47, P = 0.002), in contrast to those without CKD (hazard ratio 1.15, P = 0.210). The inclusion of any ECG-LVH parameters improved the accuracy of reclassification in any risk prediction model based on the eGFR, UACR, or Framingham 10-year risk score in the CKD participants (net reclassification improvement = 0.13-0.32, all P values less then 0.040). CONCLUSION In patients with CKD stage 1-5, ECG-LVH is useful for predicting the risk of future cardiovascular events and adds prognostic information to traditional cardiovascular risk assessments.OBJECTIVE To determine whether cerebral small vessel disease or disability modify the effect of SBP treatment on cognitive and vascular outcomes in older patients with recent lacunar stroke. METHODS Participants aged at least 65 years of the Secondary Prevention of Small Subcortical Strokes Trial were randomized to a higher (130-149 mmHg) or lower ( less then 130 mmHg) SBP target. The primary outcome was change in cognitive function (Cognitive Abilities Screening Instrument); secondary outcomes were incident mild cognitive impairment, stroke, major vascular events (all-stroke, myocardial infarction), and all-cause death. Results were stratified by severity of white matter hyperintensities (WMH; none/mild, moderate, severe) on baseline MRI, and by disability (no vs. at least one limitation in activities of daily living). RESULTS One thousand, two hundred and sixty-three participants (mean age 73.8 ± 5.9 years, 40% women) were included. Participants with severe WMH or disability had worse cognitive function at baseline and after a mean follow-up of 3.9 years. No significant interactions existed between treatment group and effect modifiers (WMH, disability) for change in cognitive function (P for interaction 0.42 and 0.66, respectively). A lower SBP target appeared more beneficial among those with worse WMH burden for vascular outcomes (P for interaction = 0.01 for stroke and 0.03 for major vascular events). CONCLUSION There was no difference in the effect of lowering SBP to less than 130 mmHg on cognitive function by cerebral small vessel disease or disability among older adults with a history of lacunar stroke. Those with evidence of small vessel disease may derive greater benefit from lower SBP on prevention of subsequent vascular events. TRIAL REGISTRATION Clinicaltrials.gov Identifier NCT00059306.OBJECTIVE The objective of this study was to determine the prevalence of rib fractures (RFs) identified by chest x-ray (CXR) among children younger than 2 years who sustained accidental versus nonaccidental injuries. It is hypothesized that RFs are uncommon among all accidental pediatric trauma mechanisms (eg, falls, motor vehicle crashes) as compared with the prevalence of RFs in the setting of nonaccidental trauma (NAT). METHODS A retrospective chart review of sequential CXRs of children younger than 2 years evaluated at a pediatric level 1 trauma center for accidental trauma and possible NAT was conducted from January 1, 2011, to October 31, 2016. Data collected included demographics, CXR indication and findings, history of cardiopulmonary resuscitation, trauma mechanism, associated injuries, final diagnoses, and outcomes. RESULTS Two ( less then 1%) of 226 CXRs obtained to evaluate accidental trauma demonstrated acute RFs. Ten (19.6%) of 51 CXRs obtained in the setting of concern for NAT revealed RFs (9/10 identified only healing RFs and 1/10 identified acute RFs). Among patients with a final diagnosis of NAT (ie, not neglect, accidental trauma, etc; n = 38), the overall prevalence increased to 26.3%. CONCLUSIONS The presence of RFs in pediatric accidental trauma is uncommon even in the setting of high-force mechanisms, and when identified, these RFs are acute. Comparatively, the overall prevalence of RFs identified on CXR among cases with a final diagnosis of NAT was much higher and almost exclusively healing RFs. These data provide support that identification of RFs is highly concerning for NAT even if an accidental mechanism is provided. When RFs are identified, a full NAT work-up should be considered.This article presents reflections of career pathways of simulation researchers as well as a discussion of the themes found in the stories presented. It is the intent of the authors to present and foster a discussion around the ways in which we as a simulation community wish to promote recognition of scholarship among simulation researchers and help support newcomers find success as simulation researchers in academia. We also present recommendations for those considering entering the field based on tactics that were successful and not successful among the scholars who shared their stories.INTRODUCTION Simulation is increasingly integrated into graduate medical education, and simulation faculty generally attempt to optimize the fidelity of simulators and simulations on behalf of trainees, so as to approach the realism of actual patient care experiences. As residents and fellows participate as learners in simulations, which faculty design, this investigation sought to address whether fellows and faculty have similar perceptions of fidelity by comparing ratings of 2 types of simulation experiences. METHODS Prospective single-center observational study comparing surveys completed by fellows and faculty participating in multiple simulation sessions during a one-day simulation-based boot camp.  https://www.selleckchem.com/products/usp22i-s02.html  RESULTS Overall, both the fellows and the faculty provided moderate to high ratings of fidelity for both a technical skill and a teamwork simulation session. Fellows' ratings of an airway skills session were significantly higher than faculty ratings in 4 of 6 questions but similar to faculty ratings of a teamwork scenario session. CONCLUSIONS Pediatric anesthesia fellows' ratings of simulation fidelity were at least as high as faculty ratings during an annual boot camp, suggesting that faculty in this setting developed simulations that the fellows found to be realistic. Faculty were relatively more critical of the fidelity of a skill session, compared with a teamwork scenario session. If this finding is generalizable, this may reassure faculty designing simulations for fellows. Continued inspection of the entwined nature of fidelity and simulation will help inform more effective learning for this growing educational modality.