Many hospitalists incorporate point‐of‐care ultrasound (POCUS) into their daily practice to answer specific diagnostic questions or to guide performance of invasive bedside procedures. However, standards for hospitalists in POCUS training and assessment are not yet established. Most internal medicine residency training programs, the major pipeline for incoming hospitalists, have only recently begun to incorporate POCUS in their curricula. The purpose of this document is to inform a broad audience on what POCUS is and how hospitalists are using it. This document is intended to provide guidance for the hospitalists who use POCUS and administrators who oversee its use. We discuss POCUS 1) applications, 2) training, 3) assessments, and 4) program management. Practicing hospitalists must continue to collaborate with their local credentialing bodies to outline requirements for POCUS use. Hospitalists should be integrally involved in decision‐making processes surrounding POCUS program management.
Ab initio quantum chemical calculations for the molecular dissociation channel of acetaldehyde are reported. The enthalpy change for the dissociation of acetaldehyde into methane and carbon monoxide was calculated to be exoergic by 1.7 kcal/mol. The transition state for this unimolecular dissociation, confirmed by normal mode analysis, was found to have an activation energy of 85.3 kcal/mol. Experimental measurements are reported for the vibrational and rotational state distribution of the CO product. No vϭ1 CO is found and the rotational temperature is 1300 Ϯ90 K. The reaction coordinate at the transition state implies that the CO product is vibrationally cold and rotationally hot. This conclusion, which requires quantum dynamics calculations to confirm definitively, does agree with and aids in explaining the experimental results.
The reaction of O(3P) atoms with CH3 radicals is shown to produce CO (in addition to the major product CH2O) which is detected by laser induced fluorescence. The rotational and vibrational temperatures of the CO product are about 2000 K. The results are explained by the assumption that the reaction takes place mainly by an indirect mechanism in which a methoxyl radical is formed and then dissociates unimolecularly.
The HCO product of the reaction of O(3P) with ethene has been detected by cavity ring-down spectroscopy using its A−X transition. For propene a somewhat smaller yield of HCO was obtained but the overall rate constant is much larger. The yield of HCO in this reaction is quite small (∼0.05). Moreover, a large number of other alkenes were tried with negative results. The failure of the 1,2 H atom shift followed by breaking the 1,2 bond implies that the unimolecular decomposition has found a more favorable channel. The proposed mechanism is as follows. For an alkene of the form RCH2CHCH2 the first step is attachment of the O(3P) to the terminal carbon atom, C1. Then, intersystem crossing occurs and finally a H atom shifts from C3 to C2 and not from C1 to C2. In this way a molecule of formaldehyde and an alkene shorter by one carbon atom are formed.
The photodissociation spectroscopy of MgCH 4 ϩ has been studied in a reflectron time-of-flight mass spectrometer. MgCH 4 ϩ molecular absorption bands are observed to the red of the Mg ϩ (3 2 P J ←3 2 S 1/2 ) atomic ion resonance lines. The photofragmentation action spectrum consists of a broad structureless continuum ranging from 310 nm to 342 nm, and peaking near 325 nm. In this spectral region, both the nonreactive ͑Mg ϩ ͒, and two reactive fragmentation products ͑MgH ϩ and MgCH 3 ϩ ͒ are observed, all with similar action spectra. The product branching is independent of wavelength, Mg ϩ :MgCH 3 ϩ :MgH ϩ ϳ60:33:7. The absorption is assigned to the transition (1 2 E←1 2 A 1 ) in C 3v symmetry ͑with 3 coordination͒, followed by a geometrical relaxation of the complex toward states of 2 B 1 and 2 B 2 symmetry in C 2v geometry ͑with 2 coordination͒.Dissociation requires a nonadiabatic transition to the ground electronic surface. Analysis of broadening in the photofragment flight time profile shows the nonreactive Mg ϩ product angular distribution to be isotropic, with an average translational energy release which increases slightly from E t ϳ370Ϯ150 cm Ϫ1 at 332.5 nm to E t ϳ520Ϯ180 cm Ϫ1 at 315 nm. These values are less than 2% of the available energy and are well below statistical expectations. Analogous experiments on MgCD 4 ϩ show the kinetic energy release in the nonreactive channel to be significantly larger for the CD 4 case, ranging from E t ϳ540Ϯ180 cm Ϫ1 at 332.5 nm to E t ϳ830Ϯ200 cm Ϫ1 . These results clearly demonstrate that the dissociation is nonstatistical. Preliminary ab initio potential surface calculations suggest a possible dynamical mechanism to explain these unusual results.
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