

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The 2014-2015 Ebola virus disease (EVD) epidemic and international public health emergency has been referred to as a "black swan" event, or an event that is unlikely, hard to predict, and highly impactful once it occurs. The Chicago Ebola Response Network (CERN) was formed in response to EVD and is capable of receiving and managing new cases of EVD, while also laying the foundation for a public health network that can anticipate, manage, and prevent the next black swan public health event. By sharing expertise, risk, and resources among 4 major academic centers, Chicago created a sustainable network to respond to the latest in a series of public health emergencies. In this respect, CERN is a roadmap for how a region can prepare to respond to public health emergencies, thereby preventing negative impacts through planning and implementation.