THE EFFECTS OF NITROGEN LOADING AND FRESHWATER RESIDENCE TIME ON THE ESTUARINE ECOSYSTEM

EPA Science Inventory

A simple mechanistic model, designed to predict annual average concentrations of total nitrogen (TN) concentrations from nitrogen inputs and freshwater residence time in estuaries, was applied to data for several North American estuaries from previously published literature. The ...

Academic Productivity of US Neurosurgery Residents as Measured by H-Index: Program Ranking with Correlation to Faculty Productivity.

PubMed

Sarkiss, Christopher A; Riley, Kyle J; Hernandez, Christopher M; Oermann, Eric K; Ladner, Travis R; Bederson, Joshua B; Shrivastava, Raj K

2017-06-01

Engagement in research and academic productivity are crucial components in the training of a neurosurgeon. This process typically begins in residency training. In this study, we analyzed individual resident productivity as it correlated to publications across all Accreditation Council for Graduate Medical Education (ACGME)-accredited neurosurgery training programs in an attempt to identify how programs have developed and fostered a research culture and environment. We obtained a list of current neurosurgery residents in ACGME-accredited programs from the American Association of Neurological Surgeons database. An expanded PubMed and Scopus search was conducted for each resident through the present time. We tabulated all articles attributed to each resident. We then categorized the publications based on each neurosurgical subspecialty while in residency. A spreadsheet-based statistical analysis was performed. This formulated the average number of resident articles, h-indices, and most common subspecialty categories by training program. We analyzed 1352 current neurosurgery residents in 105 programs. There were a total of 10 645 publications, of which 3985 were resident first-author publications during the period of study. The most common subspecialties among all resident publications were vascular (24.9%), spine (16.9%), oncology (16.1%), pediatric (5.6%), functional (4.9%), and trauma (3.8%). The average resident published 2.9 first-author papers with average of 38.0 first-author publications by total residents at each program (range 0-241). The average h-index per resident is 2.47 ± 3.25. When comparing previously published faculty h-index program rankings against our resident h-index rankings, there is a strong correlation between the 2 datasets with a clear delineation between Top-20 productivity and that of other programs (average h-index 4.2 vs 1.7, respectively, P < .001). Increasing program size leads to a clear increase in academic productivity on both the resident and faculty level (average h-index 1.6, 1.9, 3.9 for 1, 2, and 3 resident per year programs, respectively, P < .001). Resident first-author publications correlated with recently described academic departmental productivity. Subspecialty resident publications are highest in cerebrovascular surgery. Resident research and publication is a key metric for assessing the productivity of academic neurosurgery programs and is consistent with one of the core foci of neurosurgical training. Copyright © 2017 by the Congress of Neurological Surgeons.

Proficiency-based cervical cancer brachytherapy training.

PubMed

Zhao, Sherry; Francis, Louise; Todor, Dorin; Fields, Emma C

2018-04-25

Although brachytherapy increases the local control rate for cervical cancer, there has been a progressive decline in its use. Furthermore, the training among residency programs for gynecologic brachytherapy varies considerably, with some residents receiving little to no training. This trend is especially concerning given the association between poor applicator placement and decline in local control. Considering the success of proficiency-based training in other procedural specialties, we developed and implemented a proficiency-based cervical brachytherapy training curriculum for our residents. Each resident placed tandem and ovoid applicators with attending guidance and again alone 2 weeks later using a pelvic model that was modified to allow for cervical brachytherapy. Plain films were taken of the pelvic model, and applicator placement quality was evaluated. Other evaluated metrics included retention of key procedural details, the time taken for each procedure and presession and postsession surveys to assess confidence. During the initial session, residents on average met 4.5 of 5 placement criteria, which improved to 5 the second session. On average, residents were able to remember 7.6 of the 8 key procedural steps. Execution time decreased by an average of 10.5%. Resident confidence with the procedure improved dramatically, from 2.6 to 4.6 of 5. Residents who had previously never performed a tandem and ovoid procedure showed greater improvements in these criteria than those who had. All residents strongly agreed that the training was helpful and wanted to participate again the following year. Residents participating in this simulation training had measurable improvements in the time to perform the procedure, applicator placement quality, and confidence. This curriculum is easy to implement and is of great value for training residents, and would be particularly beneficial in programs with low volume of cervical brachytherapy cases. Simulation programs could also be created for other technically challenging radiation oncology procedures. Copyright © 2018 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

Impact of Residency Training Redesign on Residents' Clinical Knowledge.

PubMed

Waller, Elaine; Eiff, M Patrice; Dexter, Eve; Rinaldo, Jason C B; Marino, Miguel; Garvin, Roger; Douglass, Alan B; Phillips, Robert; Green, Larry A; Carney, Patricia A

2017-10-01

The In-training Examination (ITE) is a frequently used method to evaluate family medicine residents' clinical knowledge. We compared family medicine ITE scores among residents who trained in the 14 programs that participated in the Preparing the Personal Physician for Practice (P4) Project to national averages over time, and according to educational innovations. The ITE scores of 802 consenting P4 residents who trained in 2007 through 2011 were obtained from the American Board of Family Medicine. The primary analysis involved comparing scores within each academic year (2007 through 2011), according to program year (PGY) for P4 residents to all residents nationally. A secondary analysis compared ITE scores among residents in programs that experimented with length of training and compared scores among residents in programs that offered individualized education options with those that did not. Release of ITE scores was consented to by 95.5% of residents for this study. Scores of P4 residents were higher compared to national scores in each year. For example, in 2011, the mean P4 score for PGY1 was 401.2, compared to the national average of 386. For PGY2, the mean P4 score was 443.1, compared to the national average of 427, and for PGY3, the mean P4 score was 477.0, compared to the national PGY3 score of 456. Scores of residents in programs that experimented with length of training were similar to those in programs that did not. Scores were also similar between residents in programs with and without individualized education options. Family medicine residency programs undergoing substantial educational changes, including experiments in length of training and individualized education, did not appear to experience a negative effect on resident's clinical knowledge, as measured by ITE scores. Further research is needed to study the effect of a wide range of residency training innovations on ITE scores over time.

A MODEL OF ESTUARY RESPONSE TO NITROGEN LOADING AND FRESHWATER RESIDENCE TIME

EPA Science Inventory

We have developed a deterministic model that relates average annual nitrogen loading rate and water residence time in an estuary to in-estuary nitrogen concentrations and loss rates (e.g. denitrification and incorporation in sediments), and to rates of nitrogen export across the ...

Predictors of performance in an ophthalmology residency program.

PubMed

Alfawaz, Abdullah M; Al-Dahmash, Saad A

2016-06-01

To assess the value of current selection criteria and additional factors as predictors of performance in an ophthalmology residency training program. A retrospective study. Data were collected from the files of 166 residents who were collectively trained in an ophthalmology residency program from 2000 to 2013. The program's selection criteria included medical school grade point average (GPA), Saudi licensing examination (SLE) score, multiple-choice question ophthalmology selection (MCQ) examination score, and interview mark. Indicators of performance included average scores in the promotion examination for 4 years of training (average R), King Saud University fellowship examination (KSU) score, and Saudi Board in Ophthalmology examination (SBO) score. An average of KSU and SBO scores was also used as a performance indicator. Times of program completion and average performance score across all years in the residency program were used as second-level indicators of performance. There were strong correlations between the MCQ examination score and each training performance indicator (average R, KSU score, SBO score, and average of KSU and SBO scores; p = 0.002, 0.008, 0.05, and 0.002, respectively). The interview mark correlated well with average R (p = 0.001) but not with other indicators. The MCQ examination score and the interview mark were the only predictors of second-level indicators of performance (p = 0.009 and 0.029, respectively). The MCQ examination score and interview mark were the 2 best predictors of performance as an ophthalmology resident. GPA and SLE score were poor predictors of performance. Copyright © 2016 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

Financial Analysis of Pediatric Resident Physician Primary Care Longitudinal Outpatient Experience.

PubMed

Stipelman, Carole H; Poss, Brad; Stetson, Laura Anne; Boi, Luca; Rogers, Michael; Puzey, Caleb; Koduri, Sri; Kaplan, Robert; Lee, Vivian S; Clark, Edward B

2018-05-16

To determine whether residency training represents a net positive or negative cost to academic medical centers, we analyzed the cost of a residency program and clinical productivity of residents and faculty in outpatient primary care practice with or without residents. Patient volume and revenue data (Current Procedural Terminology codes) from an academic primary care general pediatric clinic were evaluated for faculty clinics (faculty only) and resident teaching clinics (Longitudinal Outpatient Experience [LOE]) with 1-4 residents/faculty. Detailed cost per resident was determined using a departmental financial model that included salary, benefits, faculty and administrative staff effort, non-personnel costs, and institutional GME support. The LOE clinics had greater mean number of patient visits (11.6 vs 6.8) than faculty clinics per faculty member. In the LOE clinic, the number of patient visits per clinic was directly proportional to the number of residents per faculty. The cost for each resident was $250 per clinic ($112 per resident, $88 per medical assistant per resident, and $50 per room per resident). When factoring in clinic costs and faculty supervision time, the LOE clinic (average 3.5 residents with one supervising faculty) had greater average cost (+$687.00) and revenue (+$319.45) and lower operating margin (revenue minus cost, -$367.55) than faculty clinic (one faculty member). Pediatric resident LOE clinic had a greater average number of patient visits and revenue per faculty member but higher costs and lower operating margin than faculty clinic. Copyright © 2018. Published by Elsevier Inc.

Coupled long term simulation of reach scale water and heat fluxes across the river groundwater interface and hyporheic temperature dynamics

NASA Astrophysics Data System (ADS)

Munz, Matthias; Oswald, Sascha E.; Schmidt, Christian

2017-04-01

Flow pattern and seasonal as well as diurnal temperature variations control ecological and biogeochemical conditions in hyporheic sediments. In particular, hyporheic temperatures have a great impact on many microbial processes. In this study we used 3-D coupled water flow and heat transport simulations applying the HydroGeoSphere code in combination with high frequent observations of hydraulic heads and temperatures for quantifying reach scale water and heat flux across the river groundwater interface and hyporheic temperature dynamics of a lowland gravel-bed river. The magnitude and dynamics of simulated temperatures matched the observed with an average mean absolute error of 0.7 °C and an average Nash Sutcliffe Efficiency of 0.87. Our results highlight that the average temperature in the hyporheic zone follows the temperature in the river which is characterized by distinct seasonal and daily temperature cycles. Individual hyporheic flow path temperature substantially varies around the average hyporheic temperature. Hyporheic flow path temperature was found to strongly depend on the flow path residence time and the temperature gradient between river and groundwater; that is, in winter the average flow path temperature of long flow paths is potentially higher compared to short flow paths. Based on the simulation results we derived a general empirical relationship, estimating the influence of hyporheic flow path residence time on hyporheic flow path temperature. Furthermore we used an empirical temperature relationship between effective temperature and respiration rate to estimate the influence of hyporheic flow path residence time and temperature on hyporheic oxygen consumption. This study highlights the relation between complex hyporheic temperature patterns, hyporheic residence times and their implications on temperature sensitive biogeochemical processes.

Beliefs about Obedience Levels in Studies Conducted within the Milgram Paradigm: Better than Average Effect and Comparisons of Typical Behaviors by Residents of Various Nations.

PubMed

Grzyb, Tomasz; Dolinski, Dariusz

2017-01-01

The article presents studies examining whether the better than average (BTA) effect appears in opinions regarding obedience of individuals participating in an experiment conducted in the Milgram paradigm. Participants are presented with a detailed description of the experiment, asked to declare at what moment an average participant would cease their participation in the study, and then asked to declare at what moment they themselves would quit the experiment. It turned out that the participants demonstrated a strong BTA effect. This effect also concerned those who had known the results of the Milgram experiment prior to the study. Interestingly, those individuals-in contrast to naive participants-judged that the average person would remain obedient for longer, but at the same time prior familiarity with the Milgram experiment did not impact convictions as to own obedience. By the same token, the BTA effect size was larger among those who had previously heard of the Milgram experiment than those who had not. Additionally, study participants were asked to estimate the behavior of the average resident of their country (Poland), as well as of average residents of several other European countries. It turned out that in participants' judgment the average Pole would withdraw from the experiment quicker than the average Russian and average German, but later than average residents of France and England.

Beliefs about Obedience Levels in Studies Conducted within the Milgram Paradigm: Better than Average Effect and Comparisons of Typical Behaviors by Residents of Various Nations

PubMed Central

Grzyb, Tomasz; Dolinski, Dariusz

2017-01-01

The article presents studies examining whether the better than average (BTA) effect appears in opinions regarding obedience of individuals participating in an experiment conducted in the Milgram paradigm. Participants are presented with a detailed description of the experiment, asked to declare at what moment an average participant would cease their participation in the study, and then asked to declare at what moment they themselves would quit the experiment. It turned out that the participants demonstrated a strong BTA effect. This effect also concerned those who had known the results of the Milgram experiment prior to the study. Interestingly, those individuals—in contrast to naive participants—judged that the average person would remain obedient for longer, but at the same time prior familiarity with the Milgram experiment did not impact convictions as to own obedience. By the same token, the BTA effect size was larger among those who had previously heard of the Milgram experiment than those who had not. Additionally, study participants were asked to estimate the behavior of the average resident of their country (Poland), as well as of average residents of several other European countries. It turned out that in participants’ judgment the average Pole would withdraw from the experiment quicker than the average Russian and average German, but later than average residents of France and England. PMID:28979232

Mathematical Modeling Reveals Kinetics of Lymphocyte Recirculation in the Whole Organism

PubMed Central

Ganusov, Vitaly V.; Auerbach, Jeremy

2014-01-01

The kinetics of recirculation of naive lymphocytes in the body has important implications for the speed at which local infections are detected and controlled by immune responses. With a help of a novel mathematical model, we analyze experimental data on migration of 51Cr-labeled thoracic duct lymphocytes (TDLs) via major lymphoid and nonlymphoid tissues of rats in the absence of systemic antigenic stimulation. We show that at any point of time, 95% of lymphocytes in the blood travel via capillaries in the lung or sinusoids of the liver and only 5% migrate to secondary lymphoid tissues such as lymph nodes, Peyer's patches, or the spleen. Interestingly, our analysis suggests that lymphocytes travel via lung capillaries and liver sinusoids at an extremely rapid rate with the average residence time in these tissues being less than 1 minute. The model also predicts a relatively short average residence time of TDLs in the spleen (2.5 hours) and a longer average residence time of TDLs in major lymph nodes and Peyer's patches (10 hours). Surprisingly, we find that the average residence time of lymphocytes is similar in lymph nodes draining the skin (subcutaneous LNs) or the gut (mesenteric LNs) or in Peyer's patches. Applying our model to an additional dataset on lymphocyte migration via resting and antigen-stimulated lymph nodes we find that enlargement of antigen-stimulated lymph nodes occurs mainly due to increased entrance rate of TDLs into the nodes and not due to decreased exit rate as has been suggested in some studies. Taken together, our analysis for the first time provides a comprehensive, systems view of recirculation kinetics of thoracic duct lymphocytes in the whole organism. PMID:24830705

Career Track of Society of University Surgeons Resident Research Award Recipients

PubMed Central

Hassan, Burhan; Bernstam, Elmer; Hines, Joe; Simeone, Diane M.; Weber, Sharon; Geller, David; Evers, B. Mark; Meric-Bernstam, Funda

2015-01-01

Background Society of University Surgeons (SUS) has an ongoing competitive funding program to support research training for residents. We sought to determine the career track of award recipients. Methods SUS resident awardees who completed awards from 1989-2007 were included in the study. Characteristics of awardees and their academic productivity were extracted from curriculum vitae provided by awardees (n=24), or from online sources (n=7). Results The awardees spent an average of 2.7 years (range 1-4) of dedicated research time during residency. Awardees averaged 9.8 publications (range 1-32) with 5.4 as first author (range 1-17) with their mentor within three years of award completion, with an average maximum impact factor of 5.7. Twenty-five residents (81%) pursued fellowships. At an average follow-up of 11.4 years (range 4-22) from end of the award, and 7.2 years (0-18) from end of their clinical training, the awardees had an h-index of 14.5 (2-48). At the time of the study, 26 awardees (84%) were in academic surgery. Of the 23 awardees that had completed surgical training three years earlier or more, 11 (48%) received independent research funding, of which 7 (30%) received R01 or equivalent funding. Conclusions The SUS resident research awardees had a very productive research experience. Although our retrospective study cannot determine causation, the SUS award mechanism delivers on its promise of supporting junior surgeon-scientists that pursue academic careers and establish independent research programs. Further studies are needed to determine how rates of subsequent independent research funding can be improved. PMID:23751805

Psychiatry Residents' Use of Educational Websites: A Pilot Survey Study.

PubMed

Torous, John; Franzan, Jamie; O'Connor, Ryan; Mathew, Ian; Keshavan, Matcheri; Kitts, Robert; Boland, Robert

2015-12-01

Psychiatry residents have numerous online educational resources readily available to them although currently there are no data regarding residents' use and perception of such websites. A survey was offered to 62 residents from all four years of training as well as recent graduates of a single psychiatry residency training program. Residents reported utilizing online resources on average 68 % of the time, in comparison to 32 % on average for printed materials. Residents reported UpToDate, PubMed, and Wikipedia as the most visited websites and ranked each highly but for different purposes. Thirty-five percent of residents felt that insufficient faculty guidance was a barrier to use of these educational websites. Pilot data indicate psychiatry residents use online resources daily for their education in various settings. Resident perceptions of individual website's trustworthiness, ease of use, and sources of clinical decision-making and personal learning suggest potential opportunities for educators to better understand the current use of these resources in residency training. Reported barriers including lack of faculty guidance suggest opportunities for academic psychiatry. Further study is necessary at multiple sites before such results may be generalized.

EFFECTS OF NITROGEN LOADING, FRESHWATER RESIDENCE TIME, AND INTERNAL LOSSES ON NITROGEN CONCENTRATIONS IN ESTUARIES

EPA Science Inventory

A simple model is presented that uses the annual loading rate of total nitrogen (TN) and the water residence time to calculate: 1) average annual TN concentration and intemalloss rates (e.g. denitrification and incorporation in sediments) in an estuary, and 2) the rate of nitroge...

EFFECT OF RESIDENCE TIME ON ANNUAL EXPORT AND DENITRIFICATION OF NITROGEN IN ESTUARIES: A MODEL ANALYSIS

EPA Science Inventory

A simple model of annual average response of an estuary to mean nitrogen loading rate and freshwater residence time was developed and tested. It uses nitrogen inputs from land, deposition from the atmosphere, and first-order calculations of internal loss rate and export to perfor...

Identification of registered nursing care of residents in English nursing homes using the Minimum Data Set Resident Assessment Instrument (MDS/RAI) and Resource Utilisation Groups version III (RUG-III).

PubMed

Carpenter, Iain; Perry, Michelle; Challis, David; Hope, Kevin

2003-05-01

to determine if a combination of Minimum Data Set/Resident Assessment Instrument (MDS/RAI) assessment variables and the Resource Utilisation Groups version III (RUG-III) case-mix system could be used as a method of identifying and reimbursing registered nursing care needs in long-term care. the sample included 193 nursing home residents from four nursing homes from three different locations and care providers in England. The study included assessments of residents' care needs using either the MDS/RAI assessments or RUG stand-alone questionnaires and a time study that recorded the amount of nursing time received by residents over a 24-h period. Validity of RUG-III for explaining the distribution of care time between residents in different RUG-III groups was tested. The difference in direct and indirect care provided by registered general nurses (RGN) and care assistants (CA) to residents in RUG-III clinical groups was compared. the RUG-III system explained 56% of the variance in care time (Eta2, P=0.0001). Residents in RUG-III groups associated with particular medical and nursing needs (enhanced RGN care) received more than twice as much indirect RGN care time (t-test, P<0.001) and 1.4 times as much direct RGN and direct CA time (t-test, P<0.01) than residents with primarily cognitive impairment or physical problems only (standard RGN care). Residents with enhanced RGN care received an average of 48.1 min of RGN care in 24 h (95% CI 4.1-55.2) compared with an average of 31.1 min (95% CI 26.8-35.5) for residents in the standard RGN care group. A third low RGN care group was created following publication of the Department of Health guidance on NHS Funded Nursing Care. With three levels, the enhanced care group receives about 38% more than the standard group, and the low group receives about 50% of the standard group. the RUG-III system effectively differentiated between nursing home residents who are receiving 'low', 'standard' and 'enhanced' RGN care time. The findings could provide the basis of a reimbursement system for registered nursing time in long-term care facilities in the UK.

Assessing resident performance and training of colonoscopy in a general surgery training program.

PubMed

Hope, William W; Hooks, W Borden; Kilbourne, S Nicole; Adams, Ashley; Kotwall, Cyrus A; Clancy, Thomas V

2013-05-01

Recently, the adequacy of endoscopy training in general surgery residency programs has been questioned. Efforts to improve resident endoscopic training and to judge competency are ongoing but not well studied. We assessed resident performance using two assessment tools in colonoscopy in a general surgery residency program. Prospectively collected data were reviewed from consecutive colonoscopies by a single surgeon: September 2008 to June 2011. Colonoscopies performed without residents were excluded. Data included patient demographics, procedural data, and outcomes. Following the colonoscopy, residents were graded by the attending surgeon using up two different assessment tools. Descriptive statistics were calculated and outcomes were compared. Colonoscopies were performed by residents in 100 patients. Average age was 52 (range, 22-79) years. Females made up 66 % of patients, and 63 % were Caucasian. Postgraduate level (PG-Y) 3 level residents performed 72 % of colonoscopies. The average resident participation was 73 % of the procedure. Biopsies were performed in 35 %; adenomatous polyps were found in 17 % and invasive cancer in 1 %. Bowel preparation was deemed good in 76 % of patients. Colonoscopy was completed in 90 % of patients. Reasons for incomplete exam were technical (7 patients), inability to pass a stricture (2 patients), and poor prep (1 patient). For completed full colonoscopies, the average time to reach the cecum was 22 min, and withdrawal time was 13 min. Resident assessments were made in 89 of the colonoscopies using 2 separate assessment tools. There were no mortalities; the morbidity rate was 3 %. Morbidities included a perforation related to a biopsy requiring surgery and partial colectomy, a postpolypectomy bleed requiring repeat colonoscopy with clipping of the bleeding vessel, and a patient with transient bradycardia requiring atropine during the procedure. Using objective assessment tools, overall resident skill and knowledge in performing colonoscopy appears to improve based on increasing PG-Y level, although this was not evident with all categories measured. Methods to assess competency continue to evolve and should be the focus of future research.

Phenological differences among selected residents and long-distance migrant bird species in central Europe

NASA Astrophysics Data System (ADS)

Bartošová, Lenka; Trnka, Miroslav; Bauer, Zdeněk; Možný, Martin; Štěpánek, Petr; Žalud, Zdeněk

2014-07-01

The phenological responses to climate of residents and migrants (short- and long-distance) differ. Although few previous studies have focussed on this topic, the agree that changes in phenology are more apparent for residents than for long-distance migrants. We analysed the breeding times of two selected residents ( Sitta europaea, Parus major) and one long-distance migrant ( Ficedula albicollis) from 1961 to 2007 in central Europe. The timing of the phenophases of all three bird species showed a significant advance to earlier times. Nevertheless, the most marked shift was observed for the long-distance migrant (1.9 days per decade on average in mean laying date with linearity at the 99.9 % confidence level). In contrast, the shifts shown by the residents were smaller (1.6 days for S. europaea and 1.5 days for P. major also on average in mean laying date for both, with linearity at the 95 % confidence level). Spearman rank correlation coefficients calculated for pairs of phenophases of given bird species in 20-year subsamples (e.g. 1961-1980, 1962-1981) showed higher phenological separation between the residents and the migrant. This separation is most apparent after the 1980s. Thus, our results indicate that the interconnections between the studied phenological stages of the three bird species are becoming weaker.

Connections between residence time distributions and watershed characteristics across the continental US

NASA Astrophysics Data System (ADS)

Condon, L. E.; Maxwell, R. M.; Kollet, S. J.; Maher, K.; Haggerty, R.; Forrester, M. M.

2016-12-01

Although previous studies have demonstrated fractal residence time distributions in small watersheds, analyzing residence time scaling over large spatial areas is difficult with existing observational methods. For this study we use a fully integrated groundwater surface water simulation combined with Lagrangian particle tracking to evaluate connections between residence time distributions and watershed characteristics such as geology, topography and climate. Our simulation spans more than six million square kilometers of the continental US, encompassing a broad range of watershed sizes and physiographic settings. Simulated results demonstrate power law residence time distributions with peak age rages from 1.5 to 10.5 years. These ranges agree well with previous observational work and demonstrate the feasibility of using integrated models to simulate residence times. Comparing behavior between eight major watersheds, we show spatial variability in both the peak and the variance of the residence time distributions that can be related to model inputs. Peak age is well correlated with basin averaged hydraulic conductivity and the semi-variance corresponds to aridity. While power law age distributions have previously been attributed to fractal topography, these results illustrate the importance of subsurface characteristics and macro climate as additional controls on groundwater configuration and residence times.

Family practice residents' maternity leave experiences and benefits.

PubMed

Gjerdingen, D K; Chaloner, K M; Vanderscoff, J A

1995-09-01

A growing number of residents are having babies during residency training. While many businesses are working to improve maternity conditions and benefits for their employees, residency programs are often not prepared to accommodate pregnant residents. This study was conducted to examine the maternity leave experiences of women who delivered infants during their family practice residency training. Program directors from each of the 394 family practice residency programs listed in the 1993 Directory of Family Practice Residency Programs were asked to distribute surveys to female residents who gave birth during their residency training and had returned to work by the time of the study. Of 199 known eligible residents, 171 (86%) completed surveys; these women represented 127 programs located in 36 states and Puerto Rico. Only 56.8% of women were aware of their program having a written maternity leave policy. The average length of maternity leave was 8 weeks; 76% had leaves of 10 weeks or less. For many, the maternity leave was derived from more than one source, including vacation, sick time, or a mother-child elective. Nearly all (88.3%) the women breast-fed, and the mean duration of breast-feeding was more than 19 weeks. In general, participants believed that having a baby during residency was somewhat difficult. Problems frequently encountered by women after their return to work included sleep deprivation and tiredness, difficulty arranging for child care, guilt about child care, and breast-feeding. Factors that detracted most from the childbirth experience were too little sleep, problems arranging for child care, and lack of support from the partner, residency faculty, and other residents. Having a baby during residency is somewhat difficult for the average female resident. Factors that may ease this difficulty include getting adequate sleep and receiving support from one's partner, faculty, and other residents.

An influential factor for external radiation dose estimation for residents after the Fukushima Daiichi Nuclear Power Plant accident-time spent outdoors for residents in Iitate Village.

PubMed

Ishikawa, Tetsuo; Yasumura, Seiji; Ohtsuru, Akira; Sakai, Akira; Akahane, Keiichi; Yonai, Shunsuke; Sakata, Ritsu; Ozasa, Kotaro; Hayashi, Masayuki; Ohira, Tetsuya; Kamiya, Kenji; Abe, Masafumi

2016-06-01

Many studies have been conducted on radiation doses to residents after the Fukushima Daiichi Nuclear Power Plant (FDNPP) accident. Time spent outdoors is an influential factor for external dose estimation. Since little information was available on actual time spent outdoors for residents, different values of average time spent outdoors per day have been used in dose estimation studies on the FDNPP accident. The most conservative value of 24 h was sometimes used, while 2.4 h was adopted for indoor workers in the UNSCEAR 2013 report. Fukushima Medical University has been estimating individual external doses received by residents as a part of the Fukushima Health Management Survey by collecting information on the records of moves and activities (the Basic Survey) after the accident from each resident. In the present study, these records were analyzed to estimate an average time spent outdoors per day. As an example, in Iitate Village, its arithmetic mean was 2.08 h (95% CI: 1.64-2.51) for a total of 170 persons selected from respondents to the Basic Survey. This is a much smaller value than commonly assumed. When 2.08 h is used for the external dose estimation, the dose is about 25% (23-26% when using the above 95% CI) less compared with the dose estimated for the commonly used value of 8 h.

Modeling decadal timescale interactions between surface water and ground water in the central Everglades, Florida, USA

USGS Publications Warehouse

Harvey, J.W.; Newlin, J.T.; Krupa, S.L.

2006-01-01

Surface-water and ground-water flow are coupled in the central Everglades, although the remoteness of this system has hindered many previous attempts to quantify interactions between surface water and ground water. We modeled flow through a 43,000 ha basin in the central Everglades called Water Conservation Area 2A. The purpose of the model was to quantify recharge and discharge in the basin's vast interior areas. The presence and distribution of tritium in ground water was the principal constraint on the modeling, based on measurements in 25 research wells ranging in depth from 2 to 37 m. In addition to average characteristics of surface-water flow, the model parameters included depth of the layer of 'interactive' ground water that is actively exchanged with surface water, average residence time of interactive ground water, and the associated recharge and discharge fluxes across the wetland ground surface. Results indicated that only a relatively thin (8 m) layer of the 60 m deep surfical aquifer actively exchanges surface water and ground water on a decadal timescale. The calculated storage depth of interactive ground water was 3.1 m after adjustment for the porosity of peat and sandy limestone. Modeling of the tritium data yielded an average residence time of 90 years in interactive ground water, with associated recharge and discharge fluxes equal to 0.01 cm d -1. 3H/3He isotopic ratio measurements (which correct for effects of vertical mixing in the aquifer with deeper, tritium-dead water) were available from several wells, and these indicated an average residence time of 25 years, suggesting that residence time was overestimated using tritium measurements alone. Indeed, both residence time and storage depth would be expected to be overestimated due to vertical mixing. The estimate of recharge and discharge (0.01 cm d-1) that resulted from tritium modeling therefore is still considered reliable, because the ratio of residence time and storage depth (used to calculated recharge and discharge) is much less sensitive to vertical mixing compared with residence time alone. We conclude that a small but potentially significant component of flow through the Everglades is recharged to the aquifer and stored there for years to decades before discharged back to surface water. Long-term storage of water and solutes in the ground-water system beneath the wetlands has implications for restoration of Everglades water quality.

Modeling decadal timescale interactions between surface water and ground water in the central Everglades, Florida, USA

NASA Astrophysics Data System (ADS)

Harvey, Judson W.; Newlin, Jessica T.; Krupa, Steven L.

2006-04-01

Surface-water and ground-water flow are coupled in the central Everglades, although the remoteness of this system has hindered many previous attempts to quantify interactions between surface water and ground water. We modeled flow through a 43,000 ha basin in the central Everglades called Water Conservation Area 2A. The purpose of the model was to quantify recharge and discharge in the basin's vast interior areas. The presence and distribution of tritium in ground water was the principal constraint on the modeling, based on measurements in 25 research wells ranging in depth from 2 to 37 m. In addition to average characteristics of surface-water flow, the model parameters included depth of the layer of 'interactive' ground water that is actively exchanged with surface water, average residence time of interactive ground water, and the associated recharge and discharge fluxes across the wetland ground surface. Results indicated that only a relatively thin (8 m) layer of the 60 m deep surfical aquifer actively exchanges surface water and ground water on a decadal timescale. The calculated storage depth of interactive ground water was 3.1 m after adjustment for the porosity of peat and sandy limestone. Modeling of the tritium data yielded an average residence time of 90 years in interactive ground water, with associated recharge and discharge fluxes equal to 0.01 cm d -1. 3H/ 3He isotopic ratio measurements (which correct for effects of vertical mixing in the aquifer with deeper, tritium-dead water) were available from several wells, and these indicated an average residence time of 25 years, suggesting that residence time was overestimated using tritium measurements alone. Indeed, both residence time and storage depth would be expected to be overestimated due to vertical mixing. The estimate of recharge and discharge (0.01 cm d -1) that resulted from tritium modeling therefore is still considered reliable, because the ratio of residence time and storage depth (used to calculated recharge and discharge) is much less sensitive to vertical mixing compared with residence time alone. We conclude that a small but potentially significant component of flow through the Everglades is recharged to the aquifer and stored there for years to decades before discharged back to surface water. Long-term storage of water and solutes in the ground-water system beneath the wetlands has implications for restoration of Everglades water quality.

40 CFR 63.1257 - Test methods and compliance procedures.

Code of Federal Regulations, 2012 CFR

2012-07-01

...)(2), or 63.1256(h)(2)(i)(C) with a minimum residence time of 0.5 seconds and a minimum temperature of... temperature of the organic HAP, must consider the vent stream flow rate, and must establish the design minimum and average temperature in the combustion zone and the combustion zone residence time. (B) For a...

40 CFR 63.1257 - Test methods and compliance procedures.

Code of Federal Regulations, 2011 CFR

2011-07-01

...)(2), or 63.1256(h)(2)(i)(C) with a minimum residence time of 0.5 seconds and a minimum temperature of... temperature of the organic HAP, must consider the vent stream flow rate, and must establish the design minimum and average temperature in the combustion zone and the combustion zone residence time. (B) For a...

40 CFR 63.1257 - Test methods and compliance procedures.

Code of Federal Regulations, 2010 CFR

2010-07-01

...)(2), or 63.1256(h)(2)(i)(C) with a minimum residence time of 0.5 seconds and a minimum temperature of... temperature of the organic HAP, must consider the vent stream flow rate, and must establish the design minimum and average temperature in the combustion zone and the combustion zone residence time. (B) For a...

Career track of Society of University Surgeons Resident Research Award recipients.

PubMed

Hassan, Burhan; Bernstam, Elmer; Hines, O Joe; Simeone, Diane M; Weber, Sharon M; Geller, David A; Evers, B Mark; Meric-Bernstam, Funda

2013-11-01

The Society of University Surgeons (SUS) has an ongoing competitive funding program to support research training for residents. We sought to determine the career track of award recipients. We included in the study SUS resident awardees who completed awards from 1989-2007. Characteristics of awardees and their academic productivity were extracted from curriculum vitae provided by awardees (n = 24), or from online sources (n = 7). Awardees spent an average of 2.7 y (range, 1-4 y) of dedicated research time during residency. Awardees averaged 9.8 publications (range, 1-32), with 5.4 as first author (range, 1-17), with their mentor within 3 y of award completion, with an average maximum impact factor of 5.7. A total of 25 residents (81%) pursued fellowships. At an average follow-up of 11.4 y (range, 4-22 y) from the end of the award and 7.2 y (range, 0-18 y) from end of clinical training, awardees had a Hirsch index of 14.5 (range, 2-48). At the time of the study, 26 awardees (84%) were in academic surgery. Of the 23 awardees who had completed surgical training ≥ 3 y earlier, 11 (48%) received independent research funding, seven of whom (30%) received R01 or equivalent funding. The SUS resident research awardees had a productive research experience. Although our retrospective study cannot determine causation, the SUS award mechanism delivers on its promise of supporting junior surgeon-scientists who pursue academic careers and establish independent research programs. Further studies are needed to determine how rates of subsequent independent research funding can be improved. Copyright © 2013 Elsevier Inc. All rights reserved.

General surgery residency program websites: usefulness and usability for resident applicants.

PubMed

Reilly, Eugene F; Leibrandt, Thomas J; Zonno, Alan J; Simpson, Mary Christina; Morris, Jon B

2004-01-01

To assess the content of general surgery residency program websites, the websites' potential as tools in resident recruitment, and their "usability." The homepages of general surgery residency programs were evaluated for accessibility, ease-of-use, adherence to established principles of website design, and content. Investigators completed a questionnaire on aspects of their online search, including number of mouse-clicks used, number of errors encountered, and number of returns to the residency homepage. The World Wide Web listings on the Fellowship and Residency Electronic Interactive Database (FREIDA) of the American Medical Association (AMA). A total of 251 ACGME-accredited general surgery residency programs. One hundred sixty-seven programs (67%) provided a viable link to the program's website. Evaluators found an average of 5.9 of 16 content items; 2 (1.2%) websites provided as many as 12 content items. Five of the 16 content items (program description, conference schedules, listing of faculty, caseload, and salary) were found on more than half of the sites. An average of 24 mouse-clicks was required to complete the questionnaire for each site. Forty-six sites (28%) generated at least 1 error during our search. The residency homepage was revisited an average of 5 times during each search. On average, programs adhered to 6 of the 10 design principles; only 6 (3.6%) sites adhered to all 10 design principles. Two of the 10 design principles (use of familiar fonts, absence of frames) were adhered to in more than half of the sites. Our overall success rate when searching residency websites was 38%. General surgery residency programs do not use the World Wide Web optimally, particularly for users who are potential residency candidates. The usability of these websites could be increased by providing relevant content, making that content easier to find, and adhering to established web design principles.

Coupled Long-Term Simulation of Reach-Scale Water and Heat Fluxes Across the River-Groundwater Interface for Retrieving Hyporheic Residence Times and Temperature Dynamics

NASA Astrophysics Data System (ADS)

Munz, Matthias; Oswald, Sascha E.; Schmidt, Christian

2017-11-01

Flow patterns in conjunction with seasonal and diurnal temperature variations control ecological and biogeochemical conditions in hyporheic sediments. In particular, hyporheic temperatures have a great impact on many temperature-sensitive microbial processes. In this study, we used 3-D coupled water flow and heat transport simulations applying the HydroGeoSphere code in combination with high-resolution observations of hydraulic heads and temperatures to quantify reach-scale water and heat flux across the river-groundwater interface and hyporheic temperature dynamics of a lowland gravel bed river. The model was calibrated in order to constrain estimates of the most sensitive model parameters. The magnitude and variations of the simulated temperatures matched the observed ones, with an average mean absolute error of 0.7°C and an average Nash Sutcliffe efficiency of 0.87. Our results indicate that nonsubmerged streambed structures such as gravel bars cause substantial thermal heterogeneity within the saturated sediment at the reach scale. Individual hyporheic flow path temperatures strongly depend on the flow path residence time, flow path depth, river, and groundwater temperature. Variations in individual hyporheic flow path temperatures were up to 7.9°C, significantly higher than the daily average (2.8°C), but still lower than the average seasonal hyporheic temperature difference (19.2°C). The distribution between flow path temperatures and residence times follows a power law relationship with exponent of about 0.37. Based on this empirical relation, we further estimated the influence of hyporheic flow path residence time and temperature on oxygen consumption which was found to partly increase by up to 29% in simulations.

A daily huddle facilitates patient transports from a neonatal intensive care unit

PubMed Central

Hughes Driscoll, Colleen; El Metwally, Dina

2014-01-01

To improve hospital access for expectant women and newborns in the state of Maryland, a quality improvement team reviewed the patient flow characteristics of our neonatal intensive care unit. We identified inefficiencies in patient discharges, including delays in patient transports. Several patient transport delays were caused by late preparation and delivery of the patient transfer summary. Baseline data collection revealed that transfer summaries were prepared on-time by the resident or nurse practitioner only 41% of the time on average, while the same transfer summaries were signed on-time by the neonatologist 5% of the time on average. Our aim was to improve the rate of on-time transfer summaries to 50% over a four month time period. We performed two PDSA cycles based on feedback from our quality improvement team. In the first cycle, we instituted a daily huddle to increase opportunities for communication about patient transports. In the second cycle, we increased computer access for residents and nurse practitioners preparing the transfer summaries. The on-time summary preparation by residents/nurse practitioners improved to an average of 72% over a nine month period. The same summaries were signed on-time by a neonatologist 26% of the time on average over a nine month period. In conclusion, institution of a daily huddle combined with augmented computer resources significantly increased the percentage of on-time transfer summaries. Current data show a trend toward improved ability to accept patient referrals. Further data collection and analysis is needed to determine the impact of these interventions on access to hospital care for expectant women and newborns in our state. PMID:26734275

A time-efficient web-based teaching tool to improve medical knowledge and decrease ABIM failure rate in select residents.

PubMed

Drake, Sean M; Qureshi, Waqas; Morse, William; Baker-Genaw, Kimberly

2015-01-01

The American Board of Internal Medicine (ABIM) exam's pass rate is considered a quality measure of a residency program, yet few interventions have shown benefit in reducing the failure rate. We developed a web-based Directed Reading (DR) program with an aim to increase medical knowledge and reduce ABIM exam failure rate. Internal medicine residents at our academic medical center with In-Training Examination (ITE) scores ≤ 35 th percentile from 2007 to 2013 were enrolled in DR. The program matches residents to reading assignments based on their own ITE-failed educational objectives and provides direct electronic feedback from their teaching physicians. ABIM exam pass rates were analyzed across various groups between 2002 and 2013 to examine the effect of the DR program on residents with ITE scores ≤ 35 percentile pre- (2002-2006) and post-intervention (2007-2013). A time commitment survey was also given to physicians and DR residents at the end of the study. Residents who never scored ≤ 35 percentile on ITE were the most likely to pass the ABIM exam on first attempt regardless of time period. For those who ever scored ≤ 35 percentile on ITE, 91.9% of residents who participated in DR passed the ABIM exam on first attempt vs 85.2% of their counterparts pre-intervention (p < 0.001). This showed an improvement in ABIM exam pass rate for this subset of residents after introduction of the DR program. The time survey showed that faculty used an average of 40±18 min per week to participate in DR and residents required an average of 25 min to search/read about the objective and 20 min to write a response. Although residents who ever scored ≤ 35 percentile on ITE were more likely to fail ABIM exam on first attempt, those who participated in the DR program were less likely to fail than the historical control counterparts. The web-based teaching method required little time commitment by faculty.

A time-efficient web-based teaching tool to improve medical knowledge and decrease ABIM failure rate in select residents

PubMed Central

Drake, Sean M.; Qureshi, Waqas; Morse, William; Baker-Genaw, Kimberly

2015-01-01

Aim The American Board of Internal Medicine (ABIM) exam's pass rate is considered a quality measure of a residency program, yet few interventions have shown benefit in reducing the failure rate. We developed a web-based Directed Reading (DR) program with an aim to increase medical knowledge and reduce ABIM exam failure rate. Methods Internal medicine residents at our academic medical center with In-Training Examination (ITE) scores ≤35th percentile from 2007 to 2013 were enrolled in DR. The program matches residents to reading assignments based on their own ITE-failed educational objectives and provides direct electronic feedback from their teaching physicians. ABIM exam pass rates were analyzed across various groups between 2002 and 2013 to examine the effect of the DR program on residents with ITE scores ≤35 percentile pre- (2002–2006) and post-intervention (2007–2013). A time commitment survey was also given to physicians and DR residents at the end of the study. Results Residents who never scored ≤35 percentile on ITE were the most likely to pass the ABIM exam on first attempt regardless of time period. For those who ever scored ≤35 percentile on ITE, 91.9% of residents who participated in DR passed the ABIM exam on first attempt vs 85.2% of their counterparts pre-intervention (p<0.001). This showed an improvement in ABIM exam pass rate for this subset of residents after introduction of the DR program. The time survey showed that faculty used an average of 40±18 min per week to participate in DR and residents required an average of 25 min to search/read about the objective and 20 min to write a response. Conclusions Although residents who ever scored ≤35 percentile on ITE were more likely to fail ABIM exam on first attempt, those who participated in the DR program were less likely to fail than the historical control counterparts. The web-based teaching method required little time commitment by faculty. PMID:26521767

A time-efficient web-based teaching tool to improve medical knowledge and decrease ABIM failure rate in select residents.

PubMed

Drake, Sean M; Qureshi, Waqas; Morse, William; Baker-Genaw, Kimberly

2015-01-01

Aim The American Board of Internal Medicine (ABIM) exam's pass rate is considered a quality measure of a residency program, yet few interventions have shown benefit in reducing the failure rate. We developed a web-based Directed Reading (DR) program with an aim to increase medical knowledge and reduce ABIM exam failure rate. Methods Internal medicine residents at our academic medical center with In-Training Examination (ITE) scores ≤35th percentile from 2007 to 2013 were enrolled in DR. The program matches residents to reading assignments based on their own ITE-failed educational objectives and provides direct electronic feedback from their teaching physicians. ABIM exam pass rates were analyzed across various groups between 2002 and 2013 to examine the effect of the DR program on residents with ITE scores ≤35 percentile pre- (2002-2006) and post-intervention (2007-2013). A time commitment survey was also given to physicians and DR residents at the end of the study. Results Residents who never scored ≤35 percentile on ITE were the most likely to pass the ABIM exam on first attempt regardless of time period. For those who ever scored ≤35 percentile on ITE, 91.9% of residents who participated in DR passed the ABIM exam on first attempt vs 85.2% of their counterparts pre-intervention (p<0.001). This showed an improvement in ABIM exam pass rate for this subset of residents after introduction of the DR program. The time survey showed that faculty used an average of 40±18 min per week to participate in DR and residents required an average of 25 min to search/read about the objective and 20 min to write a response. Conclusions Although residents who ever scored ≤35 percentile on ITE were more likely to fail ABIM exam on first attempt, those who participated in the DR program were less likely to fail than the historical control counterparts. The web-based teaching method required little time commitment by faculty.

The increased financial burden of further proposed orthopaedic resident work-hour reductions.

PubMed

Kamath, Atul F; Baldwin, Keith; Meade, Lauren K; Powell, Adam C; Mehta, Samir

2011-04-06

Increased funding for graduate medical education was not provided during implementation of the eighty-hour work week. Many teaching hospitals responded to decreased work hours by hiring physician extenders to maintain continuity of care. Recent proposals have included a further decrease in work hours to a total of fifty-six hours. The goal of this study was to determine the direct cost related to a further reduction in orthopaedic-resident work hours. A survey was delivered to 152 residency programs to determine the number of full-time equivalent (FTE) physician extenders hired after implementation of the eighty-hour work-week restriction. Thirty-six programs responded (twenty-nine university-based programs and seven community-based programs), encompassing 1021 residents. Previous published data were used to determine the change in resident work hours with implementation of the eighty-hour regulation. A ratio between change in full-time equivalent staff per resident and number of reduced hours was used to determine the cost of the proposed further decrease. After implementation of the eighty-hour work week, the average reduction among orthopaedic residents was approximately five work hours per week. One hundred and forty-three physician extenders (equal to 142 full-time equivalent units) were hired to meet compliance at a frequency-weighted average cost of $96,000 per full-time equivalent unit. A further reduction to fifty-six hours would increase the cost by $64,000 per resident. With approximately 3200 orthopaedic residents nationwide, sensitivity analyses (based on models of eighty and seventy-three-hour work weeks) demonstrate that the increased cost would be between $147 million and $208 million per fiscal year. For each hourly decrease in weekly work hours, the cost is $8 million to $12 million over the course of a fiscal year. Mandated reductions in resident work hours are a costly proposition, without a clear decrease in adverse events. The federal government should consider these data prior to initiating unfunded work-hour mandates, as further reductions in resident work hours may make resident education financially unsustainable. © 2011 by the Journal of Bone and Joint Surgery, Incorporated

Drinking water insecurity: water quality and access in coastal south-western Bangladesh.

PubMed

Benneyworth, Laura; Gilligan, Jonathan; Ayers, John C; Goodbred, Steven; George, Gregory; Carrico, Amanda; Karim, Md Rezaul; Akter, Farjana; Fry, David; Donato, Katherine; Piya, Bhumika

2016-01-01

National drinking water assessments for Bangladesh do not reflect local variability, or temporal differences. This paper reports on the findings of an interdisciplinary investigation of drinking water insecurity in a rural coastal south-western Bangladesh. Drinking water quality is assessed by comparison of locally measured concentrations to national levels and water quality criteria; resident's access to potable water and their perceptions are based on local social surveys. Residents in the study area use groundwater far less than the national average; salinity and local rainwater scarcity necessitates the use of multiple water sources throughout the year. Groundwater concentrations of arsenic and specific conductivity (SpC) were greater than surface water (pond) concentrations; there was no statistically significant seasonal difference in mean concentrations in groundwater, but there was for ponds, with arsenic higher in the dry season. Average arsenic concentrations in local water drinking were 2-4 times times the national average. All of the local groundwater samples exceeded the Bangladesh guidance for SpC, although the majority of residents surveyed did not perceive their water as having a 'bad' or 'salty' taste.

Spatial patterns of ecosystem carbon residence time and NPP-driven carbon uptake in the conterminous United States

NASA Astrophysics Data System (ADS)

Zhou, Tao; Luo, Yiqi

2008-09-01

Ecosystem carbon (C) uptake is determined largely by C residence times and increases in net primary production (NPP). Therefore, evaluation of C uptake at a regional scale requires knowledge on spatial patterns of both residence times and NPP increases. In this study, we first applied an inverse modeling method to estimate spatial patterns of C residence times in the conterminous United States. Then we combined the spatial patterns of estimated residence times with a NPP change trend to assess the spatial patterns of regional C uptake in the United States. The inverse analysis was done by using the genetic algorithm and was based on 12 observed data sets of C pools and fluxes. Residence times were estimated by minimizing the total deviation between modeled and observed values. Our results showed that the estimated C residence times were highly heterogeneous over the conterminous United States, with most of the regions having values between 15 and 65 years; and the averaged C residence time was 46 years. The estimated C uptake for the whole conterminous United States was 0.15 P g C a-1. Large portions of the taken C were stored in soil for grassland and cropland (47-70%) but in plant pools for forests and woodlands (73-82%). The proportion of C uptake in soil was found to be determined primarily by C residence times and be independent of the magnitude of NPP increase. Therefore, accurate estimation of spatial patterns of C residence times is crucial for the evaluation of terrestrial ecosystem C uptake.

Defining service and education: the first step to developing the correct balance.

PubMed

Reines, H David; Robinson, Linda; Nitzchke, Stephanie; Rizzo, Anne

2007-08-01

Service and education activities have not been well defined or studied. The purpose of this study is to describe how attendings and residents categorize common resident activities on a service-education continuum. A web-based survey was designed to categorize resident activities. A panel of residents and surgical educators reviewed the survey for content validity. Residents and attendings categorized 27 resident activities on a 5-point scale from 1 (pure service) to 5 (pure education). Data analysis was performed using SPSS ver.12. 125 residents and 71 attendings from eight residency programs participated. 66% of residents and 90% of attendings were male. On average, attendings had practiced 14.3 years. Residents' post-graduate year ranged from PGY-1 to PGY-6 (mean of 2.78). Attendings and residents agreed on the categorization of most activities. Residents felt more time should be devoted to pure education than did attendings. Forty percent of residents felt that more than half of their time was spent in pure service versus 10% of attendings. Twenty-five percent of residents and 23% of attendings were dissatisfied with the service-education balance. The Residency Review Committee mandates that education is the central purpose of the surgical residency without clearly defining the balance between education and service. Attendings and residents agree on the educational value of most activities and that the balance between education and service is acceptable. When compared with attendings, residents feel they need significantly more time in education. Adequate learning can be facilitated by the development of clear definitions of service and education and guidelines for the distribution of resident time.

Is council tax valuation band a predictor of mortality?

PubMed Central

Beale, Norman R; Taylor, Gordon J; Straker-Cook, Dawn MK

2002-01-01

Background All current UK indices of socio-economic status have inherent problems, especially those used to govern resource allocation to the health sphere. The search for improved markers continues: this study proposes and tests the possibility that Council Tax Valuation Band (CTVB) might match requirements. Presentation of the hypothesis To determine if there is an association between CTVB of final residence and mortality risk using the death registers of a UK general practice. Testing the hypothesis Standardised death rates and odds ratios (ORs) for groups defined by CTVB of dwelling (A – H) were calculated using one in four denominator samples from the practice lists. Analyses were repeated three times – between number of deaths and CTVB of residence of deceased 1992 – 1994 inclusive, 1995 – 1997 inc., 1998 – 2000 inc. In 856 deaths there were consistent and significant differences in death rates between CTVBs: above average for bands A and B residents; below average for other band residents. There were significantly higher ORs for A, B residents who were female and who died prematurely (before average group life expectancy). Implications of the hypothesis CTVB of final residence appears to be a proxy marker of mortality risk and could be a valuable indicator of health needs resource at household level. It is worthy of further exploration. PMID:12207828

A Time Study of Plastic Surgery Residents.

PubMed

Lau, Frank H; Sinha, Indranil; Jiang, Wei; Lipsitz, Stuart R; Eriksson, Elof

2016-05-01

Resident work hours are under scrutiny and have been subject to multiple restrictions. The studies supporting these changes have not included data on surgical residents. We studied the workday of a team of plastic surgery residents to establish prospective time-study data of plastic surgery (PRS) residents at a single tertiary-care academic medical center. Five trained research assistants observed all residents (n = 8) on a PRS service for 10 weeks and produced minute-by-minute activity logs. Data collection began when the team first met in the morning and continued until the resident being followed completed all non-call activities. We analyzed our data from 3 perspectives: 1) time spent in direct patient care (DPC), indirect patient care, and didactic activities; 2) time spent in high education-value activities (HEAs) versus low education-value activities; and 3) resident efficiency. We defined HEAs as activities that surgeons must master; other activities were LEAs. We quantified resident efficiency in terms of time fragmentation and time spent waiting. A total of 642.4 hours of data across 50 workdays were collected. Excluding call, residents worked an average of 64.2 hours per week. Approximately 50.7% of surgical resident time was allotted to DPC, with surgery accounting for the largest segment of this time (34.8%). Time spent on HEAs demonstrated trended upward with higher resident level (P = 0.086). Time in spent in surgery was significantly associated with higher resident levels (P < 0.0001); 57.7% of activities require 4 minutes or less, suggesting that resident work was highly fragmented. Residents spent 10.7% of their workdays waiting for other services. In this first-time study of PRS residents, we found that compared with medicine trainees, surgical residents spent 3.23 times more time on DPC. High education-value activities comprised most of our residents' workdays. Surgery was the leading component of both DPC and HEAs. Our residents were highly efficient and fragmented, with the majority of all activities requiring 4 minutes or less. Residents spent a large portion of their time waiting for other services. In light of these data, we suggest that future changes to residency programs be pilot tested, with preimplantation and postimplementation time studies performed to quantify the changes' impact.

Effects of an exercise and scheduled-toileting intervention on appetite and constipation in nursing home residents.

PubMed

Simmons, S F; Schnelle, J F

2004-01-01

To evaluate the effects of an exercise and scheduled-toileting intervention on appetite and constipation in nursing home (NH) residents. A controlled, clinical intervention trial with 89 residents in two NHs. Research staff provided exercise and toileting assistance every two hours, four times per day, five days a week for 32 weeks. Oral food and fluid consumption during meals was measured at baseline, eight and 32 weeks. Bowel movement frequency was measured at baseline and 32 weeks. The intervention group showed significant improvements or maintenance across all measures of daily physical activity, functional performance, and strength compared to the control group. Participants in both groups consumed an average of approximately 55% of meals at all three time points (approximately 1100 calories/day) with no change over time in either group. There was also no change in the frequency of bowel movements in either group, which averaged less than one in two days for both groups; and, approximately one-half of all participants had no bowel movement in two days. An exercise and scheduled-toileting intervention alone is not sufficient to improve oral food and fluid consumption during meals and bowel movement frequency in NH residents.

Internal Medicine Resident Engagement with a Laboratory Utilization Dashboard: Mixed Methods Study.

PubMed

Kurtzman, Gregory; Dine, Jessica; Epstein, Andrew; Gitelman, Yevgenly; Leri, Damien; Patel, Miltesh S; Ryskina, Kyra

2017-09-01

The objective of this study was to measure internal medicine resident engagement with an electronic medical record-based dashboard providing feedback on their use of routine laboratory tests relative to service averages. From January 2016 to June 2016, residents were e-mailed a snapshot of their personalized dashboard, a link to the online dashboard, and text summarizing the resident and service utilization averages. We measured resident engagement using e-mail read-receipts and web-based tracking. We also conducted 3 hour-long focus groups with residents. Using grounded theory approach, the transcripts were analyzed for common themes focusing on barriers and facilitators of dashboard use. Among 80 residents, 74% opened the e-mail containing a link to the dashboard and 21% accessed the dashboard itself. We did not observe a statistically significant difference in routine laboratory ordering by dashboard use, although residents who opened the link to the dashboard ordered 0.26 fewer labs per doctor-patient-day than those who did not (95% confidence interval, -0.77 to 0.25; = 0 .31). While they raised several concerns, focus group participants had positive attitudes toward receiving individualized feedback delivered in real time. © 2017 Society of Hospital Medicine.

Post-Katrina: study in crisis-related program adaptability.

PubMed

Pero, Colin D; Pou, Anna M; Arriaga, Moises A; Nuss, Daniel W

2008-03-01

To discuss disaster planning, didactic reorganization, and clinical realignments useful in rebuilding academic otolaryngology residency programs after disaster. We describe our reorganization and analysis of objective measures in resident education before and after Hurricane Katrina. Post-Katrina, the number of full-time faculty and part-time clinical instructors/gratis faculty has decreased (4 vs 9 and 36 vs 43, respectively), but the number of part-time LSU faculty (private-academic partnership) has increased (0 vs 3) with overall improved resident supervision. Resident complement decreased by 9.3%. Surgical case loads are essentially unchanged. Reorganization of the didactic schedule has increased attendance and maintained examination scores above national averages. Establishment of two new practice sites provided an adequate number of patients for residency training. Poststorm reorganization has maintained or exceeded pre-Katrina performance standards. Establishment of communication and data retrieval proved irreplaceable and demand advance preparation.

Drinking Water Residence Time in Distribution Networks and Emergency Department Visits for Gastrointestinal Illness in Metro Atlanta, Georgia

PubMed Central

Moe, Christine L.; Klein, Mitchel; Flanders, W. Dana; Uber, Jim; Amirtharajah, Appiah; Singer, Philip; Tolbert, Paige E.

2013-01-01

We examined whether the average water residence time, the time it takes water to travel from the treatment plant to the user, for a zip code was related to the proportion of emergency department (ED) visits for gastrointestinal (GI) illness among residents of that zip code. Individual-level ED data were collected from all hospitals located in the five-county metro Atlanta area from 1993 to 2004. Two of the largest water utilities in the area, together serving 1.7 million people, were considered. People served by these utilities had almost three million total ED visits, 164,937 of them for GI illness. The relationship between water residence time and risk for GI illness was assessed using logistic regression, controlling for potential confounding factors, including patient age and markers of socioeconomic status (SES). We observed a modestly increased risk for GI illness for residents of zip codes with the longest water residence times compared to intermediate residence times (odds ratio (OR) for Utility 1 = 1.07, 95% confidence interval (CI) = 1.03, 1.10; OR for Utility 2 = 1.05, 95% CI = 1.02, 1.08). The results suggest that drinking water contamination in the distribution system may contribute to the burden of endemic GI illness. PMID:19240359

Drinking water residence time in distribution networks and emergency department visits for gastrointestinal illness in Metro Atlanta, Georgia.

PubMed

Tinker, Sarah C; Moe, Christine L; Klein, Mitchel; Flanders, W Dana; Uber, Jim; Amirtharajah, Appiah; Singer, Philip; Tolbert, Paige E

2009-06-01

We examined whether the average water residence time, the time it takes water to travel from the treatment plant to the user, for a zip code was related to the proportion of emergency department (ED) visits for gastrointestinal (GI) illness among residents of that zip code. Individual-level ED data were collected from all hospitals located in the five-county metro Atlanta area from 1993 to 2004. Two of the largest water utilities in the area, together serving 1.7 million people, were considered. People served by these utilities had almost 3 million total ED visits, 164,937 of them for GI illness. The relationship between water residence time and risk for GI illness was assessed using logistic regression, controlling for potential confounding factors, including patient age and markers of socioeconomic status (SES). We observed a modestly increased risk for GI illness for residents of zip codes with the longest water residence times compared with intermediate residence times (odds ratio (OR) for Utility 1 = 1.07, 95% confidence interval (CI) = 1.03, 1.10; OR for Utility 2 = 1.05, 95% CI = 1.02, 1.08). The results suggest that drinking water contamination in the distribution system may contribute to the burden of endemic GI illness.

Is USMLE Step 1 score a valid predictor of success in surgical residency?

PubMed

Sutton, Erica; Richardson, James David; Ziegler, Craig; Bond, Jordan; Burke-Poole, Molly; McMasters, Kelly M

2014-12-01

Many programs rely extensively on United States Medical Licensing Examination (USMLE) scores for interviews/selection of surgical residents. However, their predictive ability remains controversial. We examined the association between USMLE scores and success in surgical residency. We compared USMLE scores for 123 general surgical residents who trained in the past 20 years and their performance evaluation. Scores were normalized to the mean for the testing year and expressed as a ratio (1 = mean). Performances were evaluated by (1) rotation evaluations; (2) "dropouts;" (3) overall American Board of Surgery pass rate; (4) first-time American Board of Surgery pass rate; and (5) a retrospective comprehensive faculty evaluation. For the latter, 16 surgeons (average faculty tenure 22 years) rated residents on a 1 to 4 score (1 = fair; 4 = excellent). Rotation evaluations by faculty and "drop out" rates were not associated with USMLE score differences (dropouts had average above the mean). One hundred percent of general surgery practitioners achieved board certification regardless of USMLE score but trainees with an average above the mean had a higher first-time pass rate (P = .04). Data from the comprehensive faculty evaluations were conflicting: there was a moderate degree of correlation between board scores and faculty evaluations (r = .287, P = .001). However, a score above the mean was associated with a faculty ranking of 3 to 4 in only 51.7% of trainees. Higher USMLE scores were associated with higher faculty evaluations and first-time board pass rates. However, their positive predictive value was only 50% for higher faculty evaluations and a high overall board pass rate can be achieved regardless of USMLE scores. USMLE Step 1 score is a valid tool for selecting residents but caution might be indicated in using it as a single selection factor. Copyright © 2014 Elsevier Inc. All rights reserved.

Strategies to Prevent MRSA Transmission in Community-Based Nursing Homes: A Cost Analysis.

PubMed

Roghmann, Mary-Claire; Lydecker, Alison; Mody, Lona; Mullins, C Daniel; Onukwugha, Eberechukwu

2016-08-01

OBJECTIVE To estimate the costs of 3 MRSA transmission prevention scenarios compared with standard precautions in community-based nursing homes. DESIGN Cost analysis of data collected from a prospective, observational study. SETTING AND PARTICIPANTS Care activity data from 401 residents from 13 nursing homes in 2 states. METHODS Cost components included the quantities of gowns and gloves, time to don and doff gown and gloves, and unit costs. Unit costs were combined with information regarding the type and frequency of care provided over a 28-day observation period. For each scenario, the estimated costs associated with each type of care were summed across all residents to calculate an average cost and standard deviation for the full sample and for subgroups. RESULTS The average cost for standard precautions was $100 (standard deviation [SD], $77) per resident over a 28-day period. If gown and glove use for high-risk care was restricted to those with MRSA colonization or chronic skin breakdown, average costs increased to $137 (SD, $120) and $125 (SD, $109), respectively. If gowns and gloves were used for high-risk care for all residents in addition to standard precautions, the average cost per resident increased substantially to $223 (SD, $127). CONCLUSIONS The use of gowns and gloves for high-risk activities with all residents increased the estimated cost by 123% compared with standard precautions. This increase was ameliorated if specific subsets (eg, those with MRSA colonization or chronic skin breakdown) were targeted for gown and glove use for high-risk activities. Infect Control Hosp Epidemiol 2016;37:962-966.

Computer usage and task-switching during resident's working day: Disruptive or not?

PubMed

Méan, Marie; Garnier, Antoine; Wenger, Nathalie; Castioni, Julien; Waeber, Gérard; Marques-Vidal, Pedro

2017-01-01

Recent implementation of electronic health records (EHR) has dramatically changed medical ward organization. While residents in general internal medicine use EHR systems half of their working time, whether computer usage impacts residents' workflow remains uncertain. We aimed to observe the frequency of task-switches occurring during resident's work and to assess whether computer usage was associated with task-switching. In a large Swiss academic university hospital, we conducted, between May 26 and July 24, 2015 a time-motion study to assess how residents in general internal medicine organize their working day. We observed 49 day and 17 evening shifts of 36 residents, amounting to 697 working hours. During day shifts, residents spent 5.4 hours using a computer (mean total working time: 11.6 hours per day). On average, residents switched 15 times per hour from a task to another. Task-switching peaked between 8:00-9:00 and 16:00-17:00. Task-switching was not associated with resident's characteristics and no association was found between task-switching and extra hours (Spearman r = 0.220, p = 0.137 for day and r = 0.483, p = 0.058 for evening shifts). Computer usage occurred more frequently at the beginning or ends of day shifts and was associated with decreased overall task-switching. Task-switching occurs very frequently during resident's working day. Despite the fact that residents used a computer half of their working time, computer usage was associated with decreased task-switching. Whether frequent task-switches and computer usage impact the quality of patient care and resident's work must be evaluated in further studies.

Measuring the direct costs of graduate medical education training in Minnesota.

PubMed

Blewett, L A; Smith, M A; Caldis, T G

2001-05-01

To demonstrate the usefulness of self-reported cost-accounting data from the sponsors of training programs for estimating the direct costs of graduate medical education (GME). The study also assesses the relative contributions of resident, faculty, and administrative costs to primary care, surgery, and the combined programs of radiology, emergency medicine, anesthesiology, and pathology (REAP). The data were the FY97 direct costs of clinical education reported to Minnesota's Department of Health by eight sponsors of 117 accredited medical education programs, representing 394 sites of training (both hospital- and community-based) and 2,084 full-time-equivalent trainees (both residents and fellows). Average costs of clinical training were calculated as residency, faculty, and administrative costs. Preliminary analysis showed average costs by type of training programs, comparing the cost components for surgery, primary care, and REAP. The average direct cost of clinical training in FY97 was $130,843. Faculty costs were 52%, resident costs were 26%, and administrative costs were 20% of the total. Primary care programs' average costs were lower than were those of either surgery or REAP programs, but proportionally they included more administrative costs. As policymakers assess government subsidies for GME, more detailed cost information will be required. Self-reported data are more cost-effective and efficient than are the more detailed and costly time-and-motion studies. This data-collection study also revealed that faculty costs, driven by faculty hours and base salaries, represent a higher proportion of direct costs of GME than studies have shown in the past.

Pharmacist home visits: A 1-year experience from a community pharmacy.

PubMed

Monte, Scott V; Passafiume, Sarah N; Kufel, Wesley D; Comerford, Patrick; Trzewieczynski, Dean P; Andrus, Kenneth; Brody, Peter M

2016-01-01

To provide experience on the methods and costs for delivering a large-scale community pharmacist home visit service. Independent urban community pharmacy, Buffalo, NY. Mobile Pharmacy Solutions provides traditional community pharmacy walk-in service and a suite of clinically oriented services, including outbound adherence calls linked to home delivery, payment planning, medication refill synchronization, adherence packaging, and pharmacist home visits. Pharmacist daily staffing included three dispensing pharmacists, one residency-trained pharmacist, and two postgraduate year 1 community pharmacy residents. A large-scale community pharmacy home visit service delivered over a 1-year period. Pharmacist time and cost to administer the home visit service as well as home visit request sources and description of patient demographics. A total of 172 visits were conducted (137 initial, 35 follow-up). Patients who received a home visit averaged 9.8 ± 5.2 medications and 3.0 ± 1.6 chronic disease states. On average, a home visit required 2.0 ± 0.8 hours, which included travel time. The percentages of visits completed by pharmacists and residents were 60% and 40%, respectively. The amounts of time to complete a visit were similar. Average home visit cost including pharmacist time and travel was $119 ($147 for a pharmacist, $77 for a resident). In this community pharmacy-based home visit service, costs are an important factor, with each pharmacist visit requiring 2 hours to complete. This experience provides a blueprint and real-world perspective for community pharmacies endeavoring to implement a home visit service and sets a foundation for future prospective trials to evaluate the impact of the service on important indicators of health and cost. Copyright © 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Comparing Real-time Versus Delayed Video Assessments for Evaluating ACGME Sub-competency Milestones in Simulated Patient Care Environments

PubMed Central

Stiegler, Marjorie; Hobbs, Gene; Martinelli, Susan M; Zvara, David; Arora, Harendra; Chen, Fei

2018-01-01

Background Simulation is an effective method for creating objective summative assessments of resident trainees. Real-time assessment (RTA) in simulated patient care environments is logistically challenging, especially when evaluating a large group of residents in multiple simulation scenarios. To date, there is very little data comparing RTA with delayed (hours, days, or weeks later) video-based assessment (DA) for simulation-based assessments of Accreditation Council for Graduate Medical Education (ACGME) sub-competency milestones. We hypothesized that sub-competency milestone evaluation scores obtained from DA, via audio-video recordings, are equivalent to the scores obtained from RTA. Methods Forty-one anesthesiology residents were evaluated in three separate simulated scenarios, representing different ACGME sub-competency milestones. All scenarios had one faculty member perform RTA and two additional faculty members perform DA. Subsequently, the scores generated by RTA were compared with the average scores generated by DA. Variance component analysis was conducted to assess the amount of variation in scores attributable to residents and raters. Results Paired t-tests showed no significant difference in scores between RTA and averaged DA for all cases. Cases 1, 2, and 3 showed an intraclass correlation coefficient (ICC) of 0.67, 0.85, and 0.50 for agreement between RTA scores and averaged DA scores, respectively. Analysis of variance of the scores assigned by the three raters showed a small proportion of variance attributable to raters (4% to 15%). Conclusions The results demonstrate that video-based delayed assessment is as reliable as real-time assessment, as both assessment methods yielded comparable scores. Based on a department’s needs or logistical constraints, our findings support the use of either real-time or delayed video evaluation for assessing milestones in a simulated patient care environment. PMID:29736352

Scholarship improved by case report curriculum.

PubMed

Stephens, John; Wardrop, Richard

2016-12-01

The Accreditation Council for Graduate Medical Education (ACGME) requires that residents participate in scholarly activity. Case reports are an accessible form of resident scholarship, given the time required relative to other forms of research. Our paediatric residency lacked a curriculum for writing and presenting case reports. We created and implemented a brief curriculum for writing case reports and scientific posters. The curriculum consisted of two 1-hour didactic sessions, followed by mentoring during the writing process. The impact of the curriculum was measured via resident surveys about the material presented and by the rate of presentations of case reports made by residents at our departmental research day, before and after implementation. In the year of curriculum implementation, there were 15 case reports presented at the departmental research day, compared with an average of 4.7 per year in the three prior years. The resident (n = 85) participation rate increased from an average of 0.06 case reports per resident per year before implementation to 0.18 case reports per resident per year after implementation (p = 0.0023). Implementation of a case report curriculum with subsequent mentoring was associated with a marked increase in resident case report presentations at the departmental research day. These results suggest that even brief instruction and subsequent faculty mentorship in preparation of case reports can significantly improve resident participation in scholarly activity. © 2016 John Wiley & Sons Ltd.

Effects of physical and morphometric factors on nutrient removal properties in agricultural ponds.

PubMed

Saito, M; Onodera, S; Okubo, K; Takagi, S; Maruyama, Y; Jin, G; Shimizu, Y

2015-01-01

Effects of physical and morphometric factors on nutrient removal properties were studied in small agricultural ponds with different depths, volumes, and residence times in western Japan. Average residence time was estimated to be >15 days, and it tended to decrease from summer to winter because of the increase in water withdrawal for agricultural activity. Water temperature was clearly different between the surface and bottom layers; this indicates that thermal stratification occurred in summer. Chlorophyll-a was significantly high (>20 μg/L) in the surface layer (<0.5 m) and influenced by the thermal stratification. Removal ratios of dissolved total nitrogen (DTN) and dissolved total phosphorus in the ponds were estimated to be 53-98% and 39-98% in August and 10-92% and 36-57% in December, respectively. Residence time of the ponds was longer in August than in December, and DTN removal, in particular, was more significant in ponds with longer residence time. Our results suggest residence time is an important factor for nitrogen removal in small agricultural ponds as well as large lakes.

Different patterns of myopia prevalence and progression between internal migrant and local resident school children in Shanghai, China: a 2-year cohort study.

PubMed

Ma, Yingyan; Lin, Senlin; Zhu, Jianfeng; Xu, Xun; Lu, Lina; Zhao, Rong; Zhao, Huijuan; Li, Qiangqiang; Hou, Zhiyuan; He, Xiangui; Zou, Haidong

2018-02-23

In 2010, there were ~ 36 million migrant children under 18 y old in China. This study compared patterns of myopia prevalence and progression between migrant and resident children. Eight hundred forty-two migrant children from 2 migrant schools and 1081 from 2 local schools in Baoshan District, Shanghai, were randomly chosen. Baseline measurements were taken on children in grades one through four, and children in grades one and two were followed for 2 y. The children underwent comprehensive ophthalmic examinations, including cycloplegic refraction and axial length. The average time per week spent on homework and outdoor activities were investigated. Migrant children in grades one and two showed a lower myopia prevalence than resident children; however, from grades three to four, the prevalence accelerated and exceeded that of residents. In the follow-up, the myopia incidence did not significantly change from grades one to two in resident children but was significantly higher in grade two in migrant children. Correspondingly, for migrant children, increased progression of refraction and axial length was observed; however, it decreased in resident children. The average time spent on homework increased from grades two to three in parallel with the acceleration of myopia prevalence for migrant children; however, the time spent outdoors did not correspondingly change. The patterns of myopia prevalence and progression are different between migrant and non-migrant children. The acceleration of myopia in migrant children might be a result of a change in their environment, such as intensive education pressure.

Experimental and numerical study of the relation between flow paths and fate of a pesticide in a riparian wetland

NASA Astrophysics Data System (ADS)

Kidmose, Jacob; Dahl, Mette; Engesgaard, Peter; Nilsson, Bertel; Christensen, Britt S. B.; Andersen, Stine; Hoffmann, Carl Christian

2010-05-01

SummaryA field-scale pulse-injection experiment with the herbicide Isoproturon was conducted in a Danish riparian wetland. A non-reactive tracer (bromide) experiment was also carried out to characterize the physical transport system. Groundwater flow and reactive transport modelling was used to simulate flow paths, residence times, as well as bromide and Isoproturon distributions. The wetland can be characterized by two distinct riparian flow paths; one flow path discharges 2/3 of the incoming groundwater directly to the free water surface of the wetland near the foot of the hillslope with an average residence time of 205 days, and another flow path diffusively discharging the remaining 1/3 of the incoming groundwater to the stream with an average residence time of 425 days. The reactive transport simulations reveal that Isoproturon is retarded by a factor of 2-4, which is explained by the high organic content in the peat layer of the wetland. Isoproturon was found to be aerobically degraded with a half-life in the order of 12-80 days. Based on the quantification of flow paths, residence times and half-lives it is estimated that about 2/3 of the injected Isoproturon is removed in the wetland. Thus, close to 1/3 may find its way to the stream through overland flow. It is also possible that high concentrations of metabolites will reach the stream.

Operative time and cost of resident surgical experience: effect of instituting an otolaryngology residency program.

PubMed

Pollei, Taylor R; Barrs, David M; Hinni, Michael L; Bansberg, Stephen F; Walter, Logan C

2013-06-01

Describe the procedure length difference between surgeries performed by an attending surgeon alone compared with the resident surgeon supervised by the same attending surgeon. Case series with chart review. Tertiary care center and residency program. Six common otolaryngologic procedures performed between August 1994 and May 2012 were divided into 2 cohorts: attending surgeon alone or resident surgeon. This division coincided with our July 2006 initiation of an otolaryngology-head and neck surgery residency program. Operative duration was compared between cohorts with confounding factors controlled. In addition, the direct result of increased surgical length on operating room cost was calculated and applied to departmental and published resident case log report data. Five of the 6 procedures evaluated showed a statistically significant increase in surgery length with resident involvement. Operative time increased 6.8 minutes for a cricopharyngeal myotomy (P = .0097), 11.3 minutes for a tonsillectomy (P < .0001), 27.4 minutes for a parotidectomy (P = .028), 38.3 minutes for a septoplasty (P < .0001), and 51 minutes for tympanomastoidectomy (P < .0021). Thyroidectomy showed no operative time difference. Cost of increased surgical time was calculated per surgery and ranged from $286 (cricopharyngeal myotomy) to $2142 (mastoidectomy). When applied to reported national case log averages for graduating residents, this resulted in a significant increase of direct training-related costs. Resident participation in the operating room results in increased surgical length and additional system cost. Although residency is a necessary part of surgical training, associated costs need to be acknowledged.

Impact of the 80-hour workweek on surgical exposure and national in-training examination scores in an orthopedic residency program.

PubMed

Froelich, John; Milbrandt, Joseph C; Allan, D Gordon

2009-01-01

This study examines the impact of the 80-hour workweek on the number of surgical cases performed by PGY-2 through PGY-5 orthopedic residents. We also evaluated orthopedic in-training examination (OITE) scores during the same time period. Data were collected from the Accreditation Council for Graduate Medical Education (ACGME) national database for 3 academic years before and 5 years after July 1, 2003. CPT surgical procedure codes logged by all residents 3 years before and 5 years after implementation of the 80-hour workweek were compared. The average raw OITE scores for each class obtained during the same time period were also evaluated. Data were reported as the mean +/- standard deviation (SD), and group means were compared using independent t-tests. No statistical difference was noted in the number of surgical procedure codes logged before or after the institution of the 80-hour week during any single year of training. However, an increase in the number of CPT codes logged in the PGY-3 years after 2003 did approach significance (457.7 vs 551.9, p = 0.057). Overall, the average number of cases performed per resident increased each year after implementation of the work-hour restriction (464.4 vs 515.5 cases). No statistically significant difference was noted in the raw OITE scores before or after work-hour restrictions for our residents or nationally. We found no statistical difference for each residency class in the average number of cases performed or OITE scores, although the total number of cases performed has increased after implementation of the work-hour restrictions. We also found no statistical difference in the national OITE scores. Our data suggest that the impact of the 80-hour workweek has not had a detrimental effect on these 2 resident training measurements.

Social Workers as Workplace-Based Instructors of Alcohol and Drug Screening, Brief Intervention, and Referral to Treatment (SBIRT) for Emergency Medicine Residents.

PubMed

Duong, David K; O'Sullivan, Patricia S; Satre, Derek D; Soskin, Philippa; Satterfield, Jason

2016-01-01

Residency education is challenged by a shortage of personnel and time, particularly for teaching behavioral interventions such as screening, brief intervention, and referral to treatment (SBIRT) to reduce hazardous drinking and drug use. However, social workers may be well placed to teach SBIRT in clinical training settings. We describe a curriculum with social workers as SBIRT trainers of emergency medicine (EM) residents during actual clinical shifts in an EM residency training program. The curriculum required 1 EM faculty member working with social workers and 1 additional hour of formal residency conference teaching time. We implemented the curriculum at both a university tertiary care hospital emergency department and a county trauma center. We trained 8 social workers at both sites as SBIRT superusers to teach and assess EM resident SBIRT performance with actual patients. We measured the length and number of sessions to attain SBIRT competence, residents' satisfaction, and resident comments (coded by authors). Five of the 8 social workers trained residents between June 2013 and May 2014, 31 EM residents trained to a level indicating SBIRT competence with 114 patients. Each patient interaction averaged 8.8 minutes and residents averaged 3.13 patients. Twenty-four (77%) residents gave ratings of 1.58 (SD = .58) for the quality of teaching, 2.33 (SD = .87) for recommending the training to a colleague, 1.38 (SD = .49) for superusers' knowledge, 1.88 (SD = .95) for usefulness of instruction, 1.54 (SD = .72) for workplace learning, and 1.58 (SD = .78) for valuing learning from social workers (on a scale of 1 [very satisfied/strongly agree] to 5 [very dissatisfied/strongly disagree]). Residents preferred learning SBIRT during the 1st and 2nd training years and in the workplace. Social work colleagues can be effective in teaching SBIRT to residents in the workplace, and our residents highly valued learning from social workers, who all had prior training in motivational interviewing. In the implementation of this curriculum, the clinical demands of residents must be taken into account when teaching occurs, and having multiple social worker instructors was instrumental.

Comparing Budget-based and Tracer-based Residence Times in Butte Basin, California

NASA Astrophysics Data System (ADS)

Moran, J. E.; Visser, A.; Esser, B.; Buck, C.

2017-12-01

The California Sustainable Groundwater Management Act of 2014 (SGMA) calls for basin-scale Groundwater Sustainability Plans (GSPs) that include a water budget covering a 50 year planning horizon. A nine layer, Integrated Water Flow Model (IWFM) developed for Butte Basin, California, allows examination of water budgets within 36 sub-regions having varying land and water use, to inform SGMA efforts. Detailed land use, soil type, groundwater pumping, and surface water delivery data were applied in the finite element IWFM calibration. In a sustainable system, the volume of storage does not change over a defined time period, and the residence time can be calculated from the water storage volume divided by the flux (recharge or discharge rate). Groundwater ages based on environmental tracer data reflect the mean residence time of groundwater, or its inverse, the turnover rate. Comparisons between budget-based residence times determined from storage and flux, and residence times determined from isotopic tracers of groundwater age, can provide insight into data quality, model reliability, and system sustainability. Budget-based groundwater residence times were calculated from IWFM model output by assuming constant storage and dividing by either averaged annual net recharge or discharge. Calculated residence times range between approximately 100 and 1000 years, with shorter times in subregions where pumping dominates discharge. Independently, 174 wells within the model boundaries were analyzed for tritium-helium groundwater age as part of the California Groundwater Ambient Monitoring and Assessment program. Age distributions from isotopic tracers were compared to model-derived groundwater residence times from groundwater budgets within the subregions of Butte Basin. Mean, apparent, tracer-based residence times are mostly between 20 and 40 years, but 25% of the long-screened wells that were sampled do not have detectable tritium, indicating residence times of more than about 60 years and broad age distributions. A key factor in making meaningful comparisons is to examine budget-based and tracer-based results over transmissive vertical sections, where pumping increases turnover time.

Lounging with robots--social spaces of residents in care: A comparison trial.

PubMed

Peri, Kathryn; Kerse, Ngaire; Broadbent, Elizabeth; Jayawardena, Chandimal; Kuo, Tony; Datta, Chandan; Stafford, Rebecca; MacDonald, Bruce

2016-03-01

To investigate whether robots could reduce resident sleeping and stimulate activity in the lounges of an older persons' care facility. Non-randomised controlled trial over a 12-week period. The intervention involved situating robots in low-level and high-dependency ward lounges and a comparison with similar lounges without robots. A time sampling observation method was utilised to observe resident behaviour, including sleep and activities over periods of time, to compare interactions in robot and no robot lounges. The use of robots was modest; overall 13% of residents in robot lounges used the robot. Utilisation was higher in the low-level care lounges; on average, 23% used the robot, whereas in high-level care lounges, the television being on was the strongest predictor of sleep. This study found that having robots in lounges was mostly a positive experience. The amount of time residents slept during the day was significantly less in low-level care lounges that had a robot. © 2015 AJA Inc.

Pregnancy and the Plastic Surgery Resident.

PubMed

Garza, Rebecca M; Weston, Jane S; Furnas, Heather J

2017-01-01

Combining pregnancy with plastic surgery residency has historically been difficult. Two decades ago, 36 percent of plastic surgery program directors surveyed actively discouraged pregnancy among residents, and 33 percent of women plastic surgeons suffered from infertility. Most alarmingly, 26 percent of plastic surgery trainees had had an elective abortion during residency. With increasing numbers of women training in plastic surgery, this historical lack of support for pregnancy deserves further attention. To explore the current accommodations made for the pregnant plastic surgery resident, an electronic survey was sent to 88 plastic surgery program directors in the United States. Fifty-four responded, for a response rate of 61.36 percent. On average, a director trained a total of 7.91 women among 17.28 residents trained over 8.19 years. Of the women residents, 1.43 were pregnant during a director's tenure, with 1.35 of those residents taking maternity leave. An average 1.75 male residents took paternity leave. Approximately one-third of programs had a formal maternity/paternity leave policy (36.54 percent) which, in most cases, was limited to defining allowed weeks of leave, time required to fulfill program requirements, and remuneration during leave. This survey of plastic surgery directors is a first step in defining the challenges training programs face in supporting the pregnant resident. Directors provided comments describing their challenges accommodating an absent resident in a small program and complying with the American Board of Plastic Surgery's required weeks of training per year. A discussion of these challenges is followed by suggested solutions.

40 CFR 63.1257 - Test methods and compliance procedures.

Code of Federal Regulations, 2013 CFR

2013-07-01

... the design minimum and average flame zone temperatures and combustion zone residence time; and shall... establish the design exhaust vent stream organic compound concentration level, adsorption cycle time, number... regeneration cycle, design carbon bed temperature after regeneration, design carbon bed regeneration time, and...

40 CFR 63.1257 - Test methods and compliance procedures.

Code of Federal Regulations, 2014 CFR

2014-07-01

... the design minimum and average flame zone temperatures and combustion zone residence time; and shall... establish the design exhaust vent stream organic compound concentration level, adsorption cycle time, number... regeneration cycle, design carbon bed temperature after regeneration, design carbon bed regeneration time, and...

A novel, web-based application for assessing and enhancing practice-based learning in surgery residency.

PubMed

Wu, Bob J; Dietz, Patrick A; Bordley, James; Borgstrom, David C

2009-01-01

Practice-Based Learning and Improvement (PBLI) is 1 of 6 integral competencies required by the Accreditation Council for Graduate Medical Education (ACGME) for proof of adequate resident training and accreditation of residency programs. Moreover, the Outcome Project of the ACGME is beginning to enforce the provision of documented, objective evidence of resident PBLI. Current assessment tools, such as resident portfolios and performance evaluations, by faculty tend to be qualitative in nature. However, few objective, outcome-based, and quantitative evaluation tools have been developed. A web-based application was designed to assess every consultation performed by senior residents at a university-affiliated general surgery residency. In real time, residents documented patient presentations along with their initial impression and plan. As patient outcomes became available, they were also documented into this application, which allowed residents to self-assess whether their impressions and plans were correct. A running "batting average" (BA) is then calculated based on percentage correct. Seven senior residents participated in this study, which included a total of 459 consults: 222 documented by PGY4 residents and 237 documented by PGY5 residents. The average BA of PGY4 residents in their first 3 months was 82.9%, which was followed by 85.9%, 88.7%, and 94.3% for each of the next 3 quarters. For PGY5 residents, the corresponding results were 96.4%, 94.4%, 93.8%, and 96.4% respectively. A web-based outcome-tracking program is useful for conducting rapid and ongoing evaluation of residents' practice-based learning, generating data for analysis of individual resident knowledge gaps, stimulating self-assessment and targeted learning, as well as providing objective data of PBLI for accreditation purposes.

No Correlation Between Work-Hours and Operative Volumes--A Comparison Between United States and Danish Operative Volumes Achieved During Surgical Residency.

PubMed

Kjærgaard, Jane; Sillesen, Martin; Beier-Holgersen, Randi

2016-01-01

Since 2003, United States residents have been limited to an 80-hour workweek. This has prompted concerns of reduced educational quality, especially inadequate operating exposure. In contrast, the Danish surgical specialty-training program mandates a cap on working hours of 37 per week. We hypothesize that there is no direct correlation between work-hours and operative volume achieved during surgical residency. To test the hypothesis, we compare Danish and US operative volumes achieved during surgical residency training. Retrospective comparative study. The data from the US population was extracted from the Accreditation Council for Graduate Medical Education database for General Surgery residents from 2012 to 2013. For Danish residents, a questionnaire with case categories matching the Accreditation Council for Graduate Medical Education categories were sent to all Danish surgeons graduating the national surgical residency program in 2012 or 2013, 54 in total. In all, 30 graduated residents (55%) responded to the Danish survey. We found no significant differences in mean total major procedures (1002.4 vs 976.9, p = 0.28) performed during residency training, but comparing average major procedures per year, the US residents achieve significantly more (132.3 vs 195.4, p <0.01). When factoring in differences in time spent in training, this amounts to a weekly average difference of 1.2 cases throughout training. In this study, we find no difference in overall surgical volumes between Danes and US residents during their surgical training. When time in training was accounted for, differences between weekly surgical volumes achieved were minor, indicating a lack of direct correlation between weekly work-hours and operative volumes achievable. Factors other than work-hours seem to effect on operative volumes achieved during training. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

A virtual reality endoscopic simulator augments general surgery resident cancer education as measured by performance improvement.

PubMed

White, Ian; Buchberg, Brian; Tsikitis, V Liana; Herzig, Daniel O; Vetto, John T; Lu, Kim C

2014-06-01

Colorectal cancer is the second most common cause of death in the USA. The need for screening colonoscopies, and thus adequately trained endoscopists, particularly in rural areas, is on the rise. Recent increases in required endoscopic cases for surgical resident graduation by the Surgery Residency Review Committee (RRC) further emphasize the need for more effective endoscopic training during residency to determine if a virtual reality colonoscopy simulator enhances surgical resident endoscopic education by detecting improvement in colonoscopy skills before and after 6 weeks of formal clinical endoscopic training. We conducted a retrospective review of prospectively collected surgery resident data on an endoscopy simulator. Residents performed four different clinical scenarios on the endoscopic simulator before and after a 6-week endoscopic training course. Data were collected over a 5-year period from 94 different residents performing a total of 795 colonoscopic simulation scenarios. Main outcome measures included time to cecal intubation, "red out" time, and severity of simulated patient discomfort (mild, moderate, severe, extreme) during colonoscopy scenarios. Average time to intubation of the cecum was 6.8 min for those residents who had not undergone endoscopic training versus 4.4 min for those who had undergone endoscopic training (p < 0.001). Residents who could be compared against themselves (pre vs. post-training), cecal intubation times decreased from 7.1 to 4.3 min (p < 0.001). Post-endoscopy rotation residents caused less severe discomfort during simulated colonoscopy than pre-endoscopy rotation residents (4 vs. 10%; p = 0.004). Virtual reality endoscopic simulation is an effective tool for both augmenting surgical resident endoscopy cancer education and measuring improvement in resident performance after formal clinical endoscopic training.

Type of oral solid medication packaging and medication preparation time in nursing homes: A direct observation study.

PubMed

Cready, C M; Hudson, C; Dreyer, K

2017-12-01

Medication administration is a substantial portion of the workday in nursing homes, with the medication preparation step being the most time-consuming. However, little is known about how medication preparation time is affected by the type of packaging used for oral solid medications (ie, tablets/capsules). We examined the effects of two types of packaging. As fewer steps are associated with strip packaging compared to bingo card packaging, we hypothesized that the increase in medication preparation seconds per resident with each additional oral solid medication would be smaller when strip packaging was used. A total of 430 medication preparations conducted by eight nurses during the regularly scheduled morning medication administration period in two nursing homes-using strip packaging and bingo card packaging, respectively-were observed. Each medication preparation observation was matched to its corresponding medication administration record and observations averaged across resident. Using the resident sample (N=149), we estimated three regression models (adjusting the standard errors for the clustering of resident by nurse). The first model regressed medication preparation seconds on the number of oral solid medications. The second model added the type of packaging used and the control variables (type of unit [long-term care, post-acute care], the number of one-half pills and the dosage form diversity in the preparation). To test our hypothesis, the third model added an interaction term between the number of oral solid medications and the type of packaging used. As hypothesized, all else equal, the number of oral solid medications tended to increase medication preparation time per resident in both nursing homes, but the increase was smaller in the strip packaging nursing home (P<.05). Each additional oral solid medication in the bingo card packaging nursing home increased medication preparation by an average of 13 seconds (b=13.077), whereas each oral solid medication administered in the strip packaging nursing home increased medication preparation by an average of only 8 seconds (13.077-5.092=7.985). This is a difference on average of about 5 seconds per oral solid medication. To our knowledge, we were the first to examine the effect of type of oral solid medication packaging on medication preparation time in nursing homes. Type of packaging matters. The time saved using strip packaging (vs bingo card packaging) has implications for quality of care and the movement towards person-centred care in the nursing home sector. Nurses (or other staff tasked with medication preparation) in nursing homes using strip packaging potentially have more time to devote to nurturing a relationship with the resident. However, time saved in medication preparation by strip packaging is counterproductive if a serious error results. Thus, future studies should investigate the effects of type of packaging on medication preparation errors. © 2017 John Wiley & Sons Ltd.

[Usage survey of care equipment in care service facilities for the elderly].

PubMed

Iwakiri, Kazuyuki; Takahashi, Masaya; Sotoyama, Midori; Hirata, Mamoru; Hisanaga, Naomi

2007-01-01

Musculoskeletal disorders(MSD)have been increasing recently among care workers. Since providing care workers with appropriate equipment is effective for preventing MSD, we conducted a questionnaire survey in two nursing homes and a healthcare facility for the elderly to clarify equipment usage, problems and points for improvement. A total of 81 care workers(average age 32.2 yr; 63 females, 18 males)participated in the survey. The average number of residents and the average resident's care level were 70.0 and 3.6, respectively. Wheelchair and height adjustable beds were fully available and always used in all facilities. Portable lifts, ceiling lifts and transfer boards were, however, few in all 3 facilities and the proportion of use was 14.8%, 16.0%, and 23.5%, respectively. Participants reported that it is time consuming to move residents from place to place with lifts and there is a danger of dropping a resident. Although approximately 90% of care workers had received education and training on care techniques, the workload on the low back was found to be great. Therefore, we thought that care workers must consistently use care equipment. To achieve such increased usage, we must improve the usability of the equipment.

Annual State of Connecticut Obstetrics and Gynecology Resident Research Day.

PubMed

Seagle, Brandon-Luke L; Ballard, Jennifer; Kakar, Freshta; Panarelli, Erin; Samuelson, Robert; Shahabi, Shohreh

2015-01-01

To increase opportunities for Obstetrics and Gynecology(Ob/Gyn) residents to present their research, an Annual State of Connecticut Ob/Gyn Resident Research Day (RRD) was created. At the first annual RRD, 33 residents, representing five of six Connecticut Ob/Gyn residency programs, presented 39 poster and eight oral presentations. RRD evaluators rated the overall symposium and the quality of resident oral and poster presentations as either "excellent" or "above average." Residency program directors reported that the symposium was "very helpful" for evidencing resident scholarship as required by the Accreditation Council for Graduate Medical Education (ACGME). Surveyed residents reported that the symposium promoted their research and was a valuable investment of their time. An annual specialty-specific, statewide RRD was created, experienced good participation, and was well evaluated. The annual, statewide Ob/Gyn RRD may serve as a model for development of other specialty-specific, statewide RRD events.

Capricorn-A Web-Based Automatic Case Log and Volume Analytics for Diagnostic Radiology Residents.

PubMed

Chen, Po-Hao; Chen, Yin Jie; Cook, Tessa S

2015-10-01

On-service clinical learning is a mainstay of radiology education. However, an accurate and timely case log is difficult to keep, especially in the absence of software tools tailored to resident education. Furthermore, volume-related feedback from the residency program sometimes occurs months after a rotation ends, limiting the opportunity for meaningful intervention. We surveyed the residents of a single academic institution to evaluate the current state of and the existing need for tracking interpretation volume. Using the results of the survey, we created an open-source automated case log software. Finally, we evaluated the effect of the software tool on the residency in a 1-month, postimplementation survey. Before implementation of the system, 89% of respondents stated that volume is an important component of training, but 71% stated that volume data was inconvenient to obtain. Although the residency program provides semiannual reviews, 90% preferred reviewing interpretation volumes at least once monthly. After implementation, 95% of the respondents stated that the software is convenient to access, 75% found it useful, and 88% stated they would use the software at least once a month. The included analytics module, which benchmarks the user using historical aggregate average volumes, is the most often used feature of the software. Server log demonstrates that, on average, residents use the system approximately twice a week. An automated case log software system may fulfill a previously unmet need in diagnostic radiology training, making accurate and timely review of volume-related performance analytics a convenient process. Copyright © 2015 AUR. Published by Elsevier Inc. All rights reserved.

Implementing a resident acute care surgery service: Improving resident education and patient care.

PubMed

Kantor, Olga; Schneider, Andrew B; Rojnica, Marko; Benjamin, Andrew J; Schindler, Nancy; Posner, Mitchell C; Matthews, Jeffrey B; Roggin, Kevin K

2017-03-01

To simulate the duties and responsibilities of an attending surgeon and allow senior residents more intraoperative and perioperative autonomy, our program created a new resident acute care surgery consult service. We structured resident acute care surgery as a new admitting and inpatient consult service managed by chief and senior residents with attending supervision. When appropriate, the chief resident served as a teaching assistant in the operation. Outcomes were recorded prospectively and reviewed at weekly quality improvement conferences. The following information was collected: (1) teaching assistant case logs for senior residents preimplentation (n = 10) and postimplementation (n = 5) of the resident acute care surgery service; (2) data on the proportion of each case performed independently by residents; (3) resident evaluations of the resident acute care surgery versus other general operative services; (4) consult time for the first 12 months of the service (June 2014 to June 2015). During the first year after implementation, the number of total teaching assistant cases logged among graduating chief residents increased from a mean of 13.4 ± 13.0 (range 4-44) for preresident acute care surgery residents to 30.8 ± 8.8 (range 27-36) for postresident acute care surgery residents (P < .01). Of 323 operative cases, the residents performed an average of 82% of the case independently. There was a significant increase in the satisfaction with the variety of cases (mean 5.08 vs 4.52, P < .01 on a 6-point Likert scale) and complexity of cases (mean 5.35 vs 4.94, P < .01) on service evaluations of resident acute care surgery (n = 27) in comparison with other general operative services (n = 127). In addition, creation of a 1-team consult service resulted in a more streamlined consult process with average consult time of 22 minutes for operative consults and 25 minutes for nonoperative consults (range 5-90 minutes). The implementation of a resident acute care surgery service has increased resident autonomy, teaching assistant cases, and satisfaction with operative case variety, as well as the efficiency of operative consultation at our institution. Copyright © 2016 Elsevier Inc. All rights reserved.

Evaluation of beach cleanup effects using linear system analysis.

PubMed

Kataoka, Tomoya; Hinata, Hirofumi

2015-02-15

We established a method for evaluating beach cleanup effects (BCEs) based on a linear system analysis, and investigated factors determining BCEs. Here we focus on two BCEs: decreasing the total mass of toxic metals that could leach into a beach from marine plastics and preventing the fragmentation of marine plastics on the beach. Both BCEs depend strongly on the average residence time of marine plastics on the beach (τ(r)) and the period of temporal variability of the input flux of marine plastics (T). Cleanups on the beach where τ(r) is longer than T are more effective than those where τ(r) is shorter than T. In addition, both BCEs are the highest near the time when the remnants of plastics reach the local maximum (peak time). Therefore, it is crucial to understand the following three factors for effective cleanups: the average residence time, the plastic input period and the peak time. Copyright © 2014 Elsevier Ltd. All rights reserved.

Residence times in river basins as determined by analysis of long-term tritium records

USGS Publications Warehouse

Michel, R.L.

1992-01-01

The US Geological Survey has maintained a network of stations to collect samples for the measurement of tritium concentrations in precipitation and streamflow since the early 1960s. Tritium data from outflow waters of river basins draining 4500-75000 km2 are used to determine average residence times of water within the basins. The basins studied are the Colorado River above Cisco, Utah; the Kissimmee River above Lake Okeechobee, Florida; the Mississippi River above Anoka, Minnesota; the Neuse River above Streets Ferry Bridge near Vanceboro, North Carolina; the Potomac River above Point of Rocks, Maryland; the Sacramento River above Sacramento, California; the Susquehanna River above Harrisburg, Pennsylvania. The basins are modeled with the assumption that the outflow in the river comes from two sources-prompt (within-year) runoff from precipitation, and flow from the long-term reservoirs of the basin. Tritium concentration in the outflow water of the basin is dependent on three factors: (1) tritium concentration in runoff from the long-term reservoir, which depends on the residence time for the reservoir and historical tritium concentrations in precipitation; (2) tritium concentrations in precipitation (the within-year runoff component); (3) relative contributions of flow from the long-term and within-year components. Predicted tritium concentrations for the outflow water in the river basins were calculated for different residence times and for different relative contributions from the two reservoirs. A box model was used to calculate tritium concentrations in the long-term reservoir. Calculated values of outflow tritium concentrations for the basin were regressed against the measured data to obtain a slope as close as possible to 1. These regressions assumed an intercept of zero and were carried out for different values of residence time and reservoir contribution to maximize the fit of modeled versus actual data for all the above rivers. The final slopes of the fitted regression lines ranged from 0.95 to 1.01 (correlation coefficient > 0.96) for the basins studied. Values for the residence time of waters within the basins and average relative contributions of the within-year and long-term reservoirs to outflow were obtained. Values for river basin residence times ranged from 2 years for the Kissimmee River basin to 20 years for the Potomac River basin. The residence times indicate the time scale in which the basin responds to anthropogenic inputs. The modeled tritium concentrations for the basins also furnish input data for urban and agricultural settings where these river waters are used. ?? 1992.

Crystal residence times from trace element zoning in plagioclase reveal changes in magma transfer dynamics at Mt. Etna during the last 400 years

NASA Astrophysics Data System (ADS)

Viccaro, Marco; Barca, Donatella; Bohrson, Wendy A.; D'Oriano, Claudia; Giuffrida, Marisa; Nicotra, Eugenio; Pitcher, Bradley W.

2016-04-01

Trace element zoning in plagioclase of selected alkaline lavas from the historic (1607-1892 AD) and recent (1983-2013 AD) activity of Mt. Etna volcano has been used to explore the possible role that volcano-tectonics exert on magma transfer dynamics. The observed textural characteristics of crystals include near-equilibrium textures (i.e., oscillatory zoning) and textures with variable extent of disequilibrium (patchy zoning, coarse sieve textures and dissolved cores). Historic crystals exhibit lower K concentrations at lower anorthite contents, a feature in agreement with the general more potassic character of the recent lavas if compared to the historic products. Historic plagioclases have statistically higher Ba and lower Sr concentrations than the recent crystals, which result in different Sr/Ba ratios for the two suites of plagioclase. Variations in the anorthite content along core-to-rim profiles obtained on crystals with different types of textures for both the historic and recent eruptive periods were evaluated particularly versus Sr/Ba. At comparable average An contents, crystals characterized by oscillatory zoning, which are representative of near-equilibrium crystallization from the magma, display distinct Sr/Ba ratios. We suggest that these features are primarily related to recharge of a new, geochemically-distinct magma into the storage and transport system of the volcano. In addition to distinct trace element and textural characteristics of plagioclase, Sr diffusion modeling for plagioclase suggests that residence times are generally shorter for crystals found in recently erupted lavas (25-77 years, average 43 years) compared to those of the historic products (43-163 years, average 99 years). Shorter residences times correlate with gradual increases in eruption volume and eruption frequency rates through time. We attribute these features to an increasing influence, since the 17th century, of extensional tectonic structures within the upper 10 km of the Etnean crust, which have promoted shorter residence times and higher eruption frequency.

Use of a mobile device by nursing home residents for long-term care comprehensive geriatric self-assessment: a feasibility study.

PubMed

Huang, Fanpin; Chang, Polun; Hou, I-Ching; Tu, Ming-Hsiang; Lan, Chung-Fu

2015-01-01

Long-term-care comprehensive geriatric assessments, such as the Minimum Data Set 3.0, are used to evaluate the clinical, psychological, and personal status of residents in long-term-care nursing facilities. Nursing staff conducts assessment interviews, thereby increasing the workload of nurses and the cost of patient care. This study explored the ability of nursing home residents to use two different mobile devices for a geriatric self-assessment. Study participants were residents of long-term-care nursing homes. A modified Minimum Data Set 3.0 was converted to a format for use with a 6-inch mobile pad and a 3.7-inch mobile smartphone. The survey completion rate and the response time were measured. A Technology Assessment Model questionnaire analyzed the participants' experience. All participants were able to use a 6-inch pad, with an average completion rate of 92.9% and an average time for completion of 21 minutes. Only 20% of the participants could complete the assessment with the 3.7-inch smartphone. The participants found the 6-inch pad easier to use than the 3.7-inch smartphone. This exploratory study suggests that nursing home residents are able to use a mobile device to perform a geriatric self-assessment and delineates the importance of the ergonomics of the device.

Numerical study of water residence time in the Yueqing Bay based on the eulerian approach

NASA Astrophysics Data System (ADS)

Ying, Chao; Li, Xinwen; Liu, Yong; Yao, Wenwei; Li, Ruijie

2018-05-01

The Yueqing Bay was a semi-enclosed bay located in the southeast of Zhejiang Province, China. Due to substantial anthropogenic influences since 1964, the water quality in the bay had deteriorated seriously. Thus urgent measures should be taken to protect the water body. In this study, a numerical model was calibrated for water surface elevation and tidal current from August 14 to August 26, 2011. Comparisons of observed and simulated data showed that the model reproduced the tidal range and phase and the variations of current at different periods fairly well. The calibrated model was then applied to investigate spatial flushing pattern of the bay by calculation of residence time. The results obtained from a series of model experiments demonstrated that the residence time increased from 10 day at the bay mouth to more than 70 day at the upper bay. The average residence time over the whole bay was 49.5 day. In addition, the adaptation of flushing homogeneity curve showed that the residence time in the bay varied smoothly. This study provides a numerical tool to quantify the transport timescale in Yueqing Bay and supports adaptive management of the bay by local authorities.

78 FR 49321 - Proposed Agency Information Collection Activities; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-13

.... Residents. Respondent Universe: 1,000 individuals. Frequency of Submission: On occasion. Respondent Total annual Average time per Total annual Form number universe responses response burden hours Alleged...

Atmospheric Residence Times of Continental Aerosols.

NASA Astrophysics Data System (ADS)

Balkanski, Yves Jacques

The global atmospheric distributions of ^{222}Rn and ^{210 }Pb are simulated with a three-dimensional model of atmospheric transport based on the meteorology of the NASA GISS^1>=neral circulation model. The short-lived radioactive gas ^ {222}Rn (half-life = 3.8d) is emitted almost exclusively from land, at a relatively uniform rate; hence it is an excellent tracer of continental influences. Lead -210 is produced by decay of ^{222} Rn and immediately condenses to preexisting aerosol surfaces. It provides an excellent measure of aerosol residence times in the atmosphere because its source is accurately defined by the ^{222} Rn distribution. Results from the three-dimensional model are compared to measurements of ^ {222}Rn and ^{210 }Pb atmospheric concentrations to evaluate model's long-range transport over oceanic regions and to study the deposition mechanisms of atmospheric aerosols. Model results for ^{222} Rn are used to examine the long-range transport of continental air over two selected oceanic regions, the subantartic Indian Ocean and the North Pacific. It is shown that fast transport of air from southern Africa causes substantial continental pollution at southern mid-latitudes, a region usually regarded as pristine. Air over the North Pacific is heavily impacted by continental influences year round, but the altitude at which the transport occurs varies seasonally. Observations of aerosols at island sites, which are commonly used as diagnostics of continental influences, may be misleading because they do not account for influences at high altitude and because aerosols are efficiently scavenged by deposition during transport. The study of ^{210}Pb focuses on defining the residence times of submicron aerosols in the troposphere. Scavenging in wet convective updrafts is found to provide the dominant sink on a global scale. The globally averaged residence time for ^{210 }Pb-containing aerosols in the troposphere is 7 days. The average increase in residence time with altitude is from 4 days near the surface to 25 days near the tropopause. Hence, aerosols produced in the upper troposphere can be transported on a global scale. Residence times averaged over the tropospheric column vary geographically from less than 2 days in rainy regions to more than 30 days in dry regions. In particular, aerosols produced by biomass burning over central Africa during the dry season might affect large areas over the tropical Atlantic Ocean, with possible implications for weather and climate. ftn ^1GISS: Goddard Institute for Space Studies, New York.

Emergency department usage by community step-down facilities--patterns and recommendations.

PubMed

Lee, S W; Goh, C; Chan, Y H

2003-09-01

This study examines the interface between institutional community step-down facilities (CSDFs) and acute hospital's Emergency Department (ED). It also provides a comprehensive description of the usage of an ED's services by CSDFs in its vicinity. This is a prospective 12-week observational study conducted in the Accident and Emergency Department of Changi General Hospital in Singapore. All patients from CSDFs transferred to the department were eligible for the study. Hospital records were used to extract relevant clinical data after admission for the length of stay and final discharge diagnosis. There was a total of 201 referrals to the ED over the 3-month period. The age of the patients ranged from 32 to 107 years, with a median of 83 years. Ninety-two patients (45.8%) were male residents. There were more referrals from CSDF on weekdays than on weekends. In particular, the number of referrals from CSDFs on Mondays were significantly higher (P < 0.05, Poisson regression) than other days of the week. Fifty-one per cent of the ED visits occurred during regular working hours. Eighty-two per cent of the transfers were admitted. The main complaint was shortness of breath with cough, followed by fever and falls. The most common investigation ordered was chest radiograph, followed by electrocardiogram and other radiographs. The most common treatment procedure in the ED was placement of an intravenous line. For those admitted residents, average length of hospital stay was 8.27 +/- 8.19 days (median, 5 days). Seventeen patients (10.3%) died within 3 days of admission, while 31 patients (18.8%) stayed less than 3 days. The admitted residents had an average turnaround time (from time of registration to time of leaving the ED and proceeding to ward) of 97.94 minutes. For patients discharged from the ED, the average turnaround time (time from registration to time of leaving the ED) was 177 minutes. Residents from CSDFs are transferred to the ED for a variety of medical reasons. The most appropriate role of the ED in evaluation of residents of CSDFs is not yet clearly defined. There is increasing need to streamline processes in acute hospitals to cope with an increasing ageing population and to ensure that quality care is delivered to the institutionalised sick.

Age Tracers and Residence Time in the Hudson River Estuary

NASA Astrophysics Data System (ADS)

Nadell, S. A.; Geyer, W. R.; Wang, T.

2016-02-01

The Hudson River is one of the most nutrient loaded rivers in the country, however phytoplankton bloom do not occur, possibly as a result of how quickly water moves though the Hudson River estuary. Slower water residence times may then allow for significant phytoplankton growth. Water age and residence time, which are compliments of one another under stead-state conditions, are important factors in determining where phytoplankton move and how long they spend within a favorable portion of the estuary. This research involved introducing a freshwater and saltwater age tracer into the Regional Ocean Modeling System (ROMS) for the Hudson River estuary domain to observe the distribution of ages within the spring-neap tidal cycle and across different river discharge rates. These discharge rates represented average (500 m3/s), relatively high (1000 m3/s), and relatively low (200 m3/s) river flow conditions for the Hudson River. Saltwater age followed a distribution similar to salinity, while freshwater age distribution mostly represented river transit time. Under steady state conditions, combined freshwater and saltwater age may be used to calculate a rough estimate of estuary residence time. The results show that the residence time of the full estuary appears to be at greater than the doubling time of phytoplankton for all discharge rates and by over five days for even the relatively high discharge case. This leads to the conclusion that other estuary factors, including light availability and salinity, may be more important for limiting phytoplankton growth than residence time.

Evaluation of a redesign initiative in an internal-medicine residency.

PubMed

McMahon, Graham T; Katz, Joel T; Thorndike, Mary E; Levy, Bruce D; Loscalzo, Joseph

2010-04-08

Several organizations have advocated for comprehensive redesign of graduate medical training, but the effect that residency redesign will have on measures of patient satisfaction, resident and intern (trainee) satisfaction, and patient care is unknown. We designed an experimental inpatient-medicine service with reduced resident workload comprising two teams, with each team consisting of two attending physicians, two residents, and three interns. Attending physicians, selected for their teaching prowess, supervised the teams throughout the workday and during bedside team-teaching rounds. This experimental model was compared with a control model comprising two teams, with each consisting of one resident and two interns, plus multiple supervising attending physicians who volunteered to participate. Patients were alternately assigned to the experimental teams and the control teams, subject to limits on the number of patients interns are allowed to admit. Over a 12-month period, 1892 patients were assigned to the experimental teams and 2096 to the control teams; the average census per intern was 3.5 and 6.6 patients, respectively. Overall satisfaction was significantly higher among trainees on the experimental teams than among those on the control teams (78% and 55%, respectively; P=0.002). As compared with the control teams, the experimental teams were not associated with a higher average length of patient stay or readmission rate; adherence to standards for quality of inpatient care was similar in both groups of teams. Interns on the experimental teams spent more time in learning and teaching activities than did interns on the control teams (learning: 20% of total time vs. 10%, P=0.01; teaching: 8% of total time vs. 2%, P=0.006). As compared with a traditional inpatient care model, an experimental model characterized by reduced trainee workload and increased participation of attending physicians was associated with higher trainee satisfaction and increased time for educational activities. 2010 Massachusetts Medical Society

Molecular Dynamics Simulation of the Cage Effect in a Wide Packing Fraction Range

NASA Astrophysics Data System (ADS)

Pestryaev, E. M.

2018-07-01

The self-diffusion coefficient and particle residence time in the first coordination shell of its neighbours were investigated by molecular dynamics simulation with the packing fraction of the model system ranging from 0.1 to 0.8. The residence time distribution spans several orders of magnitude and broadens with the system packing fraction. The distribution exhibits a maximum localized in the short residence time region. The average residence time correlates with the conventionally-used intermolecular correlation time governed by the mutual particle translational diffusion. It was shown that the use of the coordination number as an argument for all searched parameters is the obvious representation of the cage effect onset. The agreement of the self-diffusion coefficient with one of the recent theories is excellent in most of the density range, including the start of the glass transition, with the largest divergence only observed for the rare gas state. The same conclusion is true for the simulated and theoretical values of the caging number, which is nearly five, defining the start of the system liquefaction.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tribble, G.W.; Sansone, F.J.; Li, Yuan-Hui

Hydraulic exchange between overlying sea water and the internal structure of a patch reef in Kaneohe Bay, Oahu, Hawaii, was studied with an array of wells, 1, 2, and 4 m deep. Two natural chemical tracers, radon, and salinity, were used to calculate the exchange rate between surface sea water and reef interstitial waters. Dissolved radon concentrations are substantially higher in interstitial waters than is surface water. The degree of radon enrichment is quantitatively related to the time elapsed since interstitial water had equilibrated with the atmosphere. Residence time estimates are 1-40 days, with deeper wells having slower exchange. Themore » average residence time for 1-m-deep wells was 2.1 days. A rainstorm-induced dilution of the salinity of Kaneohe Bay provides the second tracer. Samples of surface and reef interstitial waters following this salinity perturbation are used to calculate an average residence time of 2.6 days at a depth of 1 m and 42 days at a depth of 2 m. Three types of physical forces thought to cause exchange between surface and interstitial water are considered by measurement of the forcing functions and reef permeability. Hydraulic conductivities are about 50 m/d, with lower values near the seaward side of the reef. Most exchange seems to be caused by high-frequency, wave-driven oscillatory pumping and by unidirectional hydraulic head gradients (of uncertain origin) that are stable for at least 3-4 days. Wave-driven mixing is probably more important shallower in the reef, whereas head-driven flow may dominate deeper in the reef. Tidal pumping does not seem to contribute to exchange. All methods indicate that exchange in the upper part of Checker Reef is primarily through vertical exchange. The best estimate for the residence time of water at a depth of 1 m is 2 days. Water at depths of 204 m probably has a residence time of weeks to months. 49 refs., 8 figs., 6 tabs.« less

Valuing a Global Environmental Good: U.S. Residents' Willingness to Pay to Protect Tropical Rain Forests

Treesearch

Randall A. Kramer; D. Evan Mercer

1997-01-01

(CV) is the most common technique for valuing nonmarket environmental resources, rarely has it been applied to global environmental goods. This study uses CV in a national survey to assess the value U.S. residents place on tropical rain forest protection. On average, respondents were willing to make a one-time payment of approximately $21-31 per household to protect an...

Psychiatric Emergency Services - Can Duty-Hour Changes Help Residents and Patients?

PubMed

Brainch, Navjot; Schule, Patrick; Laurel, Faith; Bodic, Maria; Jacob, Theresa

2018-04-14

Limitations on resident duty hours have been widely introduced with the intention of decreasing resident fatigue and improving patient outcomes. While there is evidence of improvement in resident well-being and education following such initiatives, they have inadvertently resulted in increased number of hand-offs between clinicians leading to potential errors in patient care. Current literature emphasizes need for more specialty/setting-specific scheduling, while considering residents' opinions when implementing duty-hour reforms. There are no reports examining the impact of duty-hour changes on residents or patients in psychiatric emergency service (PES) settings. Our purpose was to assess the impact of a recent scheduling change and decrease in overall duty hours, on resident well-being and sense of burnout, while also evaluating changes to patient wait-time and length of stay (LOS) in PES. Residents completed Maslach Burnout Inventory and anonymous surveys focusing on: fatigue, sleep, life outside work for shifts - regular (8 am-8 pm) and swing shifts (12 pm-10 pm). Data from the electronic medical records were collected for 6 months pre- and post-schedule change (January 2016-February 2017), for LOS and patient wait-time. Residents' preference for shifts was split. However, 86% reported getting enough sleep during swing shifts, while 83% reported lack of sleep during regular shifts. The average patient wait-time and LOS significantly decreased from 169 to 147 and 690 to 515 min, respectively. The change to swing shifts significantly impacts LOS and patient wait-time. The short shifts demonstrated an improvement in well-being for residents, but were not the singular factor for overall resident satisfaction.

The Impacts of Exposure to Environmental Risk on Physical and Mental Health in a Small Geographic Community in Houston, TX.

PubMed

Sansom, Garett; Parras, Juan; Parras, Ana; Nieto, Yudith; Arellano, Yvette; Berke, Philip; McDonald, Thomas; Shipp, Eva; Horney, Jennifer A

2017-08-01

Previous research has shown that communities with low average socioeconomic status (SES) and majority minority populations are more likely to be exposed to industrial buildings, waste facilities, and poor infrastructure compared to white communities with higher average SES. While some studies have demonstrated linkages between exposures to specific environmental contaminates within these communities and negative health outcomes, little research has analyzed the effects of environmental contaminants on the mental and physical health of these populations. A cross-sectional survey collected data from residents of Manchester, a small neighborhood in Houston, TX, that is characterized by industrial sites, unimproved infrastructure, nuisance flooding, and poor air quality. Our study (N = 109) utilized the 12 item Short Form Health Survey version 2 (SF12v2) to assess the general mental and physical health of the community. The community as a whole had reduced physical health scores compared to U.S. national averages. The time residents had lived in the neighborhood was also correlated with a reported reduction in physical health scores (r2 = 0.136; p-value <0.001). The association between time lived in the neighborhood and poorer health scores remained after adjusting for age, race, and gender (coef = -0.27, p-value <0.001). Mental health scores were within national averages and time spent living in the neighborhood did not appear to negatively impact respondent's mental health scores. These findings point to the need for more research to determine the potential for additive physical and mental health impacts in long-term residents in neighborhoods characterized by environmental justice issues.

Evaluation of an Online Program To Teach Microbiology to Internal Medicine Residents

PubMed Central

Burd, Eileen M.; Kraft, Colleen S.; Armstrong, Wendy S.; Lenorr, Kenya; Spicer, Jennifer O.; Martin, Donna; del Rio, Carlos

2014-01-01

Microbiology rounds are an integral part of infectious disease consultation service. During microbiology rounds, we highlight microbiology principles using vignettes. We created case-based, interactive, microbiology online modules similar to the vignettes presented during microbiology rounds. Since internal medicine residents rotating on our infectious disease elective have limited time to participate in rounds and learn microbiology, our objective was to evaluate the use of the microbiology online modules by internal medicine residents. We asked residents to complete 10 of 25 online modules during their infectious disease elective. We evaluated which modules they chose and the change in their knowledge level. Forty-six internal medicine residents completed assessments given before and after accessing the modules with an average of 11/20 (range, 6 to 19) and 16/20 (range, 9 to 20) correct questions, respectively (average improvement, 5 questions; P = 0.0001). The modules accessed by more than 30 residents included those related to Clostridium difficile, anaerobes, Candida spp., Streptococcus pneumoniae, influenza, Mycobacterium tuberculosis, and Neisseria meningitidis. We demonstrated improved microbiology knowledge after completion of the online modules. This improvement may not be solely attributed to completing the online modules, as fellows and faculty may have provided additional microbiology education during the rotation. PMID:25392364

Evaluation of an online program to teach microbiology to internal medicine residents.

PubMed

Guarner, Jeannette; Burd, Eileen M; Kraft, Colleen S; Armstrong, Wendy S; Lenorr, Kenya; Spicer, Jennifer O; Martin, Donna; del Rio, Carlos

2015-01-01

Microbiology rounds are an integral part of infectious disease consultation service. During microbiology rounds, we highlight microbiology principles using vignettes. We created case-based, interactive, microbiology online modules similar to the vignettes presented during microbiology rounds. Since internal medicine residents rotating on our infectious disease elective have limited time to participate in rounds and learn microbiology, our objective was to evaluate the use of the microbiology online modules by internal medicine residents. We asked residents to complete 10 of 25 online modules during their infectious disease elective. We evaluated which modules they chose and the change in their knowledge level. Forty-six internal medicine residents completed assessments given before and after accessing the modules with an average of 11/20 (range, 6 to 19) and 16/20 (range, 9 to 20) correct questions, respectively (average improvement, 5 questions; P = 0.0001). The modules accessed by more than 30 residents included those related to Clostridium difficile, anaerobes, Candida spp., Streptococcus pneumoniae, influenza, Mycobacterium tuberculosis, and Neisseria meningitidis. We demonstrated improved microbiology knowledge after completion of the online modules. This improvement may not be solely attributed to completing the online modules, as fellows and faculty may have provided additional microbiology education during the rotation. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

Selection criteria of residents for residency programs in Kuwait

PubMed Central

2013-01-01

Background In Kuwait, 21 residency training programs were offered in the year 2011; however, no data is available regarding the criteria of selecting residents for these programs. This study aims to provide information about the importance of these criteria. Methods A self-administered questionnaire was used to collect data from members (e.g. chairmen, directors, assistants …etc.) of residency programs in Kuwait. A total of 108 members were invited to participate. They were asked to rate the importance level (scale from 1 to 5) of criteria that may affect the acceptance of an applicant to their residency programs. Average scores were calculated for each criterion. Results Of the 108 members invited to participate, only 12 (11.1%) declined to participate. Interview performance was ranked as the most important criteria for selecting residents (average score: 4.63/5.00), followed by grade point average (average score: 3.78/5.00) and honors during medical school (average score: 3.67/5.00). On the other hand, receiving disciplinary action during medical school and failure in a required clerkship were considered as the most concerning among other criteria used to reject applicants (average scores: 3.83/5.00 and 3.54/5.00 respectively). Minor differences regarding the importance level of each criterion were noted across different programs. Conclusions This study provided general information about the criteria that are used to accept/reject applicants to residency programs in Kuwait. Future studies should be conducted to investigate each criterion individually, and to assess if these criteria are related to residents' success during their training. PMID:23331670

Resident aggression toward staff at a center for the developmentally disabled.

PubMed

West, Christine A; Galloway, Ellen; Niemeier, Maureen T

2014-01-01

Few studies have examined factors contributing to nonfatal assaults to staff working in residential care facilities. The authors evaluated resident assaults toward direct care/nursing staff at an intermediate Care Facility for Individuals with Mental Retardation (ICF/MR), which included observations of work areas, employee interviews, calculation of injury and assault rates for 2004 to 2007 from Occupational Safety and Health Administration Logs, and review of state ICP/MR guidelines. Most staff interviewed reported having been injured during physical restraint of a resident and the average rate of injury from assault at the center evaluated was higher than the average national rates for the health care and social assistance sector for the same time period. The center lacked policies and developing a post-incident response and evaluation program to assist staff in coping with the consequences of assault and/or occupational injury.

A survey of diagnostic radiology residency program directors and the increasing demands of program leadership.

PubMed

Webber, Grant R; Baumgarten, Deborah A; Chen, Zhengjia; Wang, Zhibo; Mullins, Mark E

2013-07-01

The aim of this study was to identify trends and opinions with respect to leadership turnover, leadership responsibilities, and residency requirements. Program directors (PDs) of diagnostic radiology (DR) residency programs were identified via the ACGME and the Fellowship and Residency Electronic Interactive Database, along with a programmatic website search. A web-based survey was e-mailed, with questions concerning lengths of time the current and prior PDs held their positions, residency size, amounts of time spent on and lengths of current and past Program Information Forms, and opinions on how the position has changed and how metrics, outcomes, and documentation may be affecting teaching, resident education, and patient care. Thirty-two percent (60 of 186) of US DR residency PDs answered at least 1 of the survey questions. The average length of time the current PDs held their positions was shorter compared with the previous PDs, and it has taken longer and required more pages to complete the current Program Information Forms compared with prior cycles. The majority of respondents felt that the job of PD was harder than 5 years ago and that turnover among PDs is a "current/impending" problem. The majority of respondents felt that time spent on metrics, outcomes, and documentation is taking away from teaching, learning, and taking care of patients. Many DR residency PDs have recognized increased administrative burdens in recent years. Some feel that these increased demands may in part have negative effects on resident education and patient care. Copyright © 2013 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Imaging appropriateness in an academic emergency medicine program.

PubMed

Dolatabadi, Ali Arhami; Shojaee, Majid; Kariman, Hamid; Shahrami, Ali; Abolmaali, Sarah

2018-01-01

As radiologic assessment is a key part in evaluating patients visited in emergency department, this survey was conducted to measure emergency medicine residents' competency in choosing appropriate diagnostic imaging in different clinical scenarios. All emergency medicine residents enrolled in an academic emergency medicine discipline in the three medical universities of Tehran, Iran were recruited. A questionnaire was designed consisting of 10 clinically common scenarios selected from the American College of Radiology appropriateness criteria. Each resident completed the survey separately with answers only given after all residents participated. 196 residents completed the survey (95% of all residents). The results were stratified by post-graduate year and university. The average number of correct answers was 6.2. First, second and third year residents scored the average of 6.1, 5.8 and 6.5, respectively (P=0.04). The average score of residents from different universities did not differ significantly. According to the low average score, it is recommended that attentive educational perfections are needed to help residents order more appropriate diagnostic images, which may also be helpful for other healthcare providers. However, it seems that our emergency medicine academic curriculum is relatively efficient to enhance residents' skills in choosing proper imaging. Copyright © 2017 Elsevier Ltd. All rights reserved.

Orthopedic resident work-shift analysis: are we making the best use of resident work hours?

PubMed

Hamid, Kamran S; Nwachukwu, Benedict U; Hsu, Eugene; Edgerton, Colston A; Hobson, David R; Lang, Jason E

2014-01-01

Surgery programs have been tasked to meet rising demands in patient surgical care while simultaneously providing adequate resident training in the midst of increasing resident work-hour restrictions. The purpose of this study was to quantify orthopedic surgery resident workflow and identify areas needing improved resident efficiency. We hypothesize that residents spend a disproportionate amount of time involved in activities that do not relate directly to patient care or maximize resident education. We observed 4 orthopedic surgery residents on the orthopedic consult service at a major tertiary care center for 72 consecutive hours (6 consecutive shifts). We collected minute-by-minute data using predefined work-task criteria: direct new patient contact, direct existing patient contact, communications with other providers, documentation/administrative time, transit time, and basic human needs. A seventh category comprised remaining less-productive work was termed as standby. In a 720-minute shift, residents spent on an average: 191 minutes (26.5%) performing documentation/administrative duties, 167.0 minutes (23.2%) in direct contact with new patient consults, 129.6 minutes (17.1%) in communication with other providers regarding patients, 116.2 (16.1%) minutes in standby, 63.7 minutes (8.8%) in transit, 32.6 minutes (4.5%) with existing patients, and 20 minutes (2.7%) attending to basic human needs. Residents performed an additional 130 minutes of administrative work off duty. Secondary analysis revealed residents were more likely to perform administrative work rather than directly interact with existing patients (p = 0.006) or attend to basic human needs (p = 0.003). Orthopedic surgery residents spend a large proportion of their time performing documentation/administrative-type work and their workday can be operationally optimized to minimize nonvalue-adding tasks. Formal workflow analysis may aid program directors in systematic process improvements to better align resident skills with tasks. III. Published by Elsevier Inc.

The state of the service: a survey of psychiatry resident education in psychosomatic medicine.

PubMed

Heinrich, Thomas W; Schwartz, Ann C; Zimbrean, Paula C; Wright, Mark T

2013-01-01

Although required by the Accreditation Council for Graduate Medical Education, training of general psychiatry residents in Psychosomatic Medicine (PM) varies significantly between programs. In 1996, the Academy of Psychosomatic Medicine (APM) developed guidelines for residency training in PM. Since then, there has been no assessment of the status of PM training during psychiatry residency. Assessment of the current state of PM training in U.S. psychiatry residency programs. A 46-item questionnaire was sent via e-mail to 206 residency directors. Four major areas were assessed: the timing and duration of the PM rotation, level of faculty supervision, didactic curriculum, and role (or potential role) of the APM in residency education. Ninety-two surveys were returned (response rate 45%). Forty-four (54%) of the general psychiatry residencies reported the total duration of the C-L rotation as being between 3 and 6 months (including both full- and part-time rotation). Only 38 (46%) programs' residents complete their PM experience in 1 year of residency. The average Full-Time Equivalent of teaching faculty per service was 1.74 (standard deviation 0.92). Sixty-four (77%) programs have a formal didactic curriculum in C-L. Eighty-one (98%) respondents were aware of the APM. Fifty-eight (70%) had APM members among faculty. The most popular responses on how the APM could best serve training programs were the creation of a subspecialty curriculum (73%) as well as the development of a competency-based evaluation tool (66%). There is significant variation in how residents are taught PM during their training. The APM is a well-recognized organization that may define what constitutes adequate residency training in PM and may help programs fulfill the educational needs of residents. © 2013 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

Chaotic itinerancy and power-law residence time distribution in stochastic dynamical systems.

PubMed

Namikawa, Jun

2005-08-01

Chaotic itinerant motion among varieties of ordered states is described by a stochastic model based on the mechanism of chaotic itinerancy. The model consists of a random walk on a half-line and a Markov chain with a transition probability matrix. The stability of attractor ruin in the model is investigated by analyzing the residence time distribution of orbits at attractor ruins. It is shown that the residence time distribution averaged over all attractor ruins can be described by the superposition of (truncated) power-law distributions if the basin of attraction for each attractor ruin has a zero measure. This result is confirmed by simulation of models exhibiting chaotic itinerancy. Chaotic itinerancy is also shown to be absent in coupled Milnor attractor systems if the transition probability among attractor ruins can be represented as a Markov chain.

Voluntary autonomous simulator based training in minimally invasive surgery, residents' compliance and reflection.

PubMed

van Empel, Pieter J; Verdam, Mathilde G E; Strypet, Magnus; van Rijssen, Lennart B; Huirne, Judith A; Scheele, Fedde; Bonjer, H Jaap; Meijerink, W Jeroen

2012-01-01

Knot tying and suturing skills in minimally invasive surgery (MIS) differ markedly from those in open surgery. Appropriate MIS training is mandatory before implementation into practice. The Advanced Suturing Course (ASC) is a structured simulator based training course that includes a 6-week autonomous training period at home on a traditional laparoscopic box trainer. Previous research did not demonstrate a significant progress in laparoscopic skills after this training period. This study aims to identify factors determining autonomous training on a laparoscopic box trainer at home. Residents (n = 97) attending 1 of 7 ASC courses between January 2009 and June 2011 were consecutively included. After 6 weeks of autonomous, training a questionnaire was completed. A random subgroup of 30 residents was requested to keep a time log. All residents received an online survey after attending the ASC. We performed outcome comparison to examine the accuracy of individual responses. Out of 97 residents, the main motives for noncompliant autonomous training included a lack of (training) time after working hours (n = 80, 83.3%), preferred practice time during working hours (n = 76, 31.6%), or another surgical interest than MIS (n = 79, 15.2%). Previously set training goals would encourage autonomous training according to 27.8% (n = 18) of residents. Thirty participants submitted a time log and reported an average 76.5-minute weekly training time. All residents confirmed that autonomous home practice on a laparoscopic box trainer is valuable. Autonomous practice should be structured and inclusive of adequate and sufficient feedback points. A minimally required practice time should be set. An obligatory assessment, including corresponding consequence should be conducted. Compliance herewith may result in increased voluntary (autonomous) simulator based (laparoscopic) training by residents. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

The Impact of Isolation on Healthcare Worker Contact and Compliance With Infection Control Practices in Nursing Homes.

PubMed

Pineles, Lisa; Petruccelli, Chris; Perencevich, Eli N; Roghmann, Mary-Claire; Gupta, Kalpana; Cadena, Jose; Baracco, Gio; Pfeiffer, Christopher D; Forrest, Graeme; Bradley, Suzanne F; Crnich, Chris; Reisinger, Heather; Morgan, Daniel J

2018-06-01

OBJECTIVETo directly observe healthcare workers in a nursing home setting to measure frequency and duration of resident contact and infection prevention behavior as a factor of isolation practiceDESIGNObservational studySETTING AND PARTICIPANTSHealthcare workers in 8 VA nursing homes in Florida, Maryland, Massachusetts, Michigan, Washington, and TexasMETHODSOver a 15-month period, trained research staff without clinical responsibilities on the units observed nursing home resident room activity for 15-30-minute intervals. Observers recorded time of entry and exit, isolation status, visitor type (staff, visitor, etc), hand hygiene, use of gloves and gowns, and activities performed in the room when visible.RESULTSA total of 999 hours of observation were conducted across 8 VA nursing homes during which 4,325 visits were observed. Residents in isolation received an average of 4.73 visits per hour of observation compared with 4.21 for nonisolation residents (P<.01), a 12.4% increase in visits for residents in isolation. Residents in isolation received an average of 3.53 resident care activities per hour of observation, compared with 2.46 for residents not in isolation (P<.01). For residents in isolation, compliance was 34% for gowns and 58% for gloves. Healthcare worker hand hygiene compliance was 45% versus 44% (P=.79) on entry and 66% versus 55% (P<.01) on exit for isolation and nonisolation rooms, respectively.CONCLUSIONSHealthcare workers visited residents in isolation more frequently, likely because they required greater assistance. Compliance with gowns and gloves for isolation was limited in the nursing home setting. Adherence to hand hygiene also was less than optimal, regardless of isolation status of residents.Infect Control Hosp Epidemiol 2018;39:683-687.

Cross-sectional study on their reproductive health status of 604 female floating residents in Beijing.

PubMed

Wang, Y; An, L; Zhang, X B; Wang, S X

1999-03-01

The rapid increases in the numbers of female labor migrants ("floating residents") in cities such as Beijing have created challenges for China's reproductive health care system. An exploratory study conducted in Beijing in 1996 of 507 floating workers engaged in household management work (average age, 27.4 years) sought to gain information to facilitate the design of reproductive health services for this group. The women had resided in Beijing for an average of 3.7 years, generally with their families. 84% were married, at a mean age of 21.87 years; married women had an average of 1.43 live births, 42% of which had occurred in Beijing. 25% did not receive any prenatal care and 60% did not know whom to consult about maternal-child health care problems. Contraceptive prevalence was 81.1% among floating workers compared with 97% among a comparison group of nonmigrant agricultural and textile workers. Most floating workers were unaware of any contraceptive methods other than the one they were using (generally the IUD or female sterilization). Finally, only 8.4% could cite symptoms of sexually transmitted diseases and 33.9% had not heard of AIDS. Laboratory examinations revealed a 29.3% prevalence of reproductive tract infections among female floating residents. bacterial vaginitis (11.6%) and Mycoplasma infection (6.7%) were most prevalent. These findings confirm that female floating residents remain in Beijing a long time and have a serious unmet need for targeted reproductive health care services.

Integrating Telehealth Emergency Department Follow-up Visits into Residency Training.

PubMed

Papanagnou, Dimitrios; Stone, Danica; Chandra, Shruti; Watts, Phillip; Chang, Anna Marie; Hollander, Judd E

2018-04-05

Introduction Given the rapid expansion of telehealth (TH), there is an emerging need for trained professionals who can effectively deliver TH services. As there is no formal TH training program for residents, the Department of Emergency Medicine (DEM) at Thomas Jefferson University (TJU) developed a pilot training program for senior post-graduate-year three (PGY-3) residents that exposed them to TH practices. The objective of the study was to determine the feasibility of developing a resident-led, post-Emergency-Department (ED) visit TH follow-up program as an educational opportunity to 1) address patient satisfaction; and 2) expose senior residents to TH delivery. Methods During a one-month block in their third-year of training, EM residents were exposed to and educated on TH delivery and utility through on-the-job, just-in-time training. Residents spent four hours per week evaluating patients previously seen in the ED within the last 5-7 days in the form of TH follow-up visits. ED patients were screened to identify which patient chief complaints and presentations were appropriate for a follow-up visit, given a specific day and time for their TH encounter, facilitated by a resident, and supervised by a faculty member trained in TH. Demographic patient and visit data were collected. Residents then completed a brief survey at the end of the rotation to capture their educational experiences and recommendations for subsequent training improvement. Results Over 12 months, 197 TH follow-up visits were performed by 12 residents. One hundred twenty-six patients (64%) were female. Top chief complaints included extremity pain (11.2%); abdominal pain (8.1%); upper respiratory infections (8.1%); lacerations (7.6%), and motor vehicle accidents (7.6%). The average number of days between the ED visit and the TH follow-up call was 5.1 days (IQR 3-6). 44.7% of patients were compliant with their discharge instructions and medications. On a Likert scale low (1) to high (10)], average patient helpfulness rating was 8.2 (IQR 7.8-10) and the average patient likelihood to recommend a TH follow-up visit was 8.5 (IQR 8-10). Ten residents completed the follow-up survey on the educational experience of the rotation (response rate 83%), of which seven described there is value to have a TH rotation in the curriculum. Thematic analysis of open-ended responses yielded constructive feedback for programmatic improvement. Conclusion The authors propose a feasible TH training opportunity integrated into EM residency training to assist them with meeting a rapidly-growing demand for TH and prepare them for diverse job opportunities.

Facts about Measles for Adults

MedlinePlus

... residents should be immune to measles before international travel. Symptoms Symptoms of measles include high fever, generalized rash, runny nose, pink, watery eyes, coughing, diarrhea, and earache. The average time between exposure to the measles virus and development ...

Internal medicine residents' clinical and didactic experiences after work hour regulation: a survey of chief residents.

PubMed

Horwitz, Leora I; Krumholz, Harlan M; Huot, Stephen J; Green, Michael L

2006-09-01

Work hour regulations for house staff were intended in part to improve resident clinical and educational performance. To characterize the effect of work hour regulation on internal medicine resident inpatient clinical experience and didactic education. Cross-sectional mail survey. Chief residents at all accredited U.S. internal medicine residency programs outside New York. The response rate was 62% (202/324). Most programs (72%) reported no change in average patient load per intern after work hour regulation. Many programs (48%) redistributed house staff admissions through the call cycle. The number of admissions per intern on long call (the day interns have the most admitting responsibility) decreased in 31% of programs, and the number of admissions on other days increased in 21% of programs. Residents on outpatient rotations were given new ward responsibilities in 36% of programs. Third-year resident ward and float time increased in 34% of programs, while third-year elective time decreased in 22% of programs. The mean weekly hours allotted to educational activities did not change significantly (12.7 vs 12.4, P = .12), but 56% of programs reported a decrease in intern attendance at educational activities. In response to work hour regulation, many internal medicine programs redistributed rather than reduced residents' inpatient clinical experience. Hours allotted to educational activities did not change; however, most programs saw a decrease in intern attendance at conferences, and many reduced third-year elective time.

Concepts and Applications of Water Transport Time Scales for Coastal Inlet Systems

DTIC Science & Technology

2010-08-01

mass or volume stays in the system. For an instantaneous material release in a reservoir, Takeoka (1984) associated the concept of average residence...of the Altamaha River estuary, Georgia. Estuaries 25:1304–1317. Takeoka , H. 1984. Fundamental concepts of exchange and transport time scales in a

[Time-series analysis of ambient PM₁₀ pollution on residential mortality in Beijing].

PubMed

Xue, Jiang-li; Wang, Qi; Cai, Yue; Zhou, Mai-geng

2012-05-01

To explore the short-term impact of ambient PM(10) on daily non-accidental death, cardiovascular and respiratory death of residents in Beijing. Mortality data of residents in Beijing during 2006 to 2009 were obtained from public health surveillance and information service center of Chinese Center for Disease Control and Prevention, contemporaneous data of average daily air concentration of PM(10), SO(2), NO(2) were obtained from Beijing Environment Protection Bureau (year 2005 - 2006) and public website of Beijing environmental protection (year 2007 - 2009), respectively, contemporaneous meteorological data were obtained from china meteorological data sharing service system. Generalized addictive model (GAM) of time serial analysis was applied. In additional to the control of confounding factors such as long-term trend, day of the week effect, meteorological factors, lag effect and the effects of other atmospheric pollutants were also analyzed. During year 2006 to 2009, the number of average daily non-accidental death, respiratory disease caused death, cardiovascular and cerebrovascular diseases caused death among Beijing residents were 140.1, 15.0, 65.8, respectively;contemporaneous medians of average daily air concentration of PM(10), SO(2), NO(2) were 123.0, 26.0, 58.0 µg/m(3), respectively;contemporaneous average atmosphere pressure, temperature and relative humidity were 10.1 kPa, 13.5°C and 51.9%, respectively. An exposure-response relationship between exposure to ambient PM(10) and increased daily death number was found as every 10 µg/m(3) increase in daily average concentration of PM(10), there was a 0.1267% (95%CI: 0.0824% - 0.1710%) increase in daily non-accidental death of residents, 0.1365% (95%CI: 0.0010% - 0.2720%) increase in respiratory death and 0.1239% (95%CI: 0.0589% - 0.1889%) increase in cardiovascular death. Ambient PM(10) had greatest influence on daily non-accidental and cardiovascular death of the same day, while its greatest influence on respiratory death occurred 5 days later. The ambient PM(10) pollution increased daily non-accidental, respiratory disease caused, cardiovascular and cerebrovascular diseases caused deaths among residents in Beijing, and lag effect existed as for the effect of ambient PM(10) pollution on respiratory disease caused death.

Modeling the Spread of Methicillin-Resistant Staphylococcus aureus in Nursing Homes for Elderly

PubMed Central

Chamchod, Farida; Ruan, Shigui

2012-01-01

Methicillin-resistant Staphylococcus aureus (MRSA) is endemic in many hospital settings, including nursing homes. It is an important nosocomial pathogen that causes mortality and an economic burden to patients, hospitals, and the community. The epidemiology of the bacteria in nursing homes is both hospital- and community-like. Transmission occurs via hands of health care workers (HCWs) and direct contacts among residents during social activities. In this work, mathematical modeling in both deterministic and stochastic frameworks is used to study dissemination of MRSA among residents and HCWs, persistence and prevalence of MRSA in a population, and possible means of controlling the spread of this pathogen in nursing homes. The model predicts that: without strict screening and decolonization of colonized individuals at admission, MRSA may persist; decolonization of colonized residents, improving hand hygiene in both residents and HCWs, reducing the duration of contamination of HCWs, and decreasing the resident∶staff ratio are possible control strategies; the mean time that a resident remains susceptible since admission may be prolonged by screening and decolonization treatment in colonized individuals; in the stochastic framework, the total number of colonized residents varies and may increase when the admission of colonized residents, the duration of colonization, the average number of contacts among residents, or the average number of contacts that each resident requires from HCWs increases; an introduction of a colonized individual into an MRSA-free nursing home has a much higher probability of leading to a major outbreak taking off than an introduction of a contaminated HCW. PMID:22238650

The ACGME case log: General surgery resident experience in pediatric surgery

PubMed Central

Gow, Kenneth W.; Drake, F. Thurston; Aarabi, Shahram; Waldhausen, John H.

2014-01-01

Background General surgery (GS) residents in ACGME programs log cases performed during their residency. We reviewed designated pediatric surgery (PS) cases to assess for changes in performed cases over time. Methods The ACGME case logs for graduating GS residents were reviewed from academic year (AY) 1989–1990 to 2010–2011 for designated pediatric cases. Overall and designated PS cases were analyzed. Data were combined into five blocks: Period I (AY1989–90 to AY1993–94), Period II (AY1994–95 to AY1998–99), Period III (AY1999–00 to AY2002–03), Period IV (AY2003–04 to AY2006–07), and Period V (AY2007–08 to AY2010–11). Periods IV and V were delineated by implementation of duty hour restrictions. Student t-tests compared averages among the time periods with significance at P < .05. Results Overall GS case load remained relatively stable. Of total cases, PS cases accounted for 5.4% in Period I and 3.7% in Period V. Designated pediatric cases declined for each period from an average of 47.7 in Period I to 33.8 in Period V. These changes are due to a decline in hernia repairs, which account for half of cases. All other cases contributed only minimally to the pediatric cases. The only laparoscopic cases in the database were anti-reflux procedures, which increased over time. Conclusions GS residents perform a diminishing number of designated PS cases. This decline occurred before the onset of work-hour restrictions. These changes have implications on the capabilities of the current graduating workforce. However, the case log does not reflect all cases trainees may be exposed to, so revision of this list is recommended. PMID:23932601

Accreditation Council for Graduate Medical Education Case Log: General Surgery Resident Thoracic Surgery Experience

PubMed Central

Kansier, Nicole; Varghese, Thomas K.; Verrier, Edward D.; Drake, F. Thurston; Gow, Kenneth W.

2014-01-01

Background General surgery resident training has changed dramatically over the past 2 decades, with likely impact on specialty exposure. We sought to assess trends in general surgery resident exposure to thoracic surgery using the Accreditation Council for Graduate Medical Education (ACGME) case logs over time. Methods The ACGME case logs for graduating general surgery residents were reviewed from academic year (AY) 1989–1990 to 2011–2012 for defined thoracic surgery cases. Data were divided into 5 eras of training for comparison: I, AY89 to 93; II, AY93 to 98; III, AY98 to 03; IV, AY03 to 08; V, AY08 to 12. We analyzed quantity and types of cases per time period. Student t tests compared averages among the time periods with significance at a p values less than 0.05. Results A total of 21,803,843 general surgery cases were reviewed over the 23-year period. Residents averaged 33.6 thoracic cases each in period I and 39.7 in period V. Thoracic cases accounted for nearly 4% of total cases performed annually (period I 3.7% [134,550 of 3,598,574]; period V 4.1% [167,957 of 4,077,939]). For the 3 most frequently performed procedures there was a statistically significant increase in thoracoscopic approach from period II to period V. Conclusions General surgery trainees today have the same volume of thoracic surgery exposure as their counterparts over the last 2 decades. This maintenance in caseload has occurred in spite of work-hour restrictions. However, general surgery graduates have a different thoracic surgery skill set at the end of their training, due to the predominance of minimally invasive techniques. Thoracic surgery educators should take into account these differences when training future cardiothoracic surgeons. PMID:24968766

Passive magnetic bearing systems stabilizer/bearing utilizing time-averaging of a periodic magnetic field

DOE Office of Scientific and Technical Information (OSTI.GOV)

Post, Richard F.

A high-stiffness stabilizer/bearings for passive magnetic bearing systems is provide where the key to its operation resides in the fact that when the frequency of variation of the repelling forces of the periodic magnet array is large compared to the reciprocal of the growth time of the unstable motion, the rotating system will feel only the time-averaged value of the force. When the time-averaged value of the force is radially repelling by the choice of the geometry of the periodic magnet array, the Earnshaw-related unstable hit motion that would occur at zero rotational speed is suppressed when the system ismore » rotating at operating speeds.« less

Are All Competencies Equal in the Eyes of Residents? A Multicenter Study of Emergency Medicine Residents' Interest in Feedback.

PubMed

Bentley, Suzanne; Hu, Kevin; Messman, Anne; Moadel, Tiffany; Khandelwal, Sorabh; Streich, Heather; Noelker, Joan

2017-01-01

Feedback, particularly real-time feedback, is critical to resident education. The emergency medicine (EM) milestones were developed in 2012 to enhance resident assessment, and many programs use them to provide focused resident feedback. The purpose of this study was to evaluate EM residents' level of interest in receiving real-time feedback on each of the 23 competencies/sub-competencies. This was a multicenter cross-sectional study of EM residents. We surveyed participants on their level of interest in receiving real-time on-shift feedback on each of the 23 competencies/sub-competencies. Anonymous paper or computerized surveys were distributed to residents at three four-year training programs and three three-year training programs with a total of 223 resident respondents. Residents rated their level of interest in each milestone on a six-point Likert-type response scale. We calculated average level of interest for each of the 23 sub-competencies, for all 223 respondents and separately by postgraduate year (PGY) levels of training. One-way analyses of variance were performed to determine if there were differences in ratings by level of training. The overall survey response rate across all institutions was 82%. Emergency stabilization had the highest mean rating (5.47/6), while technology had the lowest rating (3.24/6). However, we observed no differences between levels of training on any of the 23 competencies/sub-competencies. Residents seem to ascribe much more value in receiving feedback on domains involving high-risk, challenging procedural skills as compared to low-risk technical and communication skills. Further studies are necessary to determine whether residents' perceived importance of competencies/sub-competencies needs to be considered when developing an assessment or feedback program based on these 23 EM competencies/sub-competencies.

Seasonal variation of residence time in spring and groundwater evaluated by CFCs and numerical simulation in mountainous headwater catchment

NASA Astrophysics Data System (ADS)

Tsujimura, Maki; Watanabe, Yasuto; Ikeda, Koichi; Yano, Shinjiro; Abe, Yutaka

2016-04-01

Headwater catchments in mountainous region are the most important recharge area for surface and subsurface waters, additionally time information of the water is principal to understand hydrological processes in the catchments. However, there have been few researches to evaluate variation of residence time of subsurface water in time and space at the mountainous headwaters especially with steep slope. We investigated the temporal variation of the residence time of the spring and groundwater with tracing of hydrological flow processes in mountainous catchments underlain by granite, Yamanashi Prefecture, central Japan. We conducted intensive hydrological monitoring and water sampling of spring, stream and ground waters in high-flow and low-flow seasons from 2008 through 2013 in River Jingu Watershed underlain by granite, with an area of approximately 15 km2 and elevation ranging from 950 m to 2000 m. The CFCs, stable isotopic ratios of oxygen-18 and deuterium, inorganic solute constituent concentrations were determined on all water samples. Also, a numerical simulation was conducted to reproduce of the average residence times of the spring and groundwater. The residence time of the spring water estimated by the CFCs concentration ranged from 10 years to 60 years in space within the watershed, and it was higher (older) during the low flow season and lower (younger) during the high flow season. We tried to reproduce the seasonal change of the residence time in the spring water by numerical simulation, and the calculated residence time of the spring water and discharge of the stream agreed well with the observed values. The groundwater level was higher during the high flow season and the groundwater dominantly flowed through the weathered granite with higher permeability, whereas that was lower during the low flow season and that flowed dominantly through the fresh granite with lower permeability. This caused the seasonal variation of the residence time of the spring water, older in low flow season and younger in the high flow season in the watershed. As a result, the numerical model simulated successfully the dynamics of the groundwater flow and residence time in the spring water.

Fluorescent biological aerosol particles: Concentrations, emissions, and exposures in a northern California residence.

PubMed

Tian, Y; Liu, Y; Misztal, P K; Xiong, J; Arata, C M; Goldstein, A H; Nazaroff, W W

2018-04-06

Residences represent an important site for bioaerosol exposure. We studied bioaerosol concentrations, emissions, and exposures in a single-family residence in northern California with 2 occupants using real-time instrumentation during 2 monitoring campaigns (8 weeks during August-October 2016 and 5 weeks during January-March 2017). Time- and size-resolved fluorescent biological aerosol particles (FBAP) and total airborne particles were measured in real time in the kitchen using an ultraviolet aerodynamic particle sizer (UVAPS). Time-resolved occupancy status, household activity data, air-change rates, and spatial distribution of size-resolved particles were also determined throughout the house. Occupant activities strongly influenced indoor FBAP levels. Indoor FBAP concentrations were an order of magnitude higher when the house was occupied than when the house was vacant. Applying an integral material-balance approach, geometric mean of total FBAP emissions from human activities observed to perturb indoor levels were in the range of 10-50 million particles per event. During the summer and winter campaigns, occupants spent an average of 10 and 8.5 hours per day, respectively, awake and at home. During these hours, the geometric mean daily-averaged FBAP exposure concentration (1-10 μm diameter) was similar for each subject at 40 particles/L for summer and 29 particles/L for winter. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Incorporating performance improvement methods into a needs assessment: experience with a nutrition and exercise curriculum.

PubMed

Fluker, Shelly-Ann; Whalen, Ursula; Schneider, Jason; Cantey, Paul; Bussey-Jones, Jada; Brady, Donald; Doyle, Joyce P

2010-09-01

Clinical guidelines recommend that physicians counsel patients on diet and exercise; however, physician counseling remains suboptimal. To determine if incorporating performance improvement (PI) methodologies into a needs assessment for an internal medicine (IM) residency curriculum on nutrition and exercise counseling was feasible and enhanced our understanding of the curricular needs. One hundred and fifty-eight IM residents completed a questionnaire to assess their knowledge, attitudes, and practices (KAP) about nutrition and exercise counseling for hypertensive patients. Residents' baseline nutrition and exercise counseling rates were also obtained using chart abstraction. Fishbone diagrams were created by the residents to delineate perceived barriers to diet and exercise counseling. The KAP questionnaire was analyzed using descriptive statistics. Chart abstraction data was plotted on run charts and average counseling rates were calculated. Pareto charts were developed from the fishbone diagrams depicting the number of times each barrier was reported. Almost 90% of the residents reported counseling their hypertensive patients about diet and exercise more than 20% of the time on the KAP questionnaire. In contrast, chart abstraction revealed average counseling rates of 3% and 4% for nutrition and exercise, respectively. The KAP questionnaire exposed a clinical knowledge deficit, lack of familiarity with the national guidelines, and low self-efficacy. In contrast, the fishbone analysis highlighted patient apathy, patient co-morbidities, and time pressure as the major perceived barriers. We found that incorporating PI methods into a needs assessment for an IM residency curriculum on nutrition and exercise counseling for patients at risk of cardiovascular disease was feasible, provided additional information not obtained through other means, and provided the opportunity to pilot the use of PI techniques as an educational strategy and means of measuring outcomes. Our findings suggest that utilization of PI principles provides a useful framework for developing and implementing a medical education curriculum and measuring its effectiveness.

Costs of a Staff Communication Intervention to Reduce Dementia Behaviors in Nursing Home Care

PubMed Central

Williams, Kristine N.; Ayyagari, Padmaja; Perkhounkova, Yelena; Bott, Marjorie J.; Herman, Ruth; Bossen, Ann

2017-01-01

CONTEXT Persons with Alzheimer’s disease and other dementias experience behavioral symptoms that frequently result in nursing home (NH) placement. Managing behavioral symptoms in the NH increases staff time required to complete care, and adds to staff stress and turnover, with estimated cost increases of 30%. The Changing Talk to Reduce Resistivenes to Dementia Care (CHAT) study found that an intervention that improved staff communication by reducing elderspeak led to reduced behavioral symptoms of dementia or resistiveness to care (RTC). OBJECTIVE This analysis evaluates the cost-effectiveness of the CHAT intervention to reduce elderspeak communication by staff and RTC behaviors of NH residents with dementia. DESIGN Costs to provide the intervention were determined in eleven NHs that participated in the CHAT study during 2011–2013 using process-based costing. Each NH provided data on staff wages for the quarter before and for two quarters after the CHAT intervention. An incremental cost-effectiveness analysis was completed. ANALYSIS An average cost per participant was calculated based on the number and type of staff attending the CHAT training, plus materials and interventionist time. Regression estimates from the parent study then were applied to determine costs per unit reduction in staff elderspeak communication and resident RTC. RESULTS A one percentage point reduction in elderspeak costs $6.75 per staff member with average baseline elderspeak usage. Assuming that each staff cares for 2 residents with RTC, a one percentage point reduction in RTC costs $4.31 per resident using average baseline RTC. CONCLUSIONS Costs to reduce elderspeak and RTC depend on baseline levels of elderspeak and RTC, as well as the number of staff participating in CHAT training and numbers of residents with dementia-related behaviors. Overall, the 3-session CHAT training program is a cost-effective intervention for reducing RTC behaviors in dementia care. PMID:28503675

An Innovative Approach to Improve Communication and Reduce Physician Stress and Burnout in a University Affiliated Residency Program.

PubMed

Lapointe, Ryan; Bhesania, Siddharth; Tanner, Tristan; Peruri, Adithya; Mehta, Parag

2018-05-28

Ineffective communication between nursing staff and residents leads to numerous educational and patient-care interruptions, increasing resident stress and overall workload. We developed an innovative and simple, secure electronic health record (EHR) base text paging system to communicate with internal medicine residents. The goal is to avoid unnecessary interruption during patient care or educational activities and reduce stress. Traditional paging system can send a phone number to call back. We developed and implemented a HIPPA-compliant, EHR-integrated text paging at a busy 591-bed urban hospital. Access was granted to unit clerks, nursing staff, case managers, and physicians. Senders could either send a traditional telephone number page or a text page through our EHR. The recipient could then either acknowledge receipt of the page or take appropriate actions. Afterward, Internal medicine residents were polled on overall satisfaction difference between basic phone based numeric paging and the enhanced EHR text paging system. Educational interruptions (averaging over 7 pages) decreased from 64% to 16%. Patient care interruptions fell from 68% to 12%. 88% of residents felt that 50% or less of the pages were non-emergent and did not require an immediate action. 92% of 25 surveyed internal medicine residents preferred text paging over numeric paging and responded through the EHR 60% of the time by placing direct orders. Time savings using the new system over a 3-month span amounted to 72.5 h in transmission time alone. Text paging among medical caregivers and internal medicine residents through EHR-associated communication reduced patient care and educational interruptions. It saved time spent sending pages, answering unnecessary pages and it improved resident's subjective stress and satisfaction levels.

American Association of State Colleges and Universities Annual Survey of Tuition and Fees and Room and Board Charges, 1980-81.

ERIC Educational Resources Information Center

American Association of State Colleges and Universities, Washington, DC.

In 1980, full-time state resident undergraduate students attending AASCU-member institutions paid an average of $712 for tuition and fees, and $1,605 for room and board charges. These figures reflect a 10.6 percent average increase over 1979 costs. Including books and supplies, transportation, and personal expenses, the cost of college attendance…

Internal Medicine Residents' Clinical and Didactic Experiences After Work Hour Regulation

PubMed Central

Horwitz, Leora I; Krumholz, Harlan M; Huot, Stephen J; Green, Michael L

2006-01-01

BACKGROUND Work hour regulations for house staff were intended in part to improve resident clinical and educational performance. OBJECTIVE To characterize the effect of work hour regulation on internal medicine resident inpatient clinical experience and didactic education. DESIGN Cross-sectional mail survey. PARTICIPANTS Chief residents at all accredited U.S. internal medicine residency programs outside New York. MEASUREMENTS AND MAIN RESULTS The response rate was 62% (202/324). Most programs (72%) reported no change in average patient load per intern after work hour regulation. Many programs (48%) redistributed house staff admissions through the call cycle. The number of admissions per intern on long call (the day interns have the most admitting responsibility) decreased in 31% of programs, and the number of admissions on other days increased in 21% of programs. Residents on outpatient rotations were given new ward responsibilities in 36% of programs. Third-year resident ward and float time increased in 34% of programs, while third-year elective time decreased in 22% of programs. The mean weekly hours allotted to educational activities did not change significantly (12.7 vs 12.4, P = .12), but 56% of programs reported a decrease in intern attendance at educational activities. CONCLUSIONS In response to work hour regulation, many internal medicine programs redistributed rather than reduced residents' inpatient clinical experience. Hours allotted to educational activities did not change; however, most programs saw a decrease in intern attendance at conferences, and many reduced third-year elective time. PMID:16918742

Improving the Transition of Care in Patients Transferred Through the Ochsner Medical Center Transfer Center

PubMed Central

Amedee, Ronald G.; Maronge, Genevieve F.; Pinsky, William W.

2012-01-01

Background Patient transfers from other hospitals within the Ochsner Health System to the main campus are coordinated through a Transfer Center that was established in fall 2008. We analyzed the transfer process to assess distinct opportunities to enhance the overall transition of patient care. Methods We surveyed internal medicine residents and nocturnists to determine their satisfaction with transfers in terms of safety, efficiency, and usefulness of information provided at the time of transfer. After a kaizen event at which complementary goals for the institution and members of the study team were recognized and implemented, we resurveyed the group to evaluate improvement in the transfer process. Results The preintervention average satisfaction score was 1.18 (SD=0.46), while the postintervention score was 3.7 (SD=1.01). A t test showed a significant difference in the average scores between the preintervention and postintervention surveys (P<0.0001). Conclusions By including residents in the transfer calls (a result of the kaizen event), data were collected that facilitated fewer and higher quality handoffs that were performed in less time. In addition, the process resulted in increased awareness of the value of resident participation in institutional quality improvement projects. PMID:23267257

Improving the transition of care in patients transferred through the ochsner medical center transfer center.

PubMed

Amedee, Ronald G; Maronge, Genevieve F; Pinsky, William W

2012-01-01

Patient transfers from other hospitals within the Ochsner Health System to the main campus are coordinated through a Transfer Center that was established in fall 2008. We analyzed the transfer process to assess distinct opportunities to enhance the overall transition of patient care. We surveyed internal medicine residents and nocturnists to determine their satisfaction with transfers in terms of safety, efficiency, and usefulness of information provided at the time of transfer. After a kaizen event at which complementary goals for the institution and members of the study team were recognized and implemented, we resurveyed the group to evaluate improvement in the transfer process. The preintervention average satisfaction score was 1.18 (SD=0.46), while the postintervention score was 3.7 (SD=1.01). A t test showed a significant difference in the average scores between the preintervention and postintervention surveys (P<0.0001). By including residents in the transfer calls (a result of the kaizen event), data were collected that facilitated fewer and higher quality handoffs that were performed in less time. In addition, the process resulted in increased awareness of the value of resident participation in institutional quality improvement projects.

Anticipated Supply and Demand for Independent Interventional Radiology Residency Positions: A Survey of Department Chairs.

PubMed

Herwald, Sanna E; Spies, James B; Yucel, E Kent

2017-02-01

The first participants in the independent interventional radiology (IR) residency match will begin prerequisite diagnostic radiology (DR) residencies before the anticipated launch of the independent IR programs in 2020. The aim of this study was to estimate the competitiveness level of the first independent IR residency matches before these applicants have already committed to DR residencies and possibly early specialization in IR (ESIR) programs. The Society of Chairs of Academic Radiology Departments (SCARD) Task Force on the IR Residency distributed a survey to all active SCARD members using SurveyMonkey. The survey requested the number of planned IR residency and ESIR positions. The average, minimum, and maximum of the range of planned independent IR residency positions were compared with the average, maximum, and minimum, respectively, of the range of planned ESIR positions, to model matches of average, high, and low competitiveness. Seventy-four active SCARD members (56%) answered at least one survey question. The respondents' programs planned to fill, in total, 98 to 102 positions in integrated IR residency programs, 61 to 76 positions in independent IR residency programs, and 50 to 77 positions in ESIR DR residency programs each year. The ranges indicate the uncertainty of some programs regarding the number of positions. The survey suggests that participating programs will fill sufficient independent IR residency positions to accommodate all ESIR applicants in a match year of average or low competitiveness, but not in a match year of high competitiveness. This suggestion does not account for certain difficult-to-predict factors that may affect the independent IR residency match. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Operative experience of residents in US general surgery programs: a gap between expectation and experience.

PubMed

Bell, Richard H; Biester, Thomas W; Tabuenca, Arnold; Rhodes, Robert S; Cofer, Joseph B; Britt, L D; Lewis, Frank R

2009-05-01

The purpose of the study was to identify a group of operations which general surgery residency program directors believed residents should be competent to perform by the end of 5 years of training and then ascertain actual resident experience with these procedures during their training. There is concern about the adequacy of training of general surgeons in the United States. The American Board of Surgery and the Association of Program Directors in Surgery undertook a study to determine what operative procedures residency program directors consider to be essential to the practice of general surgery and then we measured the actual operative experience of graduating residents in those procedures, as reported to the Residency Review Committee for Surgery (RRC). An electronic survey was sent to residency program directors at the 254 general surgery programs in the US accredited by the RRC as of spring 2006. The program directors were presented with a list of 300 types of operations. Program directors graded the 300 procedures "A," "B," or "C" using the following criteria: A--graduating general surgery residents should be competent to perform the procedure independently; B--graduating residents should be familiar with the procedure, but not necessarily competent to perform it; and C--graduating residents neither need to be familiar with nor competent to perform the procedure. After ballots were tallied, the actual resident operative experience reported to the RRC by all residents finishing general surgery training in June 2005 was reviewed. One hundred twenty-one of the 300 operations were considered A level procedures by a majority of program directors (PDs). Graduating 2005 US residents (n = 1022) performed only 18 of the 121 A procedures, an average of more than 10 times during residency; 83 of 121 procedures were performed on an average less than 5 times and 31 procedures less than once. For 63 of the 121 procedures, the mode (most commonly reported) experience was 0. In addition, there was significant variation between residents in operative experience for specific procedures. In virtually all cases, the mean reported experience exceeded the mode, suggesting that the mean is a poor measure of typical experience. These data pose important problems for surgical educators. Methods will have to be developed to allow surgeons to reach a basic level of competence in procedures which they are likely to experience only rarely during residency. Even for more commonly performed procedures, the numbers of repetitions are not very robust, stressing the need to determine objectively whether residents are actually achieving basic competency in these operations. Finally, the large variations in experience between individuals in our residency system need to be explored, understood, and remedied.

Storage and residence time of suspended sediment in gravel bars of Difficult Run, VA

NASA Astrophysics Data System (ADS)

George, J.; Benthem, A.; Pizzuto, J. E.; Skalak, K.

2016-12-01

Reducing the export of suspended sediment is an important consideration for restoring water quality to the Chesapeake Bay, but sediment budgets for in-channel landforms are poorly constrained. We quantified fine (< 2 mm) sediment storage and residence times for gravel bars at two reaches along Difficult Run, a 5th order tributary to the Potomac River. Eight gravel bars were mapped in a 150m headwater reach at Miller Heights (bankfull width 11m; total bar volume 114 m3) and 6 gravel bars were mapped in a 160m reach downstream near Leesburg Pike (bankfull width 19m; total bar volume 210 m3). Grain size analyses of surface and subsurface samples from 2 bars at each reach indicate an average suspended sediment content of 55%, suggesting a total volume of suspended sediment stored in the mapped bars to be 178 m3, or 283000 kg, comprising 5% of the average annual suspended sediment load of the two study reaches. Estimates of the annual bedload flux at Miller Heights based on stream gaging records and the Wilcock-Crowe bedload transport equation imply that the bars are entirely reworked at least annually. Scour chains installed in 2 bars at each site (a total of 50 chains) recorded scour and fill events during the winter and spring of 2016. These data indicate that 38% of the total volume of the bars is exchanged per year, for a residence time of 2.6 ± 1.2 years, a value we interpret as the residence time of suspended sediment stored in the bars. These results are supported by mapping of topographic changes derived from structure-from-motion analyses of digital aerial imagery. Storage in alluvial bars therefore represents a significant component of the suspended sediment budget of mid-Atlantic streams.

Integration of Mobile Devices to Facilitate Patient Care and Teaching During Family-Centered Rounds.

PubMed

Byrd, Angela S; McMahon, Pamela M; Vath, Richard J; Bolton, Michael; Roy, Melissa

2018-01-01

The increasing prevalence of mobile devices in clinical settings has the potential to improve both patient care and education. The benefits are particularly promising in the context of family-centered rounds in inpatient pediatric settings. We aimed to increase mobile device usage by inpatient rounding teams by 50% in 6 months. We hoped to demonstrate that use of mobile devices would improve access to patient care and educational information and to determine if use would improve efficiency and perceptions of clinical teaching. We designed a mixed-methods study involving pre- and post-implementation surveys to residents, families, and faculty as well as direct observations of family-centered rounds. We conducted rapid cycles of continual quality improvement by using the Plan-Do-Study-Act framework involving 3 interventions. Pre-intervention, the mobile computing cart was used for resident education on average 3.3 times per rounding session. After cycle 3, teaching through the use of mobile devices increased by ∼79% to 5.9 times per rounding session. On the basis of survey data, we determined there was a statistically significant increase in residents' perception of feeling prepared for rounds, receiving teaching on clinical care, and ability to teach families. Additionally, average time spent per patient on rounds decreased after implementation of mobile devices. Integration of mobile devices into a pediatric hospital medicine teaching service can facilitate patient care and perception of resident teaching by extending the utility of electronic medical records in care decisions and by improving access to knowledge resources. Copyright © 2018 by the American Academy of Pediatrics.

Resident Aggression Toward Staff at a Center for the Developmentally Disabled

PubMed Central

West, Christine A.; Galloway, Ellen; Niemeier, Maureen T.

2015-01-01

Few studies have examined factors contributing to nonfatal assaults to staff working in residential care facilities. The authors evaluated resident assaults toward direct care/nursing staff at an Intermediate Care Facility for Individuals with Mental Retardation (ICF/MR), which included observations of work areas, employee interviews, calculation of injury and assault rates for 2004 to 2007 from Occupational Safety and Health Administration Logs, and review of state ICF/MR guidelines. Most staff interviewed reported having been injured during physical restraint of a resident and the average rate of injury from assault at the center evaluated was higher than the average national rates for the health care and social assistance sector for the same time period. The center lacked policies for a safe workplace. The authors recommended review and maintenance of workplace violence prevention policies and developing a post-incident response and evaluation program to assist staff in coping with the consequences of assault and/or occupational injury. PMID:24571051

Feeding the world's largest fish: highly variable whale shark residency patterns at a provisioning site in the Philippines

PubMed Central

Araujo, Gonzalo; Labaja, Jessica; McCoy, Emer; Murray, Ryan; Ponzo, Alessandro

2017-01-01

Provisioning wildlife for tourism is a controversial yet widespread practice. We analysed the residency patterns of juvenile whale sharks (Rhincodon typus) in Oslob, Philippines, where provisioning has facilitated a large shark-watching operation since 2011. We identified 208 individual sharks over three years, with an average of 18.6 (s.d. = 7.8, range = 6–43) individuals sighted per week. Weekly shark abundance varied seasonally and peak-season abundance (approx. May–November) increased across years. Whale sharks displayed diverse individual site visitation patterns ranging from a single visit to sporadic visits, seasonal residency and year-round residency. Nine individuals became year-round residents, which represents a clear response to provisioning. The timing of the seasonal peak at Oslob did not align with known non-provisioned seasonal aggregations elsewhere in the Philippines, which could suggest that seasonal residents at Oslob exploit this food source when prey availability at alternative sites is low. Since prolonged residency equates to less time foraging naturally, provisioning could influence foraging success, alter distributions and lead to dependency in later life stages. Such impacts must be carefully weighed against the benefits of provisioning (i.e. tourism revenue in a remote community) to facilitate informed management decisions. PMID:28989750

Feeding the world's largest fish: highly variable whale shark residency patterns at a provisioning site in the Philippines.

PubMed

Thomson, Jordan A; Araujo, Gonzalo; Labaja, Jessica; McCoy, Emer; Murray, Ryan; Ponzo, Alessandro

2017-09-01

Provisioning wildlife for tourism is a controversial yet widespread practice. We analysed the residency patterns of juvenile whale sharks ( Rhincodon typus ) in Oslob, Philippines, where provisioning has facilitated a large shark-watching operation since 2011. We identified 208 individual sharks over three years, with an average of 18.6 (s.d. = 7.8, range = 6-43) individuals sighted per week. Weekly shark abundance varied seasonally and peak-season abundance (approx. May-November) increased across years. Whale sharks displayed diverse individual site visitation patterns ranging from a single visit to sporadic visits, seasonal residency and year-round residency. Nine individuals became year-round residents, which represents a clear response to provisioning. The timing of the seasonal peak at Oslob did not align with known non-provisioned seasonal aggregations elsewhere in the Philippines, which could suggest that seasonal residents at Oslob exploit this food source when prey availability at alternative sites is low. Since prolonged residency equates to less time foraging naturally, provisioning could influence foraging success, alter distributions and lead to dependency in later life stages. Such impacts must be carefully weighed against the benefits of provisioning (i.e. tourism revenue in a remote community) to facilitate informed management decisions.

Rural hospital wages

PubMed Central

Hendricks, Ann M.

1989-01-01

Average fiscal year 1982 wages from 2,302 rural American hospitals were used to test for a gradient descending from hospitals in counties adjacent to metropolitan areas to those not adjacent. Considerable variation in the ratios of adjacent to nonadjacent averages existed. No statistically significant difference was found, however. Of greater importance in explaining relative wages within States were occupational mix, mix of part-time and full-time workers, case mix, presence of medical residencies, and location in a high-rent county within the State. Medicare already adjusts payments for only two of these variables. PMID:10313454

'Born in Michigan? You're in the biobank': engaging population biobank participants through Facebook advertisements.

PubMed

Platt, J E; Platt, T; Thiel, D; Kardia, S L R

2013-01-01

Despite a broad call for biobanks to use social media, data is lacking regarding the capacity of social media tools, especially advertising, to engage large populations on this topic. We used Facebook advertising to engage Michigan residents about the BioTrust for Health. We conducted a low-budget (

‘Born in Michigan? You’re in the Biobank’: Engaging Population Biobank Participants through Facebook Advertisements

PubMed Central

Platt, J.E.; Platt, T.; Thiel, D.; Kardia, S.L.R.

2016-01-01

Background/Aims Despite a broad call for biobanks to use social media, data is lacking regarding the capacity of social media tools, especially advertising, to engage large populations on this topic. Methods We used Facebook advertising to engage Michigan residents about the BioTrust for Health. We conducted a low-budget (

The Swedish duty hour enigma.

PubMed

Sundberg, Kristina; Frydén, Hanna; Kihlström, Lars; Nordquist, Jonas

2014-01-01

The Swedish resident duty hour limit is regulated by Swedish and European legal frameworks. With a maximum average of 40 working hours per week, the Swedish duty hour regulation is one of the most restrictive in the world. At the same time, the effects of resident duty hour limits have been neither debated nor researched in the Swedish context. As a result, little is known about the Swedish conceptual framework for resident duty hours, their restriction, or their outcomes: we call this "the Swedish duty hour enigma." This situation poses a further question: How do Swedish residents themselves construct a conceptual framework for duty hour restrictions? A case study was conducted at Karolinska University Hospital, Stockholm--an urban, research-intensive hospital setting. Semi-structured interviews were carried out with 34 residents currently in training in 6 specialties. The empirical data analysis relied on theoretical propositions and was conducted thematically using a pattern-matching technique. The interview guide was based on four main topics: the perceived effect of duty hour restrictions on (1) patient care, (2) resident education, (3) resident well-being, and (4) research. The residents did not perceive the volume of duty hours to be the main determinant of success or failure in the four contextual domains of patient care, resident education, resident well-being, and research. Instead, they emphasized resident well-being and a desire for flexibility. According to Swedish residents' conceptual framework on duty hours, the amount of time spent on duty is not a proxy for the quality of resident training. Instead, flexibility, organization, and scheduling of duty hours are considered to be the factors that have the greatest influence on resident well-being, quality of learning, and opportunities to attain the competence needed for independent practice.

Variability in benthic exchange rate, depth, and residence time beneath a shallow coastal estuary

NASA Astrophysics Data System (ADS)

Russoniello, C. J.; Michael, H. A.; Heiss, J.

2017-12-01

Hydrodynamically-driven exchange of water between the water column and shallow seabed aquifer, benthic exchange, is a significant and dynamic component of coastal and estuarine fluid budgets, but wave-induced benthic exchange has not been measured in the field. Mixing between surface water and groundwater solutes promotes ecologically important chemical reactions, so quantifying benthic exchange rates, depths, and residence times, constrains estimates of coastal chemical cycling. In this study, we present the first field-based direct measurements of wave-induced exchange and compare it to exchange induced by the other primary drivers of exchange - tides, and currents. We deployed instruments in a shallow estuary to measure benthic exchange and temporal variability over an 11-day period. Differential pressure sensors recorded pressure gradients across the seabed, and up-and down-looking ADCPs recorded currents and pressures from which wave parameters, surface-water currents, and water depth were determined. Wave-induced exchange was calculated directly from 1) differential pressure measurements, and indirectly with an analytical solution based on wave parameters from 2) ADCP and 3) weather station data. Groundwater flow models were used to assess the effects of aquifer properties on benthic exchange depth and residence time. Benthic exchange driven by tidal pumping or current-bedform interaction was calculated from tidal stage variation and from ADCP-measured currents at the bed, respectively. Waves were the primary benthic exchange driver (average = 20.0 cm/d, maximum = 92.3 cm/d) during the measurement period. Benthic exchange due to tides (average = 3.7 cm/d) and current-bedform interaction (average = 6.5x10-2 cm/d) was much lower. Wave-induced exchange calculated from pressure measurements and ADCP-measured wave parameters matched well, but wind-based rates underestimated wave energy and exchange. Groundwater models showed that residence time and depth increased in high-permeability, incompressible aquifers, and exchange rates increased in low-permeability, compressible aquifers. These findings support and extend the utility of existing wave-induced exchange solutions and will help managers assess the importance of benthic exchange on coastal chemical cycling.

Ultrasound Vein and Artery Mapping by General Surgery Residents During Initial Consult Can Decrease Time to Dialysis Access Creation.

PubMed

Gray, Kelsey; Korn, Abraham; Zane, Joshua; Gonzalez, Gabriel; Kaji, Amy; Bowens, Nina; de Virgilio, Christian

2018-05-01

Formal preoperative ultrasound (US) mapping of vascular anatomy by radiology is recommended before hemodialysis access surgery. We hypothesized that US performed by general surgery residents in place of formal US would decrease the time from initial consult to creation of dialysis access without affecting patient outcomes. This is a retrospective review of all patients who underwent dialysis access surgery from November 2014 to July 2016 and received preoperative upper extremity US vein and artery evaluation by either radiology or general surgery residents. The primary endpoints were days from initial consult to dialysis access creation, rate of arteriovenous fistula (AVF) creation, fistula maturation, and 1-year primary assisted patency. Of 242 patients, 167 (69%) had formal US, and 75 (31%) had only a resident US. The resident US group had 100% AVF creation compared with the formal US group with 92.2% AVF creation (P = 0.01). There was no difference between the groups in rate of fistula maturation (P = 0.1) and 1-year assisted patency (P = 0.9). Of the resident US 90.7% occurred in the outpatient setting. On multivariable analysis controlling for outpatient consult, the average time to the operating room was 13.7 days longer for the formal US group in the outpatient setting (P = 0.0006). Ultrasound vein and artery evaluation at the time of the initial consult by general surgery residents can decrease the time to dialysis access creation by bypassing the need for formal US with a higher rate of AVF creation and no difference in fistula maturation or 1-year primary assisted patency. Copyright © 2018 Elsevier Inc. All rights reserved.

The State of Communication Education in Family Medicine Residencies.

PubMed

Jansen, Kate L; Rosenbaum, Marcy E

2016-06-01

Communication skills are essential to medical training and have lasting effects on patient satisfaction and adherence rates. However, relatively little is reported in the literature identifying how communication is taught in the context of residency education. Our goal was to determine current practices in communication curricula across family medicine residency programs. Behavioral scientists and program directors in US family medicine residencies were surveyed via email and professional organization listservs. Questions included whether programs use a standardized communication model, methods used for teaching communication, hours devoted to teaching communication, as well as strengths and areas for improvement in their program. Analysis identified response frequencies and ranges complemented by analysis of narrative comments. A total of 204 programs out of 458 family medicine residency training sites responded (45%), with 48 out of 50 US states represented. The majority of respondents were behavioral scientists. Seventy-five percent of programs identified using a standard communication model; Mauksch's patient-centered observation model (34%) was most often used. Training programs generally dedicated more time to experiential teaching methods (video review, work with simulated patients, role plays, small groups, and direct observation of patient encounters) than to lectures (62% of time and 24% of time, respectively). The amount of time dedicated to communication education varied across programs (average of 25 hours per year). Respondent comments suggest that time dedicated to communication education and having a formal curriculum in place are most valued by educators. This study provides a picture of how communication skills teaching is conducted in US family medicine residency programs. These findings can provide a comparative reference and rationale for residency programs seeking to evaluate their current approaches to communication skills teaching and develop new or enhanced curricula.

Nutritional situation of Beijing residents.

PubMed

Zhao, X H

1992-01-01

Beijing is the capital of China with the population of 10.32 million in 1990 and the area of 1687.8 km2. It is the economic and cultural center of the country. Since the founding of new China, the development of Beijing city has been very fast. The gross national product (GNP) of Beijing in 1988 is 2.78 times the average GNP of the whole country. The sanitary institution has increased 71 times from 1949 to 1989. The prevalence of infectious diseases decreased significantly. The infant mortality is 11.6 per thousand approaching the figure of developed countries. The main food products increased rapidly. The grain, meat and egg increased from 100.7 kg and 0.48 kg per capita per year in 1949 to 217.1 kg and 20.17 kg in 1988 respectively. The food consumption of residents have been increasing consistently with the increasing of food production in Beijing. The food available in Beijing is well both in quantity and in quality. The results of the nutritional survey in 1985 showed that the daily average energy intake was 2549 kcal per capita. The average protein intake was 70g per person per day. The fat intake as the percentage of the total energy was 25.7. The average nutrients intake of Beijing residents meets the Chinese RDA basically. The nutritional status of people living in the city is good in general. But there are still some nutritional problem exist. Zn and Fe deficiencies anemia are common in infants and children along with the decreasing rate of breast feeding. Riboflavin, Zn and Ca intakes are inadequate in a lot of adults and the elderly.(ABSTRACT TRUNCATED AT 250 WORDS)

7 CFR 1714.8 - Hardship rate loans.

Code of Federal Regulations, 2011 CFR

2011-01-01

... either the average per capita income of the residents receiving electric service from the borrower is less than the average per capita income of the residents of the state in which the borrower provides... the consumer income tests will be determined on a weighted average based on the percentage of the...

A 5-Year Update on the Uneven Distribution of Women in Orthopaedic Surgery Residency Training Programs in the United States.

PubMed

Van Heest, Ann E; Fishman, Felicity; Agel, Julie

2016-08-03

This study was undertaken to update our report from academic years 2004-2005 through 2008-2009, to include 5 additional years of the Association of American Medical Colleges GME Track data. This study will test the hypothesis that, when compared with the data from 2004-2005 through 2008-2009, there were no substantial changes from 2009-2010 through 2013-2014 in the distribution of orthopaedic surgery residency programs that train female residents and have been accredited by the Accreditation Council for Graduate Medical Education (ACGME). Data for all ACGME-accredited orthopaedic surgery residency training programs in the United States were analyzed for 2009-2010 through 2013-2014, in the same manner as our previous report analyzed data for 2004-2005 through 2008-2009. Programs were classified as having 0, 1, 2, or >2 women in training (i.e., for postgraduate year [PGY]-1 through PGY-5) for each of the 5 academic years. Programs were also analyzed for the percentage of female residents in training and were classified as being above the national average (>20%), similar to the national average (between 10% and 20%), or below the national average (<10%) for each of the 5 academic years. During the time period of 2004 to 2009, the mean percentage of female trainees in U.S. orthopaedic surgery residency programs was 11.6%, and during the time period of 2009 to 2014, this mean percentage increased to 12.6%. Residency programs in the United States do not train women at an equal rate. In the 5 years examined (2009 to 2014), 30 programs had no female trainees and 49 programs had >20% women enrolled in at least 1 of the 5 years, 8 programs had no female trainees enrolled in any of the 5 years, and 9 programs had >20% women enrolled in each of the 5 years. Female medical students continue to pursue orthopaedic surgery as a career at rates lagging behind all other surgical specialties. Not all residency programs train women at equal rates. The period of 2009-2010 through 2013-2014 showed a greater percentage of programs (68%) training ≥2 women than the period of 2004-2005 through 2008-2009 (61%). Obstacles to attracting women to orthopaedic surgery should continue to be identified and to be addressed. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

Smartphones, Smart Feedback: Using Mobile Devices to Collect In-the-Moment Feedback.

PubMed

Havel, Lauren Koehler; Powell, Samantha D; Cabaniss, Deborah L; Arbuckle, Melissa R

2017-02-01

The goal of this study was to streamline the collection of resident feedback in order to support faculty development and program improvement in psychiatry training. The authors developed and implemented a brief, free, mobile survey to track resident feedback and class attendance. Prior to instituting this system, resident feedback was obtained semi-annually for each course (n = 90) and not each individual class. In comparison, this new system allowed the authors to collect feedback on 477 of the 519 classes held over the 2014-15 academic year (92 %). Written comments about the curriculum increased over tenfold from 42 in 2013-14 to 541 during a comparative time period in 2014-15. One year after instituting this new system, resident participation increased to 81 % on average (compared to 64 % previously). Mobile devices may provide an inexpensive and relatively untapped mechanism for improving the process of collecting resident feedback and tracking class attendance.

Evaluation of a haptics-based virtual reality temporal bone simulator for anatomy and surgery training.

PubMed

Fang, Te-Yung; Wang, Pa-Chun; Liu, Chih-Hsien; Su, Mu-Chun; Yeh, Shih-Ching

2014-02-01

Virtual reality simulation training may improve knowledge of anatomy and surgical skills. We evaluated a 3-dimensional, haptic, virtual reality temporal bone simulator for dissection training. The subjects were 7 otolaryngology residents (3 training sessions each) and 7 medical students (1 training session each). The virtual reality temporal bone simulation station included a computer with software that was linked to a force-feedback hand stylus, and the system recorded performance and collisions with vital anatomic structures. Subjects performed virtual reality dissections and completed questionnaires after the training sessions. Residents and students had favorable responses to most questions of the technology acceptance model (TAM) questionnaire. The average TAM scores were above neutral for residents and medical students in all domains, and the average TAM score for residents was significantly higher for the usefulness domain and lower for the playful domain than students. The average satisfaction questionnaire for residents showed that residents had greater overall satisfaction with cadaver temporal bone dissection training than training with the virtual reality simulator or plastic temporal bone. For medical students, the average comprehension score was significantly increased from before to after training for all anatomic structures. Medical students had significantly more collisions with the dura than residents. The residents had similar mean performance scores after the first and third training sessions for all dissection procedures. The virtual reality temporal bone simulator provided satisfactory training for otolaryngology residents and medical students. Copyright © 2013. Published by Elsevier Ireland Ltd.

The role of residence time in diagnostic models of global carbon storage capacity: model decomposition based on a traceable scheme.

PubMed

Yizhao, Chen; Jianyang, Xia; Zhengguo, Sun; Jianlong, Li; Yiqi, Luo; Chengcheng, Gang; Zhaoqi, Wang

2015-11-06

As a key factor that determines carbon storage capacity, residence time (τE) is not well constrained in terrestrial biosphere models. This factor is recognized as an important source of model uncertainty. In this study, to understand how τE influences terrestrial carbon storage prediction in diagnostic models, we introduced a model decomposition scheme in the Boreal Ecosystem Productivity Simulator (BEPS) and then compared it with a prognostic model. The result showed that τE ranged from 32.7 to 158.2 years. The baseline residence time (τ'E) was stable for each biome, ranging from 12 to 53.7 years for forest biomes and 4.2 to 5.3 years for non-forest biomes. The spatiotemporal variations in τE were mainly determined by the environmental scalar (ξ). By comparing models, we found that the BEPS uses a more detailed pool construction but rougher parameterization for carbon allocation and decomposition. With respect to ξ comparison, the global difference in the temperature scalar (ξt) averaged 0.045, whereas the moisture scalar (ξw) had a much larger variation, with an average of 0.312. We propose that further evaluations and improvements in τ'E and ξw predictions are essential to reduce the uncertainties in predicting carbon storage by the BEPS and similar diagnostic models.

The role of residence time in diagnostic models of global carbon storage capacity: model decomposition based on a traceable scheme

PubMed Central

Yizhao, Chen; Jianyang, Xia; Zhengguo, Sun; Jianlong, Li; Yiqi, Luo; Chengcheng, Gang; Zhaoqi, Wang

2015-01-01

As a key factor that determines carbon storage capacity, residence time (τE) is not well constrained in terrestrial biosphere models. This factor is recognized as an important source of model uncertainty. In this study, to understand how τE influences terrestrial carbon storage prediction in diagnostic models, we introduced a model decomposition scheme in the Boreal Ecosystem Productivity Simulator (BEPS) and then compared it with a prognostic model. The result showed that τE ranged from 32.7 to 158.2 years. The baseline residence time (τ′E) was stable for each biome, ranging from 12 to 53.7 years for forest biomes and 4.2 to 5.3 years for non-forest biomes. The spatiotemporal variations in τE were mainly determined by the environmental scalar (ξ). By comparing models, we found that the BEPS uses a more detailed pool construction but rougher parameterization for carbon allocation and decomposition. With respect to ξ comparison, the global difference in the temperature scalar (ξt) averaged 0.045, whereas the moisture scalar (ξw) had a much larger variation, with an average of 0.312. We propose that further evaluations and improvements in τ′E and ξw predictions are essential to reduce the uncertainties in predicting carbon storage by the BEPS and similar diagnostic models. PMID:26541245

The Swedish duty hour enigma

PubMed Central

2014-01-01

Background The Swedish resident duty hour limit is regulated by Swedish and European legal frameworks. With a maximum average of 40 working hours per week, the Swedish duty hour regulation is one of the most restrictive in the world. At the same time, the effects of resident duty hour limits have been neither debated nor researched in the Swedish context. As a result, little is known about the Swedish conceptual framework for resident duty hours, their restriction, or their outcomes: we call this “the Swedish duty hour enigma.” This situation poses a further question: How do Swedish residents themselves construct a conceptual framework for duty hour restrictions? Methods A case study was conducted at Karolinska University Hospital, Stockholm – an urban, research-intensive hospital setting. Semi-structured interviews were carried out with 34 residents currently in training in 6 specialties. The empirical data analysis relied on theoretical propositions and was conducted thematically using a pattern-matching technique. The interview guide was based on four main topics: the perceived effect of duty hour restrictions on (1) patient care, (2) resident education, (3) resident well-being, and (4) research. Results The residents did not perceive the volume of duty hours to be the main determinant of success or failure in the four contextual domains of patient care, resident education, resident well-being, and research. Instead, they emphasized resident well-being and a desire for flexibility. Conclusions According to Swedish residents’ conceptual framework on duty hours, the amount of time spent on duty is not a proxy for the quality of resident training. Instead, flexibility, organization, and scheduling of duty hours are considered to be the factors that have the greatest influence on resident well-being, quality of learning, and opportunities to attain the competence needed for independent practice. PMID:25559074

Ultrafine particle concentrations and exposures in seven residences in northern California.

PubMed

Bhangar, S; Mullen, N A; Hering, S V; Kreisberg, N M; Nazaroff, W W

2011-04-01

Human exposures to ultrafine particles (UFP) are poorly characterized given the potential associated health risks. Residences are important sites of exposure. To characterize residential exposures to UFP in some circumstances and to investigate governing factors, seven single-family houses in California were studied during 2007-2009. During multiday periods, time-resolved particle number concentrations were monitored indoors and outdoors and information was acquired concerning occupancy, source-related activities, and building operation. On average, occupants were home for 70% of their time. The geometric mean time-average residential exposure concentration for 21 study subjects was 14,500 particles per cm(3) (GSD = 1.8; arithmetic mean ± standard deviation = 17,000 ± 10,300 particles per cm(3)). The average contribution to residential exposures from indoor episodic sources was 150% of the contribution from particles of outdoor origin. Unvented natural-gas pilot lights contributed up to 19% to exposure for the two households where present. Episodic indoor source activities, most notably cooking, caused the highest peak exposures and most of the variation in exposure among houses. Owing to the importance of indoor sources and variations in the infiltration factor, residential exposure to UFP cannot be characterized by ambient measurements alone. Indoor and outdoor sources each contribute to residential ultrafine particle (UFP) concentrations and exposures. Under the conditions investigated, peak exposure concentrations indoors were associated with cooking, using candles, or the use of a furnace. Active particle removal systems can mitigate exposure by reducing the persistence of particles indoors. Eliminating the use of unvented gas pilot lights on cooking appliances could also be beneficial. The study results indicate that characterization of human exposure to UFP, an air pollutant of emerging public health concern, cannot be accomplished without a good understanding of conditions inside residences. © 2010 John Wiley & Sons A/S.

Pilot Study of iPad Incorporation Into Graduate Medical Education.

PubMed

Lobo, Mark J; Crandley, Edwin F; Rumph, Jake S; Kirk, Susan E; Dunlap, Neal E; Rahimi, Asal S; Turner, A Benton; Larner, James M; Read, Paul W

2013-03-01

Increased documentation and charting requirements are challenging for residents, given duty hour limits. Use of mobile electronic devices may help residents complete these tasks efficiently. To collect initial data on usage rates, information technology (IT) support requirements, and resident use of iPads during training. In this pilot study, we provided 12 residents/fellows from various specialties at the University of Virginia with an iPad with IT support. The system used a virtual private network with access to the institution's electronic health record. Participants were allowed to develop their own methods and systems for personalized iPad use, and after 9 months they provided data on the utility of the iPad. Feedback from the IT team also was obtained. Average iPad use was 2.1 h/d (range, 0.5-6 h/d). The average self-reported reduction in administrative work due to the iPad was 2.7 h/wk (range, 0-9 h/wk). A total of 75% (9 of 12) of the users would recommend universal adoption among residents and fellows. More than 90% (11 of 12) of users reported the iPad would improve communication for coordination of care. A total of 68% (8 of 12) of users reported that an iPad facilitated their activities as educators of medical students and junior residents. Residents cited slow data entry into the electronic health record and hospital areas lacking Wi-Fi connectivity as potential drawbacks to iPad use. The IT team reported minimal support time for device setup, maintenance, and upgrades, and limited security risks. The iPad may contribute to increased clinical efficiency, reduced hours spent on administrative tasks, and enhanced educational opportunities for residents, with minimal IT support.

Variability in spine surgery procedures performed during orthopaedic and neurological surgery residency training: an analysis of ACGME case log data.

PubMed

Daniels, Alan H; Ames, Christopher P; Smith, Justin S; Hart, Robert A

2014-12-03

Current spine surgeon training in the United States consists of either an orthopaedic or neurological surgery residency, followed by an optional spine surgery fellowship. Resident spine surgery procedure volume may vary between and within specialties. The Accreditation Council for Graduate Medical Education surgical case logs for graduating orthopaedic surgery and neurosurgery residents from 2009 to 2012 were examined and were compared for spine surgery resident experience. The average number of reported spine surgery procedures performed during residency was 160.2 spine surgery procedures performed by orthopaedic surgery residents and 375.0 procedures performed by neurosurgery residents; the mean difference of 214.8 procedures (95% confidence interval, 196.3 to 231.7 procedures) was significant (p = 0.002). From 2009 to 2012, the average total spinal surgery procedures logged by orthopaedic surgery residents increased 24.3% from 141.1 to 175.4 procedures, and those logged by neurosurgery residents increased 6.5% from 367.9 to 391.8 procedures. There was a significant difference (p < 0.002) in the average number of spinal deformity procedures between graduating orthopaedic surgery residents (9.5 procedures) and graduating neurosurgery residents (2.0 procedures). There was substantial variability in spine surgery exposure within both specialties; when comparing the top 10% and bottom 10% of 2012 graduates for spinal instrumentation or arthrodesis procedures, there was a 13.1-fold difference for orthopaedic surgery residents and an 8.3-fold difference for neurosurgery residents. Spine surgery procedure volumes in orthopaedic and neurosurgery residency training programs vary greatly both within and between specialties. Although orthopaedic surgery residents had an increase in the number of spine procedures that they performed from 2009 to 2012, they averaged less than half of the number of spine procedures performed by neurological surgery residents. However, orthopaedic surgery residents appear to have greater exposure to spinal deformity than neurosurgery residents. Furthermore, orthopaedic spine fellowship training provides additional spine surgery case exposure of approximately 300 to 500 procedures; thus, before entering independent practice, when compared with neurosurgery residents, most orthopaedic spine surgeons complete as many spinal procedures or more. Although case volume is not the sole determinant of surgical skills or clinical decision making, variability in spine surgery procedure volume does exist among residency programs in the United States. Copyright © 2014 by The Journal of Bone and Joint Surgery, Incorporated.

Electronic mail was not better than postal mail for surveying residents and faculty.

PubMed

Akl, Elie A; Maroun, Nancy; Klocke, Robert A; Montori, Victor; Schünemann, Holger J

2005-04-01

To compare response rate, time to response, and data quality of electronic and postal surveys in the setting of postgraduate medical education. A randomized controlled trial in a university-based internal medicine residency program. We randomized 119 residents and 83 faculty to an electronic versus a postal survey with up to two reminders and measured response rate, time to response, and data quality. For residents, the e-survey resulted in a lower response rate than the postal survey (63.3% versus 79.7%; difference -16.3%, 95% confidence interval (95% CI) -32.3% to -0.4%%; P=.049), but a shorter mean response time, by 3.8 days (95% CI 0.2-7.4; P=.042). For faculty, the e-survey did not result in a significantly lower response rate than the postal survey (85.4% vs. 81.0%; difference 4.4%, 95% CI -11.7 to 20.5%; P=.591), but resulted in a shorter average response time, by 8.4 days (95% CI 4.4 to 12.4; P < 0.001). There were no differences in the quality of data or responses to the survey between the two methods. E-surveys were not superior to postal surveys in terms of response rate, but resulted in shorter time to response and equivalent data quality.

Determining Resident Sleep During and After Call With Commercial Sleep Monitoring Devices.

PubMed

Morhardt, Duncan R; Luckenbaugh, Amy; Goldstein, Cathy; Faerber, Gary J

2017-08-01

To demonstrate that commercial activity monitoring devices (CAMDs) are practical for monitoring resident sleep while on call. Studies that have directly monitored resident sleep are limited, likely owing to both cost and difficulty in study interpretation. The advent of wearable CAMDs that estimate sleep presents the opportunity to more readily evaluate resident sleep in physically active settings and "home call," a coverage arrangement familiar to urology programs. Twelve urology residents were outfitted with Fitbit Flex devices during "home call" for a total of 57 (out of 64, or 89%) call or post-call night pairs. Residents were surveyed with the Stanford Sleepiness Scale (SSS), a single-question alertness survey. Time in bed (TIB) was "time to bed" to "rise for day." Fitbit accelerometers register activity as follows: (1) not moving; (2) minimal movement or restless; or (3) above threshold for accelerometer to register steps. Total sleep time (TST) was the number of minutes in level 1 activity during TIB. Sleep efficiency (SE) was defined as TST divided by TIB. While on call, 10 responding (of 12 available, 83%) residents on average reported TIB as 347 minutes, TST as 165 minutes, and had an SE of 47%. Interestingly, SSS responses did not correlate with sleep parameters. Post-call sleep demonstrated increases in TIB, SE, and TST (+23%, +15%, and +44%, respectively) while sleepiness was reduced by 22%. We demonstrate that urologic residents can consistently wear CAMDs while on home call. SSS did not correlate with Fitbit-estimated sleep duration. Further study with such devices may enhance sleep deprivation recognition to improve resident sleep. Copyright © 2017 Elsevier Inc. All rights reserved.

Exploring the Association Between Electronic Health Record Use and Burnout Among Psychiatry Residents and Faculty: a Pilot Survey Study.

PubMed

Domaney, Nicholas M; Torous, John; Greenberg, William E

2018-05-21

Burnout is a phenomenon with profound negative effects on the US healthcare system. Little is known about the relationship between time spent working on electronic health record (EHR) and burnout among psychiatry residents. The purpose of this study is to generate preliminary data on EHR use and burnout among psychiatry residents and faculty. In August 2017, psychiatry residents and faculty at an academic medical center were given the Maslach Burnout Inventory (MBI), a standardized measurement tool for burnout, and a survey of factors related to EHR use and potential risk factors for burnout. MBI data along with selected burnout risk and protective factors were analyzed with R Studio software. Responses were obtained from 40 psychiatry residents (73%) and 12 clinical faculty members (40%). Residents reported 22 h per week using EHR on average. Mean score of residents surveyed in postgraduate year (PGY)-1-4 met criteria for high emotional exhaustion associated with burnout. The magnitude of correlation between EHR use and emotional exhaustion was stronger than for other burnout factors including sleep, exercise, and clinical service. Psychiatry residents show signs of high emotional exhaustion, which is associated with burnout. Results demonstrate a strong positive correlation between EHR use and resident burnout. Time spent on EHR use may be an area of importance for psychiatry program directors and other psychiatric educators to consider when seeking to minimize burnout and promote wellness.

Accessing doctors at times of need-measuring the distance tolerance of rural residents for health-related travel.

PubMed

McGrail, Matthew Richard; Humphreys, John Stirling; Ward, Bernadette

2015-05-29

Poor access to doctors at times of need remains a significant impediment to achieving good health for many rural residents. The two-step floating catchment area (2SFCA) method has emerged as a key tool for measuring healthcare access in rural areas. However, the choice of catchment size, a key component of the 2SFCA method, is problematic because little is known about the distance tolerance of rural residents for health-related travel. Our study sought new evidence to test the hypothesis that residents of sparsely settled rural areas are prepared to travel further than residents of closely settled rural areas when accessing primary health care at times of need. A questionnaire survey of residents in five small rural communities of Victoria and New South Wales in Australia was used. The two outcome measures were current travel time to visit their usual doctor and maximum time prepared to travel to visit a doctor, both for non-emergency care. Kaplan-Meier charts were used to compare the association between increased distance and decreased travel propensity for closely-settled and sparsely-settled areas, and ordinal multivariate regression models tested significance after controlling for health-related travel moderating factors and town clustering. A total of 1079 questionnaires were completed with 363 from residents in closely-settled locations and 716 from residents in sparsely-settled areas. Residents of sparsely-settled communities travel, on average, 10 min further than residents of closely-settled communities (26.3 vs 16.9 min, p < 0.001), though this difference was not significant after controlling for town clustering. Differences were more apparent in terms of maximum time prepared to travel (54.1 vs 31.9 min, p < 0.001). Differences of maximum time remained significant after controlling for demographic and other constraints to access, such as transport availability or difficulties getting doctor appointments, as well as after controlling for town clustering and current travel times. Improved geographical access remains a key issue underpinning health policies designed to improve the provision of rural primary health care services. This study provides empirical evidence that travel behaviour should not be implicitly assumed constant amongst rural populations when modelling access through methods like the 2SFCA.

Repaying in Kind: Examination of the Reciprocity Effect in Faculty and Resident Evaluations.

PubMed

Gardner, Aimee K; Scott, Daniel J

Although the reciprocity hypothesis (that trainees have a tendency to modify evaluations based on the grades they receive from instructors) has been documented in other fields, very little work has examined this phenomenon in the surgical residency environment. The purpose of this study was to investigate the extent to which lenient-grading faculty receive higher evaluations from surgery residents. Evaluation data from 2 consecutive academic years were collected retrospectively at a large university-based General Surgery residency program. Monthly faculty evaluations of residents (15 items) and resident evaluations of faculty (8 items; 1 = never demonstrates, 10 = always demonstrates) were included. Correlation and regression analyses were conducted with SPSS version 22 (IBM; Chicago, IL). A total of 2274 faculty assessments and 1480 resident assessments were included in this study, representing 2 years of evaluations for 32 core faculty members responsible for completing all resident evaluations and 68 PGY1-5 general surgery residents. Faculty (63% men, 13.5 ± 9.8 years out of training) represented 5 different divisions (general surgery, surgical oncology, transplant, trauma critical care, and vascular) within the general surgery department. Faculty received an average of 71.1 ± 33.9 evaluations from residents over the course of 2 years. The average rating of faculty teaching by residents was 9.5 ± 0.4. Residents received an average of 21.8 ± 0.5 evaluations with average ratings of 4.2 ± 0.4. Correlation analyses indicated a positive relationship between the average rating received from residents and the number of years since faculty completed training (r = 0.44, p = 0.01). Additionally, a significant relationship emerged between ratings received from residents and ratings given to residents (r = 0.40, p = 0.04). Regression analyses indicated that when both variables (years since training, ratings given to residents) were included in the model, only ratings given to residents remained a significant predictor of evaluation ratings received from residents (F (1,32) = 4.40, p = 0.04), with an R 2 of 0.16. Sex or division affiliation did not account for any unique variance. These findings suggest that a reciprocity effect exists between surgery faculty and resident evaluations. This effect warrants further exploration, such that efforts to mitigate the risks of providing inaccurate assessments may be developed. Providing trainees with accurate assessments is particularly important given the high-stakes use of these data for milestones, promotion, and graduation purposes, which currently do not account for this reciprocity effect. Results suggest that there is a reciprocity effect in the faculty and resident evaluation process. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Robotics training program: evaluation of the satisfaction and the factors that influence success of skills training in a resident robotics curriculum.

PubMed

Lucas, Steven M; Gilley, David A; Joshi, Shreyas S; Gardner, Thomas A; Sundaram, Chandru P

2011-10-01

We present our experience of training residents in a weekend robotic training program to assess its effectiveness and perceived usefulness. Bimonthly training sessions were arranged such that residents could sign up for hour-long, weekend training sessions. They are required to complete four training sessions. Five tasks were scored for time and accuracy: Peg-Board, checkerboard, string running, pattern cutting, and suturing. Participants completed surveys (5-point Likert scale) regarding program utility, ease of attendance, and interest in future weekend training sessions. Mean number of trials completed by 19 residents was >4, and 16 completed the trials within an average of 13.7±8.1 mos. Significant improvements (P<0.05) were seen in final trials for Peg-Board accuracy (95.8% vs 79.0%), checkerboard deviation (4.8% vs 18.2%), and time (293 s vs 404 s), pattern-cutting time (257 s vs 399 s), and suture time (203 s vs 305 s). Time to previous session correlated with relative improvement in Peg-Board and pattern-cutting time (r=0.300 and 0.277, P=0.021 and 0.041), but no specific training interval was predictive of improvement. Residents found the course easy to attend (3.6), noted skills improvement (4.1), and found it useful (4.0). Training in the weekend sessions improved performance of basic tasks on the robot. Training interval had a modest effect on some exercises and may be more important for difficult tasks. This training program is a useful supplement to resident training and would be easy to implement in most programs.

Annual Survey of Optometric Educational Institutions, 1984-85.

ERIC Educational Resources Information Center

Journal of Optometric Education, 1986

1986-01-01

Tabulations include entering class grade point averages and educational backgrounds, loan and non-loan student financial aid granted by the institutions, resident and nonresident student expenses, full-time male and female enrollment in each class, and minority student enrollment in colleges of optometry. (MSE)

Incorporating Performance Improvement Methods into a Needs Assessment: Experience with a Nutrition and Exercise Curriculum

PubMed Central

Whalen, Ursula; Schneider, Jason; Cantey, Paul; Bussey-Jones, Jada; Brady, Donald; Doyle, Joyce P.

2010-01-01

BACKGROUND Clinical guidelines recommend that physicians counsel patients on diet and exercise; however, physician counseling remains suboptimal. OBJECTIVES To determine if incorporating performance improvement (PI) methodologies into a needs assessment for an internal medicine (IM) residency curriculum on nutrition and exercise counseling was feasible and enhanced our understanding of the curricular needs. DESIGN AND PARTICIPANTS One hundred and fifty-eight IM residents completed a questionnaire to assess their knowledge, attitudes, and practices (KAP) about nutrition and exercise counseling for hypertensive patients. Residents’ baseline nutrition and exercise counseling rates were also obtained using chart abstraction. Fishbone diagrams were created by the residents to delineate perceived barriers to diet and exercise counseling. MAIN MEASURES The KAP questionnaire was analyzed using descriptive statistics. Chart abstraction data was plotted on run charts and average counseling rates were calculated. Pareto charts were developed from the fishbone diagrams depicting the number of times each barrier was reported. KEY RESULTS Almost 90% of the residents reported counseling their hypertensive patients about diet and exercise more than 20% of the time on the KAP questionnaire. In contrast, chart abstraction revealed average counseling rates of 3% and 4% for nutrition and exercise, respectively. The KAP questionnaire exposed a clinical knowledge deficit, lack of familiarity with the national guidelines, and low self-efficacy. In contrast, the fishbone analysis highlighted patient apathy, patient co-morbidities, and time pressure as the major perceived barriers. CONCLUSIONS We found that incorporating PI methods into a needs assessment for an IM residency curriculum on nutrition and exercise counseling for patients at risk of cardiovascular disease was feasible, provided additional information not obtained through other means, and provided the opportunity to pilot the use of PI techniques as an educational strategy and means of measuring outcomes. Our findings suggest that utilization of PI principles provides a useful framework for developing and implementing a medical education curriculum and measuring its effectiveness. PMID:20737239

Resident compliance with the american academy of ophthalmology preferred practice pattern guidelines for primary open-angle glaucoma.

PubMed

Ong, Sally S; Sanka, Krishna; Mettu, Priyatham S; Brosnan, Thomas M; Stinnett, Sandra S; Lee, Paul P; Challa, Pratap

2013-12-01

To examine resident adherence to preferred practice pattern (PPP) guidelines set up by the American Academy of Ophthalmology for follow-up care of primary open-angle glaucoma (POAG) patients. Retrospective chart review. One hundred three charts were selected for analysis from all patients with an International Classification of Diseases, Ninth Revision, code of open-angle glaucoma or its related entities who underwent a follow-up evaluation between July 2, 2003, and December 15, 2004, at the resident ophthalmology clinic in the Durham Veteran Affairs Medical Center. Follow-up visits of POAG patients were evaluated for documentation of 19 elements in accordance to PPP guidelines. Compliance rates for the 19 elements of PPP guidelines first were averaged in all charts, and then were averaged per resident and were compared among 8 residents between their first and second years of residency. The overall mean compliance rate for all 19 elements was 82.6% for all charts (n = 103), 78.8% for first-year residents, and 81.7% for second-year residents. The increase from first to second year of residency was not significant (P>0.05). Documentation rates were high (>90%) for 14 elements, including all components of the physical examination and follow-up as well as most components of the examination history and management plan. Residents documented adjusting target intraocular pressure downward, local or systemic problems with medications, and impact of visual function on daily living approximately 50% to 80% of the time. Documentation rates for components of patient education were the lowest, between 5% and 16% in all charts. Residents' compliance with PPP guidelines for a POAG follow-up visit was very high for most elements, but documentation rates for components of patient education were poor. Adherence rates to PPP guidelines can be used as a tool to evaluate and improve resident performance during training. However, further studies are needed to establish the advantages of using PPP guidelines for resident education and to determine if such assessments can lead to improved patient care. Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

The 1997–1998 El Niño as an unforgettable phenomenon in northern Peru: a qualitative study

PubMed Central

Bayer, Angela M.; Danysh, Heather E.; Garvich, Mijail; Gonzálvez, Guillermo; Checkley, William; Alvarez, María; Gilman, Robert H.

2014-01-01

During the 1997–98 El Niño Southern Oscillation (ENSO), Tumbes, Peru received 16 times the annual average rainfall. We explored how Tumbes residents perceived the ENSO’s impact on basic necessities, transport, healthcare, jobs and migration. Forty-five individuals from five rural communities, including those that were isolated and not isolated from the rest of Tumbes during this ENSO, participated in five focus groups and six individuals constructed nutrition diaries. When asked about events in the past twenty years, participants considered the El Niño as a major negative event. Negative effects that were ameliorated quickly were decreased access to transport and healthcare and increased infectious diseases. Residents needed more time to rebuild housing, recover agriculture, livestock and income stability, and return to eating sufficient animal protein. Although large-scale assistance minimized the ENSO’s effects, residents needed more timely support. Residents’ perspectives on their risks to flooding should be considered to generate effective assistance. PMID:24601921

The relationship between physical activity, and physical performance and psycho-cognitive functioning in older adults living in residential aged care facilities.

PubMed

Bootsman, Natalia J M; Skinner, Tina L; Lal, Ravin; Glindemann, Delma; Lagasca, Carmela; Peeters, G M E E Geeske

2018-02-01

Insight into modifiable factors related to falls risk in older adults living in residential aged care facilities (RACFs) is necessary to tailor preventive strategies for this high-risk population. Associations between physical activity (PA), physical performance and psycho-cognitive functioning have been understudied in aged care residents. This study investigated associations between PA, and both physical performance and psycho-cognitive functioning in older adults living in RACFs. Cross-sectional study. Forty-four residents aged 85±8years were recruited from four RACFs located in Southeast Queensland. PA was assessed as the average time spent walking in hours/day using activPAL3™. Physical performance tests included balance, gait speed, dual-task ability, reaction time, coordination, grip strength, and leg strength and power. Psycho-cognitive questionnaires included quality of life, balance confidence, fear of falling and cognitive functioning. Associations between PA and each outcome measure were analysed using linear or ordinal regression models. The average time spent walking was 0.5±0.4h/day. Higher levels of PA were significantly associated with better balance (compared with low PA, medium: B=1.6; high: B=1.3) and dual-task ability (OR=7.9 per 0.5h/day increase). No statistically significant associations were found between PA and the other physical and psycho-cognitive measures. More physically active residents scored higher on balance and dual-task ability, which are key predictors of falls risk. This suggests that physical activity programs targeting balance and dual-task ability could help prevent falls in aged care residents. Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Time spent on daytime direct care activities by personal carers in two Australian residential aged care facilities: a time-motion study.

PubMed

Qian, Siyu; Yu, Ping; Hailey, David M; Zhang, Zhenyu; Davy, Pamela J; Nelson, Mark I

2014-05-01

To examine the time, frequency and duration of each direct care activity conducted by personal carers in Australian residential aged care homes. A time-motion study was conducted to observe 46 personal carers at two high-care houses in two facilities (14 days at Site 1 and 16 days at Site 2). Twenty-three direct care activities were classified into eight categories for analysis. Overall, a personal carer spent approximately 45% of their time on direct care, corresponding to 3.5h in an 8-h daytime shift. The two sites had similar ratios of personal carers to residents, and each resident received 30 min of direct care. No significant differences between the two sites were found in the time spent on oral communication, personal hygiene and continence activities. Personal carers at Site 1 spent significantly less time on toileting and mobility activities than those at Site 2, but more time on lunch activity. Although oral communication took the longest time (2h), it occurred concurrently with other activities (e.g. dressing) for 1.5h. The findings provide information that may assist decision makers in managing the operation of high-care residential aged care facilities, such as planning for task allocation and staffing. What is known about the topic? Overall, 30%-45% of the care staff's time is spent on direct care in residential aged care facilities. What does this paper add? This paper adds knowledge about how much time is required to conduct each direct care activity and the frequency and duration of conducting these activities to meet residents' day-to-day care needs in two high-care houses in two aged care facilities. What are the implications for practitioners? On average, a resident with high-care needs requires 30 min direct care. There may exist a basic minimum desirable ratio of personal carers to residents in high-care facilities. Residents' toileting needs are high after meals. Communication with residents represents an essential role in providing care.

Results of the 2012-2013 Association of Residents in Radiation Oncology (ARRO) Job Search and Career Planning Survey of Graduating Residents in the United States

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mattes, Malcolm D., E-mail: mdm9007@nyp.org; Kharofa, Jordan; Zeidan, Youssef H.

Purpose/Objective(s): To determine the timeline used by postgraduate year (PGY)-5 radiation oncology residents during the job application process and the factors most important to them when deciding on a first job. Methods and Materials: In 2012 and 2013, the Association of Residents in Radiation Oncology conducted a nationwide electronic survey of PGY-5 radiation oncology residents in the United States during the final 2 months of their training. Descriptive statistics are reported. In addition, subgroup analysis was performed. Results: Surveys were completed by 180 of 314 residents contacted. The median time to start networking for the purpose of employment was Januarymore » PGY-4; to start contacting practices, complete and upload a curriculum vitae to a job search website, and use the American Society of Radiation Oncology Career Center was June PGY-4; to obtain letters of recommendation was July PGY-5; to start interviewing was August PGY-5; to finish interviewing was December PGY-5; and to accept a contract was January PGY-5. Those applying for a community position began interviewing at an earlier average time than did those applying for an academic position (P=.04). The most important factors to residents when they evaluated job offers included (in order from most to least important) a collegial environment, geographic location, emphasis on best patient care, quality of support staff and facility, and multidisciplinary approach to patient care. Factors that were rated significantly different between subgroups based on the type of position applied for included adequate mentoring, dedicated research time, access to clinical trials, amount of time it takes to become a partner, geographic location, size of group, starting salary, and amount of vacation and days off. Conclusions: The residents' perspective on the job application process over 2 years is documented to provide a resource for current and future residents and employers to use.« less

Results of the 2012-2013 Association of Residents in Radiation Oncology (ARRO) job search and career planning survey of graduating residents in the United States.

PubMed

Mattes, Malcolm D; Kharofa, Jordan; Zeidan, Youssef H; Tung, Kaity; Gondi, Vinai; Golden, Daniel W

2014-01-01

To determine the timeline used by postgraduate year (PGY)-5 radiation oncology residents during the job application process and the factors most important to them when deciding on a first job. In 2012 and 2013, the Association of Residents in Radiation Oncology conducted a nationwide electronic survey of PGY-5 radiation oncology residents in the United States during the final 2 months of their training. Descriptive statistics are reported. In addition, subgroup analysis was performed. Surveys were completed by 180 of 314 residents contacted. The median time to start networking for the purpose of employment was January PGY-4; to start contacting practices, complete and upload a curriculum vitae to a job search website, and use the American Society of Radiation Oncology Career Center was June PGY-4; to obtain letters of recommendation was July PGY-5; to start interviewing was August PGY-5; to finish interviewing was December PGY-5; and to accept a contract was January PGY-5. Those applying for a community position began interviewing at an earlier average time than did those applying for an academic position (P=.04). The most important factors to residents when they evaluated job offers included (in order from most to least important) a collegial environment, geographic location, emphasis on best patient care, quality of support staff and facility, and multidisciplinary approach to patient care. Factors that were rated significantly different between subgroups based on the type of position applied for included adequate mentoring, dedicated research time, access to clinical trials, amount of time it takes to become a partner, geographic location, size of group, starting salary, and amount of vacation and days off. The residents' perspective on the job application process over 2 years is documented to provide a resource for current and future residents and employers to use. Copyright © 2014 Elsevier Inc. All rights reserved.

The accelerated residency program: the Marshall University family practice 9-year experience.

PubMed

Petrany, Stephen M; Crespo, Richard

2002-10-01

In 1989, the American Board of Family Practice (ABFP) approved the first of 12 accelerated residency programs in family practice. These experimental programs provide a 1-year experience for select medical students that combines the requirements of the fourth year of medical school with those of the first year of residency, reducing the total training time by 1 year. This paper reports on the achievements and limitations of the Marshall University accelerated residency program over a 9-year period that began in 1992. Several parameters have been monitored since the inception of the accelerated program and provide the basis for comparison of accelerated and traditional residents. These include initial resident characteristics, performance outcomes, and practice choices. A total of 16 students were accepted into the accelerated track from 1992 through 1998. During the same time period, 44 residents entered the traditional residency program. Accelerated resident tended to be older and had more career experience than their traditional counterparts. As a group, the accelerated residents scored an average of 30 points higher on the final in-training exams provided by the ABFP. All residents in both groups remained at Marshall to complete the full residency training experience, and all those who have taken the ABFP certifying exam have passed. Accelerated residents were more likely to practice in West Virginia, consistent with one of the initial goals for the program. In addition, accelerated residents were more likely to be elected chief resident and choose an academic career than those in the traditional group. Both groups opted for small town or rural practice equally. The Marshall University family practice 9-year experience with the accelerated residency track demonstrates that for carefully selected candidates, the program can provide an overall shortened path to board certification and attract students who excel academically and have high leadership potential. Reports from other accelerated programs are needed to fully assess the outcomes of this experiment in postgraduate medical education.

40 CFR 61.356 - Recordkeeping requirements.

Code of Federal Regulations, 2011 CFR

2011-07-01

... also establish the design minimum and average temperature in the combustion zone and the combustion... temperatures, combustion zone residence time, and description of method and location where the vent stream is... control device are not operated as designed including all periods and the duration when: (i) Any valve car...

Effect of Resident Involvement on Operative Time and Operating Room Staffing Costs.

PubMed

Allen, Robert William; Pruitt, Mark; Taaffe, Kevin M

The operating room (OR) is a major driver of hospital costs; therefore, operative time is an expensive resource. The training of surgical residents must include time spent in the OR, but that experience comes with a cost to the surgeon and hospital. The objective of this article is to determine the effect of surgical resident involvement in the OR on operative time and subsequent hospital labor costs. The Kruskal-Wallis statistical test is used to determine whether or not there is a difference in operative times between 2 groups of cases (with residents and without residents). This difference leads to an increased cost in associated hospital labor costs for the group with the longer operative time. Cases were performed at Greenville Memorial Hospital. Greenville Memorial Hospital is part of the larger healthcare system, Greenville Health System, located in Greenville, SC and is a level 1 trauma center with up to 33 staffed ORs. A total of 84,997 cases were performed at the partnering hospital between January 1st, 2011 and July 31st, 2015. Cases were only chosen for analysis if there was only one CPT code associated with the case and there were more than 5 observations for each group being studied. This article presents a comprehensive retrospective analysis of 29,134 cases covering 246 procedures. The analysis shows that 45 procedures took significantly longer with a resident present in the room. The average increase in operative time was 4.8 minutes and the cost per minute of extra operative time was determined to be $9.57 per minute. OR labor costs at the partnering hospital was found to be $2,257,433, or $492,889 per year. Knowing the affect on operative time and OR costs allows managers to make smart decisions when considering alternative educational and training techniques. In addition, knowing the connection between residents in the room and surgical duration could help provide better estimates of surgical time in the future and increase the predictability of procedure duration. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Flashes and floaters: a survey of Canadian ophthalmology residents' practice patterns.

PubMed

Arjmand, Parnian; Hurley, Bernard

2017-10-01

Residents are often the first point of contact in assessing patients who present with "flashes and floaters" in the emergency ophthalmology clinic. Most often, these symptoms are attributed to a posterior vitreous detachment (PVD), which may be associated with a retinal tear in up to 14% of cases. A proper peripheral retinal exam is, thus, imperative, and techniques other than scleral depression may not be sufficient. We conducted a cross-sectional survey of Canadian ophthalmology residents-in-training to understand the current resident practice patterns for examination of the peripheral retina. Anonymous electronic survey of all Canadian ophthalmology residents (postgraduate years 2-5). On average, residents (n = 47) perform a peripheral retinal examination 5 to 7 times per day in the emergency clinic and on call. Reported techniques for assessing the peripheral retina include scleral depression with indirect ophthalmoscopy alone (45.7%), scleral depression combined with the 3-mirror (15.2%) or panretinal lens (10.9%), or each of these techniques alone (23.9% and 4.3%, respectively). The major factors deterring resident use of scleral depression include history of recent trauma (47.5%), patient discomfort (16.3%), personal discomfort (16.3%), or lack of time (13.8%). Although scleral depression is the recommended standard of care for assessment of flashes and floaters, residents in training may routinely use alternative techniques as a result of extrinsic and intrinsic factors. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

Stress and coping among orthopaedic surgery residents and faculty.

PubMed

Sargent, M Catherine; Sotile, Wayne; Sotile, Mary O; Rubash, Harry; Barrack, Robert L

2004-07-01

Evaluations of physicians and residents have revealed concerning levels of psychosocial dysfunction. The purposes of this study were to determine the quality of life of orthopaedic residents and faculty and to identify the risk factors for decompensation. Twenty-one orthopaedic residents and twenty-five full-time orthopaedic faculty completed a 102-question voluntary, anonymous survey. The survey consisted of three validated instruments, i.e., the Maslach Burnout Inventory, the General Health Questionnaire-12, and the Revised Dyadic Adjustment Scale; and three novel question sets addressing background and demographic information, stress reaction and management, and the balance between work and home life. Descriptive statistics, pairwise correlations, simple t tests, and Pearson and nonparametric Spearman correlations were calculated. The simple correlation coefficient was used to assess bivariate relationships. The mean overall quality-of-life score, on a scale of 0 to 4 points, was 2.5 points for residents compared with 3.6 points for faculty members. Residents reported considerable burnout, showing a high level of emotional exhaustion and depersonalization and an average level of personal achievement, whereas faculty reported minimal burnout, showing a low level of emotional exhaustion (p < 0.0003), an average level of depersonalization (p < 0.0001), and a high level of personal achievement (p < 0.0001). Only two of twenty-five faculty members (compared with seven of twenty-one residents) scored over 4 points on the General Health Questionnaire-12, indicating significant symptomatology (p < 0.01). The majority of subjects reported that a partner or spouse showed nondistressed levels of marital adjustment and satisfaction. All residents and nine of the twenty-five faculty members had mentors but judged the resource to be minimally beneficial. Resident burnout and psychiatric morbidity correlated with weekly work hours; conflict between the commitments of work and home life; discord with faculty, nursing staff, and senior residents; debt load; and work-related stress. Protective factors included being a parent, spending time with a spouse, having a physician father, and deriving satisfaction from discussing concerns with colleagues, friends, and family. In pursuit of our goal of determining the quality of life of orthopaedic residents and faculty, we identified a large disparity between the two groups. The resident group reported much greater levels of dysfunction particularly with regard to burnout and psychiatric morbidity. Furthermore, with regard to our second goal; our data revealed a number of risk factors for resident decompensation, most notably, increased workload, high debt levels, and discord with superiors. In addition, our research revealed that the current support interventions by the residency program, including mentoring and facilitation of spousal adjustment, are viewed as being of little help.

Comparison of small diameter stone baskets in an in vitro caliceal and ureteral model.

PubMed

Korman, Emily; Hendlin, Kari; Chotikawanich, Ekkarin; Monga, Manoj

2011-01-01

Three small diameter (<1.5F) stone baskets have recently been introduced. Our objective was to evaluate the stone capture rate of these baskets in an in vitro ureteral model and an in vitro caliceal model using novice, resident, and expert operators. Sacred Heart Medical Halo™ (1.5F), Cook N-Circle(®) Nitinol Tipless Stone Extractor (1.5F), and Boston Scientific OptiFlex(®) (1.3F) stone baskets were tested in an in vitro ureteral and a caliceal model by three novices, three residents, and three experts. The caliceal model consisted of a 7-cm length of 10-mm O.D. plastic tubing with a convex base. Each operator was timed during removal of a 3-mm calculus from each model with three repetitions for each basket. Data were analyzed by analysis of variance single factor tests and t tests assuming unequal variances. In the ureteral model, the Halo had the fastest average rate of stone extraction for experts and novices (0:02 ± 0:01 and 0:08 ± 0:04 min, respectively), as well as the overall fastest average stone extraction rate (0:08 ± 0:06 min). No statistical significant differences in extraction times between baskets were identified in the resident group. In the novice group, the Halo stone extraction rate was significantly faster than the OptiFlex (P=0.029). In the expert group, the OptiFlex had statistically significant slower average extraction rates compared with the Halo (P=0.005) and the N-Circle (P=0.017). In the caliceal model, no statistically significant differences were noted. While no significant differences were noted in extraction times for the caliceal model, the extraction times for the ureteral model were slowest with the OptiFlex basket. Other variables important in selection of the appropriate basket include operator preference, clinical setting, and cost.

Long-term isolation and local adaptation in Palau's Nikko Bay help corals thrive in acidic waters

NASA Astrophysics Data System (ADS)

Golbuu, Yimnang; Gouezo, Marine; Kurihara, Haruko; Rehm, Lincoln; Wolanski, Eric

2016-09-01

The reefs in Palau's Nikko Bay live in seawater with low pH that is similar to conditions predicted for 2100 because of ocean acidification. Nevertheless, the reefs at Nikko Bay have high coral cover and high diversity. We hypothesize that the low-pH environment in Nikko Bay is caused by low flushing rates, which causes long-term isolation and local adaptation. To test this hypothesis, we modeled the water circulation in and around Nikko Bay. Model results show that average residence time is 71 d, which is ten times the residence time on fore-reef habitats. The long residence time restricts the exchange of coral larvae in the bay with adjacent reefs, allowing persistent selection for tolerant traits and local adaptation. The corals in Nikko Bay are also more susceptible to local pollution because the waters are poorly flushed. Therefore, local management must focus on minimizing human impacts such as dredging, overfishing and pollution in the bay, which would compromise the condition of the corals that have already adapted to low-pH conditions.

Automation Improves Schedule Quality and Increases Scheduling Efficiency for Residents.

PubMed

Perelstein, Elizabeth; Rose, Ariella; Hong, Young-Chae; Cohn, Amy; Long, Micah T

2016-02-01

Medical resident scheduling is difficult due to multiple rules, competing educational goals, and ever-evolving graduate medical education requirements. Despite this, schedules are typically created manually, consuming hours of work, producing schedules of varying quality, and yielding negative consequences for resident morale and learning. To determine whether computerized decision support can improve the construction of residency schedules, saving time and improving schedule quality. The Optimized Residency Scheduling Assistant was designed by a team from the University of Michigan Department of Industrial and Operations Engineering. It was implemented in the C.S. Mott Children's Hospital Pediatric Emergency Department in the 2012-2013 academic year. The 4 metrics of schedule quality that were compared between the 2010-2011 and 2012-2013 academic years were the incidence of challenging shift transitions, the incidence of shifts following continuity clinics, the total shift inequity, and the night shift inequity. All scheduling rules were successfully incorporated. Average schedule creation time fell from 22 to 28 hours to 4 to 6 hours per month, and 3 of 4 metrics of schedule quality significantly improved. For the implementation year, the incidence of challenging shift transitions decreased from 83 to 14 (P < .01); the incidence of postclinic shifts decreased from 72 to 32 (P < .01); and the SD of night shifts dropped by 55.6% (P < .01). This automated shift scheduling system improves the current manual scheduling process, reducing time spent and improving schedule quality. Embracing such automated tools can benefit residency programs with shift-based scheduling needs.

On residents' satisfaction with community health services after health care system reform in Shanghai, China, 2011.

PubMed

Li, Zhijian; Hou, Jiale; Lu, Lin; Tang, Shenglan; Ma, Jin

2012-01-01

Health care system reform is a major issue in many countries and therefore how to evaluate the effects of changes is incredibly important. This study measured residents' satisfaction with community health care service in Shanghai, China, and aimed to evaluate the effect of recent health care system reform. Face-to-face interviews were performed with a stratified random sample of 2212 residents of the Shanghai residents using structured questionnaires. In addition, 972 valid responses were retrieved from internet contact. Controlling for sex, age, income and education, the study used logistic regression modeling to analyze factors associated with satisfaction and to explain the factors that affect the residents' satisfaction. Comparing current attitudes with those held at the initial implementation of the reform in this investigation, four dimensions of health care were analyzed: 1) the health insurance system; 2) essential drugs; 3) basic clinical services; and 4) public health services. Satisfaction across all dimensions improved since the reform was initiated, but differences of satisfaction level were found among most dimensions and groups. Residents currently expressed greater satisfaction with clinical service (average score=3.79, with 5 being most satisfied) and the public health/preventive services (average score=3.62); but less satisfied with the provision of essential drugs (average score=3.20) and health insurance schemes (average score=3.23). The disadvantaged groups (the elderly, the retired, those with only an elementary education, those with lower incomes) had overall poorer satisfaction levels on these four aspects of health care (P<0.01). 25.39% of the respondents thought that their financial burden had increased and 38.49% thought that drugs had become more expensive. The respondents showed more satisfaction with the clinical services (average score=3.79) and public health services/interventions (average score=3.79); and less satisfaction with the health insurance system (average score=3.23) and the essential drug system (average score=3.20). Disadvantaged groups showed lower satisfaction levels overall relative to non-disadvantaged groups.

Survey and analysis of the current state of residency training in medical-school-affiliated hospitals in China

PubMed Central

2014-01-01

Background Since the global standards for postgraduate medical education (PGME) were published in January 2003, they have gained worldwide attention. The current state of residency training programs in medical-school-affiliated hospitals throughout China was assessed in this study. Methods Based on the internationally recognized global standards for PGME, residents undergoing residency training at that time and the relevant residency training instructors and management personnel from 15 medical-school-affiliated hospitals throughout China were recruited and surveyed regarding the current state of residency training programs. A total of 938 questionnaire surveys were distributed between June 30, 2006 and July 30, 2006; of 892 surveys collected, 841 were valid. Results For six items, the total proportions of “basically meets standards” and “completely meets standards” were <70% for the basic standards. These items were identified in the fields of “training settings and educational resources”, “evaluation of training process”, and “trainees”. In all fields other than “continuous updates”, the average scores of the western regions were significantly lower than those of the eastern regions for both the basic and target standards. Specifically, the average scores for the basic standards on as many as 25 of the 38 items in the nine fields were significantly lower in the western regions. There were significant differences in the basic standards scores on 13 of the 38 items among trainees, instructors, and managers. Conclusions The residency training programs have achieved satisfactory outcomes in the hospitals affiliated with various medical schools in China. However, overall, the programs remain inadequate in certain areas. For the governments, organizations, and institutions responsible for PGME, such global standards for PGME are a very useful self-assessment tool and can help identify problems, promote reform, and ultimately standardize PGME. PMID:24885865

Nanotexturing of High-Performance Woven Fabrics for Novel Composite Applications

DTIC Science & Technology

2006-11-29

biocompatibility , and adhesion of dyes. At the same time the glow discharge assists in the removal of a weak boundary layer (WBL) residing on the... polyimides , polyetherimides, carbon fibers, silk, cellulose, wool, cotton, linen, etc… PLASMA ON Average process speed: 15 ft/min web width: >20 inches

Evaluation of CAESAR-Lisflood as a tool for modelling river channel change and floodplain sediment residence times.

NASA Astrophysics Data System (ADS)

Feeney, Christopher; Smith, Hugh; Chiverrell, Richard; Hooke, Janet; Cooper, James

2017-04-01

Sediment residence time represents the duration of particle storage, from initial deposition to remobilisation, within reservoirs such as floodplains. Residence time influences rates of downstream redistribution of sediment and associated contaminants and is a useful indicator of landform stability and hence, preservation potential of alluvial archives of environmental change. River channel change controls residence times, reworking sediments via lateral migration, avulsion and incision through floodplain deposits. As reworking progresses, the floodplain age distribution is 'updated', reflecting the time since 'older' sediments were removed and replaced with 'younger' ones. The relationship between ages and the spatial extents they occupy can be used to estimate the average floodplain sediment residence times. While dating techniques, historic maps and remote sensing can reconstruct age distributions from historic reworking, modelling provides advantages, including: i) capturing detailed river channel changes and resulting floodplain ages over longer timescales and higher resolutions than from historic mapping, and ii) control over inputs to simulate hypothetical scenarios to investigate the effects of different environmental drivers on residence times. CAESAR-Lisflood is a landform evolution model capable of simulating variable channel width, divergent flow, and both braided and meandering planforms. However, the model's ability to accurately simulate channel changes requires evaluation if it is to be useful for quantitative evaluation of floodplain sediment residence times. This study aims to simulate recent historic river channel changes along ten 1 km reaches in northern England. Simulation periods were defined by available overlapping historic map and mean daily flow datasets, ranging 27-39 years. LiDAR-derived 2 m DEMs were modified to smooth out present-day channels and burn in historic channel locations. To reduce run times, DEMs were resampled to coarser resolutions based on the size of the channel and historic rate of lateral channel migration. Separate pre-defined coarse and finer channel bed and floodplain grain size distributions were used, respectively, in combination with constructed reach DEMs for model simulations. Calibration was performed by modifying selected parameters to obtain best fits between observed and modelled channel planforms. Initial simulations suggest the model can broadly reproduce observed planform change and is comparable in terms of channel sinuosities and the mean radius of curvature. As such, CAESAR-Lisflood may provide a useful tool for evaluating floodplain sediment residence times under environmental change scenarios.

Pediatricians working part-time: past, present, and future.

PubMed

Cull, William L; Mulvey, Holly J; O'Connor, Karen G; Sowell, Debra R; Berkowitz, Carol D; Britton, Carmelita V

2002-06-01

Pediatrics has consistently attracted a large number of women. Although the majority of practicing pediatricians are male, female pediatricians will soon constitute the majority. The challenge to balance personal and professional life is of particular concern to women, and part-time positions may provide a potential solution. To examine how many pediatricians currently work part-time, to examine trends in part-time employment from 1993 to present, to determine pediatric residents' interest in part-time employment, and to identify perceived barriers to part-time work. Two data sources were used for these analyses. The first was an American Academy of Pediatrics Periodic Survey from 1993 and 2000 asking a combined national sample of 3218 American Academy of Pediatrics members about their employment status. Multiple mailings were conducted for each survey producing an overall response rate of 62%. The second data source was a survey asking a national random sample of 500 pediatric residents completing training in 2000 about their job search experiences and attitudes toward part-time employment. Four mailings of this survey were completed, and responses were obtained from 71% of residents. The percentage of pediatricians working part-time increased from 11% in 1993 to 15% in 2000. This increase did not exceed what would be expected based on the rise in the percentage of pediatricians who are female from 36% in 1993 to 45% in 2000. On average, pediatricians working part-time provided 36% fewer direct patient care hours than full-time pediatricians (42 hours vs 27 hours). No statistically significant difference in direct patient care hours was apparent between male and female pediatricians working full-time. Female residents were more likely than male residents to consider part-time or reduced-hours positions (42% vs 14%) and to accept part-time or reduced-hours positions (14% vs 3%). Also, considerably more female residents (58%) than male residents (15%) indicated that they would be interested in arranging a part-time position within the next 5 years. The most commonly perceived barriers to working part-time by both male and female residents included loss of income (70%), reduction in job benefits such as health insurance (47%), and loan repayment (46%). When those who reported some interest in part-time employment were asked how they would spend their extra time, most reported that they would address family needs related to children (females: 92%; males: 63%). Finally, residents interested in working part-time were more likely to be without a position when surveyed than residents not interested in part-time work (15% vs 2%). The relative percentages of female pediatricians and pediatricians working part-time will likely continue to grow. As a result, the total direct patient care hours available for children may be reduced. Pediatric practices will benefit by better accommodating the needs of pediatricians to balance work and family goals, and future workforce projections and training decisions must begin taking part-time employment rates into account.

Production of zinc and manganese oxide particles by pyrolysis of alkaline and Zn-C battery waste.

PubMed

Ebin, Burçak; Petranikova, Martina; Steenari, Britt-Marie; Ekberg, Christian

2016-05-01

Production of zinc and manganese oxide particles from alkaline and zinc-carbon battery black mass was studied by a pyrolysis process at 850-950°C with various residence times under 1L/minN2(g) flow rate conditions without using any additive. The particular and chemical properties of the battery waste were characterized to investigate the possible reactions and effects on the properties of the reaction products. The thermodynamics of the pyrolysis process were studied using the HSC Chemistry 5.11 software. The carbothermic reduction reaction of battery black mass takes place and makes it possible to produce fine zinc particles by a rapid condensation, after the evaporation of zinc from a pyrolysis batch. The amount of zinc that can be separated from the black mass is increased by both pyrolysis temperature and residence time. Zinc recovery of 97% was achieved at 950°C and 1h residence time using the proposed alkaline battery recycling process. The pyrolysis residue is mainly MnO powder with a low amount of zinc, iron and potassium impurities and has an average particle size of 2.9μm. The obtained zinc particles have an average particle size of about 860nm and consist of hexagonal crystals around 110nm in size. The morphology of the zinc particles changes from a hexagonal shape to s spherical morphology by elevating the pyrolysis temperature. Copyright © 2015 Elsevier Ltd. All rights reserved.

Faculty and resident evaluations of medical students on a surgery clerkship correlate poorly with standardized exam scores.

PubMed

Goldstein, Seth D; Lindeman, Brenessa; Colbert-Getz, Jorie; Arbella, Trisha; Dudas, Robert; Lidor, Anne; Sacks, Bethany

2014-02-01

The clinical knowledge of medical students on a surgery clerkship is routinely assessed via subjective evaluations from faculty members and residents. Interpretation of these ratings should ideally be valid and reliable. However, prior literature has questioned the correlation between subjective and objective components when assessing students' clinical knowledge. Retrospective cross-sectional data were collected from medical student records at The Johns Hopkins University School of Medicine from July 2009 through June 2011. Surgical faculty members and residents rated students' clinical knowledge on a 5-point, Likert-type scale. Interrater reliability was assessed using intraclass correlation coefficients for students with ≥4 attending surgeon evaluations (n = 216) and ≥4 resident evaluations (n = 207). Convergent validity was assessed by correlating average evaluation ratings with scores on the National Board of Medical Examiners (NBME) clinical subject examination for surgery. Average resident and attending surgeon ratings were also compared by NBME quartile using analysis of variance. There were high degrees of reliability for resident ratings (intraclass correlation coefficient, .81) and attending surgeon ratings (intraclass correlation coefficient, .76). Resident and attending surgeon ratings shared a moderate degree of variance (19%). However, average resident ratings and average attending surgeon ratings shared a small degree of variance with NBME surgery examination scores (ρ(2) ≤ .09). When ratings were compared among NBME quartile groups, the only significant difference was for residents' ratings of students with the lower 25th percentile of scores compared with the top 25th percentile of scores (P = .007). Although high interrater reliability suggests that attending surgeons and residents rate students with consistency, the lack of convergent validity suggests that these ratings may not be reflective of actual clinical knowledge. Both faculty members and residents may benefit from training in knowledge assessment, which will likely increase opportunities to recognize deficiencies and make student evaluation a more valuable tool. Copyright © 2014 Elsevier Inc. All rights reserved.

Improving safety and operational efficiency in residential care settings with WiFi-based localization.

PubMed

Doshi-Velez, Finale; Li, William; Battat, Yoni; Charrow, Ben; Curtis, Dorothy; Curthis, Dorothy; Park, Jun-geun; Hemachandra, Sachithra; Velez, Javier; Walsh, Cynthia; Fredette, Don; Reimer, Bryan; Roy, Nicholas; Teller, Seth

2012-07-01

To assess the effectiveness of a wireless network (WiFi-based) localization system (devices mounted on resident wheelchairs) in decreasing caretaker time spent searching for residents and providing alerts of residents going outdoors in a skilled nursing facility. A controlled study over two 2-month periods approved by the institutional review board. A long-term skilled nursing facility in Massachusetts specializing in multiple sclerosis previously instrumented with wireless network infrastructure. Nineteen residents and 9 staff members at the facility for the first 2-month period; 9 residents and 3 staff members at the facility for the second 2-month period. Software was installed on 4 staff computers to display the locations of residents enrolled in the study. This software was made available to enrolled staff for the second half of the first 2-month period and the entirety of the second 2-month study. In the second 2-month study, the software was modified to provide alerts if any 1 of 9 participating "high-risk"' residents went outdoors, and the accuracy of the alert system was evaluated. In the first 2-month study, 9 staff members recorded the amount of time it took them to locate participating residents (as and when needed during the course of their daily activities). In the second 2-month study, 3 staff members recorded whether outdoor-alerts correctly identified a resident leaving the building or if it was a false alarm. In both phases, participating staff members made frequent use of the system (44 searches and 215 outdoor alerts). Overall, the localization information decreased the average time needed to find residents by about two-thirds (from 311.1 seconds to 110.9 seconds). For outdoor alerts, the system had a false-alarm rate of 9.1% (under normal facility operations); systematic tests of the outdoor-alert system carried out by the authors had a false-negative, or missed-alarm, rate of 1.7%. Using timely resident location information can provide significant gains for both operational efficiency (finding residents) and enhanced resident safety (outdoor alerts). This approach may provide an inexpensive alternative for facilities that have sufficient wireless infrastructure; future work should assess its effectiveness in additional settings. Copyright © 2012 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.

Disaster preparedness networks in rural Midwest communities: Organizational roles, collaborations, and support for older residents.

PubMed

Ashida, Sato; Zhu, Xi; Robinson, Erin L; Schroer, Audrey

2018-05-17

This study investigated the roles and interconnections among community organizations belonging to local disaster coalitions in Midwest in supporting older residents. Representatives from 44 organizations participated in one-time survey. Most were non-profit (68%) or federal/state/local government agencies (23%). The analyses of 761 relationships showed stronger collaborations in assessment (average strength=2.88 on a 5-point scale), emergency response (2.72), and planning (2.61); and weaker collaborations in co-sponsoring programs (1.71) and supporting older residents (2.03). The extent of collaboration (network density) to support older adults was also low. Coalitions may enhance network density and centralization by developing sub-committee structure and strengthening existing collaborations.

Factors influencing nursing time spent on administration of medication in an Australian residential aged care home.

PubMed

Qian, Siyu; Yu, Ping; Hailey, David M; Wang, Ning

2016-04-01

To examine nursing time spent on administration of medications in a residential aged care (RAC) home, and to determine factors that influence the time to medicate a resident. Information on nursing time spent on medication administration is useful for planning and implementation of nursing resources. Nurses were observed over 12 morning medication rounds using a time-motion observational method and field notes, at two high-care units in an Australian RAC home. Nurses spent between 2.5 and 4.5 hours in a medication round. Administration of medication averaged 200 seconds per resident. Four factors had significant impact on medication time: number of types of medication, number of tablets taken by a resident, methods used by a nurse to prepare tablets and methods to provide tablets. Administration of medication consumed a substantial, though variable amount of time in the RAC home. Nursing managers need to consider the factors that influenced the nursing time required for the administration of medication in their estimation of nursing workload and required resources. To ensure safe medication administration for older people, managers should regularly assess the changes in the factors influencing nursing time on the administration of medication when estimating nursing workload and required resources. © 2015 John Wiley & Sons Ltd.

[The Current State of Inappropriate Drug Use among Elderly Assisted-Living Residents].

PubMed

Hirotani, Yoshihiko; Kawamura, Hitomi; Nakamura, Mayuri; Urashima, Yoko; Myotoku, Michiaki

2015-12-01

Previous studies have reported that elderly assisted-living residents use multiple drug combinations and inappropriate drugs.The aim of this study was to assess the drug use and its consequences in residents of a nursing facility.We examined the prescriptions of all residents in a nursing facility in Osaka from their medical records.Of the total 67 residents, 48 were women.The average age of the residents was 86 years, the average number of prescription drugs they took was 6.4, and the average number of diseases present was 4.9. Correlation between the number of diseases and the drugs taken was significant (p<0.05), but the correlation between the degree of independence for activities of daily living and the number of the drugs taken was not significant.The most commonly present health condition was bone fracture.About 50% of the residents used a psychotropic drug and prescription drugs such as amantadine and hydroxyzine, which are not advisable for elderly people.It is necessary for the elderly to avoid the use of drugs that cause delirium and drowsiness, and future studies should focus on methods to prevent disuse syndrome in the elderly.

Educational Impact of Trainee-Facilitated Head and Neck Radiology-Pathology Correlation Conferences.

PubMed

Ginat, Daniel Thomas; Cipriani, Nicole A; Christoforidis, Gregory

2018-05-17

The goal of this study was to evaluate the benefits of resident and fellow-facilitated radiology-pathology head and neck conferences. A total of seven resident-facilitated and six fellow-facilitated head and neck radiology-pathology cases were presented as part of the radiology department conference series. The radiology residents were surveyed regarding the perceived quality and effectiveness of the fellow-facilitated sessions. The number of publications yielded from all the cases presented was tracked. Overall, the residents assessed the quality of the fellow-facilitated conferences with an average score of 3.9 out of 5 and the overall helpfulness with an average of 3.5 out of 5. The overall average level of resident understanding among the residents for the topics presented to them by the fellows at baseline was 2.5 out of 5 and 3.4 out of 5 after the presentations, which was a significant increase (p-value < 0.01). There were three peer-reviewed publications generated from the resident presentations and four peer-reviewed publications generated from the fellow presentations, which represents a 54% publication rate collectively. Therefore, trainee-facilitated head and neck radiology-pathology conferences at our institution provide added learning and scholarly activity opportunities.

Awareness of Diagnostic Error among Japanese Residents: a Nationwide Study.

PubMed

Nishizaki, Yuji; Shinozaki, Tomohiro; Kinoshita, Kensuke; Shimizu, Taro; Tokuda, Yasuharu

2018-04-01

Residents' understanding of diagnostic error may differ between countries. We sought to explore the relationship between diagnostic error knowledge and self-study, clinical knowledge, and experience. Our nationwide study involved postgraduate year 1 and 2 (PGY-1 and -2) Japanese residents. The Diagnostic Error Knowledge Assessment Test (D-KAT) and General Medicine In-Training Examination (GM-ITE) were administered at the end of the 2014 academic year. D-KAT scores were compared with the benchmark scores of US residents. Associations between D-KAT score and gender, PGY, emergency department (ED) rotations per month, mean number of inpatients handled at any given time, and mean daily minutes of self-study were also analyzed, both with and without adjusting for GM-ITE scores. Student's t test was used for comparisons with linear mixed models and structural equation models (SEM) to explore associations with D-KAT or GM-ITE scores. The mean D-KAT score among Japanese PGY-2 residents was significantly lower than that of their US PGY-2 counterparts (6.2 vs. 8.3, p < 0.001). GM-ITE scores correlated with ED rotations (≥6 rotations: 2.14; 0.16-4.13; p = 0.03), inpatient caseloads (5-9 patients: 1.79; 0.82-2.76; p < 0.001), and average daily minutes of self-study (≥91 min: 2.05; 0.56-3.53; p = 0.01). SEM revealed that D-KAT scores were directly associated with GM-ITE scores (ß = 0.37, 95% CI: 0.34-0.41) and indirectly associated with ED rotations (ß = 0.06, 95% CI: 0.02-0.10), inpatient caseload (ß = 0.04, 95% CI: 0.003-0.08), and average daily minutes of study (ß = 0.13, 95% CI: 0.09-0.17). Knowledge regarding diagnostic error among Japanese residents was poor compared with that among US residents. D-KAT scores correlated strongly with GM-ITE scores, and the latter scores were positively associated with a greater number of ED rotations, larger caseload (though only up to 15 patients), and more time spent studying.

The Stanford Microsurgery and Resident Training (SMaRT) Scale: validation of an on-line global rating scale for technical assessment.

PubMed

Satterwhite, Thomas; Son, Ji; Carey, Joseph; Echo, Anthony; Spurling, Terry; Paro, John; Gurtner, Geoffrey; Chang, James; Lee, Gordon K

2014-05-01

We previously reported results of our on-line microsurgery training program, showing that residents who had access to our website significantly improved their cognitive and technical skills. In this study, we report an objective means for expert evaluators to reliably rate trainees' technical skills under the microscope, with the use of our novel global rating scale. "Microsurgery Essentials" (http://smartmicrosurgery.com) is our on-line training curriculum. Residents were randomly divided into 2 groups: 1 group reviewed this online resource and the other did not. Pre- and post-tests consisted of videotaped microsurgical sessions in which the trainee performed "microsurgery" on 3 different models: latex glove, penrose drain, and the dorsal vessel of a chicken foot. The SMaRT (Stanford Microsurgery and Resident Training) scale, consisting of 9 categories graded on a 5-point Likert scale, was used to assess the trainees. Results were analyzed with ANOVA and Student t test, with P less than 0.05 indicating statistical significance. Seventeen residents participated in the study. The SMaRT scale adequately differentiated the performance of more experienced senior residents (PGY-4 to PGY-6, total average score=3.43) from less experienced junior residents (PGY-1 to PGY-3, total average score=2.10, P<0.0001). Residents who viewed themselves as being confident received a higher score on the SMaRT scale (average score 3.5), compared to residents who were not as confident (average score 2.1) (P<0.001). There were no significant differences in scoring among all 3 evaluators (P>0.05). Additionally, junior residents who had access to our website showed a significant increase in their graded technical performance by 0.7 points when compared to residents who did not have access to the website who showed an improvement of only 0.2 points (P=0.01). Our SMaRT scale is valid and reliable in assessing the microsurgical skills of residents and other trainees. Current trainees are more likely to use self-directed on-line education because of its easy accessibility and interactive format. Our global rating scale can help ensure residents are achieving appropriate technical milestones.

Modifications of exposure to ambient particulate matter: Tackling bias in using ambient concentration as surrogate with particle infiltration factor and ambient exposure factor.

PubMed

Shi, Shanshan; Chen, Chen; Zhao, Bin

2017-01-01

Numerous epidemiological studies explored health risks attributed to outdoor particle pollution. However, a number of these studies routinely utilized ambient concentration as a surrogate for personal exposure to ambient particles. This simplification ignored the difference between indoor and outdoor concentrations of outdoor originated particles and may bias the estimate of particle-health associations. Intending to avoid the bias, particle infiltration factor (F inf ), which describes the penetration of outdoor particles in indoor environment, and ambient exposure factor (α), which represents the fraction of outdoor particles people are truly exposed to, are utilized as modification factors to modify outdoor particle concentration. In this study, the probabilistic distributions of annually-averaged and seasonally-averaged F inf and α were assessed for residences and residents in Beijing. F inf of a single residence and α of an individual was estimated based on the mechanisms governing particle outdoor-to-indoor migration and human time-activity pattern. With this as the core deterministic model, probabilistic distributions of F inf and α were estimated via Monte Carlo Simulation. Annually-averaged F inf of PM 2.5 and PM 10 for residences in Beijing tended to be log-normally distributed as lnN(-0.74,0.14) and lnN(-0.94,0.15) with geometric mean value as 0.47 and 0.39, respectively. Annually-averaged α of PM 2.5 and PM 10 for Beijing residents also tended to be log-normally distributed as lnN(-0.59,0.12) and lnN(-0.73,0.13) with geometric mean value as 0.55 and 0.48, respectively. As for seasonally-averaged results, F inf and α of PM 2.5 and PM 10 were largest in summer and smallest in winter. The obvious difference between these modification factors and unity suggested that modifications of ambient particle concentration need to be considered in epidemiological studies to avoid misclassifications of personal exposure to ambient particles. Moreover, considering the inter-individual difference of F inf and α may lead to a brand new perspective of particle-health associations in further epidemiological study. Copyright © 2016 Elsevier Ltd. All rights reserved.

Spectral narrowing and spin echo for localized carriers with heavy-tailed L evy distribution of hopping times

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yue, Z.; Mkhitaryan, Vagharsh; Raikh, M. E.

2016-02-02

We study analytically the free induction decay and the spin echo decay originating from the localized carriers moving between the sites which host random magnetic fields. Due to disorder in the site positions and energies, the on-site residence times, , are widely spread according to the L evy distribution. The power-law tail ∝ τ -1-∝ in the distribution of does not affect the conventional spectral narrowing for α > 2, but leads to a dramatic acceleration of the free induction decay in the domain 2 > α > 1. The next abrupt acceleration of the decay takes place as becomesmore » smaller than 1. In the latter domain the decay does not follow a simple-exponent law. To capture the behavior of the average spin in this domain, we solve the evolution equation for the average spin using the approach different from the conventional approach based on the Laplace transform. Unlike the free induction decay, the tail in the distribution of the residence times leads to the slow decay of the spin echo. The echo is dominated by realizations of the carrier motion for which the number of sites, visited by the carrier, is minimal.« less

The Canadian general surgery resident: defining current challenges for surgical leadership.

PubMed

Tomlinson, Corey; Labossière, Joseph; Rommens, Kenton; Birch, Daniel W

2012-08-01

Surgery training programs in Canada and the United States have recognized the need to modify current models of training and education. The shifting demographic of surgery trainees, lifestyle issues and an increased trend toward subspecialization are the major influences. To guide these important educational initiatives, a contemporary profile of Canadian general surgery residents and their impressions of training in Canada is required. We developed and distributed a questionnaire to residents in each Canadian general surgery training program, and residents responded during dedicated teaching time. In all, 186 surveys were returned for analysis (62% response rate). The average age of Canadian general surgery residents is 30 years, 38% are women, 41% are married, 18% have dependants younger than 18 years and 41% plan to add to or start a family during residency. Most (87%) residents plan to pursue postgraduate education. On completion of training, 74% of residents plan to stay in Canada and 49% want to practice in an academic setting. Almost half (42%) of residents identify a poor balance between work and personal life during residency. Forty-seven percent of respondents have appropriate access to mentorship, whereas 37% describe suitable access to career guidance and 40% identify the availability of appropriate social supports. Just over half (54%) believe the stress level during residency is manageable. This survey provides a profile of contemporary Canadian general surgery residents. Important challenges within the residency system are identified. Program directors and chairs of surgery are encouraged to recognize these challenges and intervene where appropriate.

A randomized, controlled trial of team-based competition to increase learner participation in quality-improvement education.

PubMed

Scales, Charles D; Moin, Tannaz; Fink, Arlene; Berry, Sandra H; Afsar-Manesh, Nasim; Mangione, Carol M; Kerfoot, B Price

2016-04-01

Several barriers challenge resident engagement in learning quality improvement (QI). We investigated whether the incorporation of team-based game mechanics into an evidence-based online learning platform could increase resident participation in a QI curriculum. Randomized, controlled trial. Tertiary-care medical center residency training programs. Resident physicians (n = 422) from nine training programs (anesthesia, emergency medicine, family medicine, internal medicine, ophthalmology, orthopedics, pediatrics, psychiatry and general surgery) randomly allocated to a team competition environment (n = 200) or the control group (n = 222). Specialty-based team assignment with leaderboards to foster competition, and alias assignment to de-identify individual participants. Participation in online learning, as measured by percentage of questions attempted (primary outcome) and additional secondary measures of engagement (i.e. response time). Changes in participation measures over time between groups were assessed with a repeated measures ANOVA framework. Residents in the intervention arm demonstrated greater participation than the control group. The percentage of questions attempted at least once was greater in the competition group (79% [SD ± 32] versus control, 68% [SD ± 37], P= 0.03). Median response time was faster in the competition group (P= 0.006). Differences in participation continued to increase over the duration of the intervention, as measured by average response time and cumulative percent of questions attempted (each P< 0.001). Team competition increases resident participation in an online course delivering QI content. Medical educators should consider game mechanics to optimize participation when designing learning experiences. Published by Oxford University Press in association with the International Society for Quality in Health Care 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Measurement error in mobile source air pollution exposure estimates due to residential mobility during pregnancy

PubMed Central

Pennington, Audrey Flak; Strickland, Matthew J.; Klein, Mitchel; Zhai, Xinxin; Russell, Armistead G.; Hansen, Craig; Darrow, Lyndsey A.

2018-01-01

Prenatal air pollution exposure is frequently estimated using maternal residential location at the time of delivery as a proxy for residence during pregnancy. We describe residential mobility during pregnancy among 19,951 children from the Kaiser Air Pollution and Pediatric Asthma Study, quantify measurement error in spatially-resolved estimates of prenatal exposure to mobile source fine particulate matter (PM2.5) due to ignoring this mobility, and simulate the impact of this error on estimates of epidemiologic associations. Two exposure estimates were compared, one calculated using complete residential histories during pregnancy (weighted average based on time spent at each address) and the second calculated using only residence at birth. Estimates were computed using annual averages of primary PM2.5 from traffic emissions modeled using a research line-source dispersion model (RLINE) at 250 meter resolution. In this cohort, 18.6% of children were born to mothers who moved at least once during pregnancy. Mobile source PM2.5 exposure estimates calculated using complete residential histories during pregnancy and only residence at birth were highly correlated (rS>0.9). Simulations indicated that ignoring residential mobility resulted in modest bias of epidemiologic associations toward the null, but varied by maternal characteristics and prenatal exposure windows of interest (ranging from −2% to −10% bias). PMID:27966666

Measurement error in mobile source air pollution exposure estimates due to residential mobility during pregnancy.

PubMed

Pennington, Audrey Flak; Strickland, Matthew J; Klein, Mitchel; Zhai, Xinxin; Russell, Armistead G; Hansen, Craig; Darrow, Lyndsey A

2017-09-01

Prenatal air pollution exposure is frequently estimated using maternal residential location at the time of delivery as a proxy for residence during pregnancy. We describe residential mobility during pregnancy among 19,951 children from the Kaiser Air Pollution and Pediatric Asthma Study, quantify measurement error in spatially resolved estimates of prenatal exposure to mobile source fine particulate matter (PM 2.5 ) due to ignoring this mobility, and simulate the impact of this error on estimates of epidemiologic associations. Two exposure estimates were compared, one calculated using complete residential histories during pregnancy (weighted average based on time spent at each address) and the second calculated using only residence at birth. Estimates were computed using annual averages of primary PM 2.5 from traffic emissions modeled using a Research LINE-source dispersion model for near-surface releases (RLINE) at 250 m resolution. In this cohort, 18.6% of children were born to mothers who moved at least once during pregnancy. Mobile source PM 2.5 exposure estimates calculated using complete residential histories during pregnancy and only residence at birth were highly correlated (r S >0.9). Simulations indicated that ignoring residential mobility resulted in modest bias of epidemiologic associations toward the null, but varied by maternal characteristics and prenatal exposure windows of interest (ranging from -2% to -10% bias).

Dual process theory and intermediate effect: are faculty and residents' performance on multiple-choice, licensing exam questions different?

PubMed

Dong, Ting; Durning, Steven J; Artino, Anthony R; van der Vleuten, Cees; Holmboe, Eric; Lipner, Rebecca; Schuwirth, Lambert

2015-04-01

Clinical reasoning is essential for the practice of medicine. Dual process theory conceptualizes reasoning as falling into two general categories: nonanalytic reasoning (pattern recognition) and analytic reasoning (active comparing and contrasting of alternatives). The debate continues regarding how expert performance develops and how individuals make the best use of analytic and nonanalytic processes. Several investigators have identified the unexpected finding that intermediates tend to perform better on licensing examination items than experts, which has been termed the "intermediate effect." We explored differences between faculty and residents on multiple-choice questions (MCQs) using dual process measures (both reading and answering times) to inform this ongoing debate. Faculty (board-certified internists; experts) and residents (internal medicine interns; intermediates) answered live licensing examination MCQs (U.S. Medical Licensing Examination Step 2 Clinical Knowledge and American Board of Internal Medicine Certifying Examination) while being timed. We conducted repeated analysis of variance to compare the 2 groups on average reading time, answering time, and accuracy on various types of items. Faculty and residents did not differ significantly in reading time [F (1,35) = 0.01, p = 0.93], answering time [F (1,35) = 0.60, p = 0.44], or accuracy [F (1,35) = 0.24, p = 0.63] regardless of easy or hard items. Dual process theory was not evidenced in this study. However, this lack of difference between faculty and residents may have been affected by the small sample size of participants and MCQs may not reflect how physicians made decisions in actual practice setting. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

Replacing Lectures with Small Groups: The Impact of Flipping the Residency Conference Day

PubMed Central

King, Andrew M.; Mayer, Chad; Barrie, Michael; Greenberger, Sarah; Way, David P.

2018-01-01

The flipped classroom, an educational alternative to the traditional lecture, has been widely adopted by educators at all levels of education and across many disciplines. In the flipped classroom, learners prepare in advance of the face-to-face meeting by learning content material on their own. Classroom time is reserved for application of the learned content to solving problems or discussing cases. Over the past year, we replaced most residency program lectures with small-group discussions using the flipped-classroom model, case-based learning, simulation and procedure labs. In the new model, residents prepared for conference by reviewing a patient case and studying suggested learning materials. Conference day was set aside for facilitated small-group discussions about the case. This is a cross-cohort study of emergency medicine residents who experienced the lecture-based curriculum to residents in the new flipped-classroom curriculum using paired comparisons (independent t-tests) on in-training exam scores while controlling for program year level. We also compared results of the evaluation of various program components. We observed no differences between cohorts on in-training examination scores. Small-group methods were rated the same across program years. Two program components in the new curriculum, an updated format of both adult and pediatric case conferences, were rated significantly higher on program quality. In preparation for didactics, residents in the new curriculum report spending more time on average with outside learning materials, including almost twice as much time reviewing textbooks. Residents found the new format of the case conferences to be of higher quality because of the inclusion of rapid-fire case discussions with targeted learning points. PMID:29383050

A Novel Tool for Assessment of Emergency Medicine Resident Skill in Determining Diagnosis and Management for Emergent Electrocardiograms: A Multicenter Study.

PubMed

Hartman, Nicholas D; Wheaton, Natasha B; Williamson, Kelly; Quattromani, Erin N; Branzetti, Jeremy B; Aldeen, Amer Z

2016-12-01

Reading emergent electrocardiograms (ECGs) is one of the emergency physician's most crucial tasks, yet no well-validated tool exists to measure resident competence in this skill. To assess validity of a novel tool measuring emergency medicine resident competency for interpreting, and responding to, critical ECGs. In addition, we aim to observe trends in this skill for resident physicians at different levels of training. This is a multi-center, prospective study of postgraduate year (PGY) 1-4 residents at five emergency medicine (EM) residency programs in the United States. An assessment tool was created that asks the physician to identify either the ECG diagnosis or the best immediate management. One hundred thirteen EM residents from five EM residency programs submitted completed assessment surveys, including 43 PGY-1s, 33 PGY-2s, and 37 PGY-3/4s. PGY-3/4s averaged 74.6% correct (95% confidence interval [CI] 70.9-78.4) and performed significantly better than PGY-1s, who averaged 63.2% correct (95% CI 58.0-68.3). PGY-2s averaged 69.0% (95% CI 62.2-73.7). Year-to-year differences were more pronounced in management than in diagnosis. Residency training in EM seems to be associated with improved ability to interpret "critical" ECGs as measured by our assessment tool. This lends validity evidence for the tool by correlating with a previously observed association between residency training and improved ECG interpretation. Resident skill in ECG interpretation remains less than ideal. Creation of this sort of tool may allow programs to assess resident performance as well as evaluate interventions designed to improve competency. Copyright © 2016 Elsevier Inc. All rights reserved.

Are All Competencies Equal in the Eyes of Residents? A Multicenter Study of Emergency Medicine Residents’ Interest in Feedback

PubMed Central

Bentley, Suzanne; Hu, Kevin; Messman, Anne; Moadel, Tiffany; Khandelwal, Sorabh; Streich, Heather; Noelker, Joan

2017-01-01

Introduction Feedback, particularly real-time feedback, is critical to resident education. The emergency medicine (EM) milestones were developed in 2012 to enhance resident assessment, and many programs use them to provide focused resident feedback. The purpose of this study was to evaluate EM residents’ level of interest in receiving real-time feedback on each of the 23 competencies/sub-competencies. Methods This was a multicenter cross-sectional study of EM residents. We surveyed participants on their level of interest in receiving real-time on-shift feedback on each of the 23 competencies/sub-competencies. Anonymous paper or computerized surveys were distributed to residents at three four-year training programs and three three-year training programs with a total of 223 resident respondents. Residents rated their level of interest in each milestone on a six-point Likert-type response scale. We calculated average level of interest for each of the 23 sub-competencies, for all 223 respondents and separately by postgraduate year (PGY) levels of training. One-way analyses of variance were performed to determine if there were differences in ratings by level of training. Results The overall survey response rate across all institutions was 82%. Emergency stabilization had the highest mean rating (5.47/6), while technology had the lowest rating (3.24/6). However, we observed no differences between levels of training on any of the 23 competencies/sub-competencies. Conclusion Residents seem to ascribe much more value in receiving feedback on domains involving high-risk, challenging procedural skills as compared to low-risk technical and communication skills. Further studies are necessary to determine whether residents’ perceived importance of competencies/sub-competencies needs to be considered when developing an assessment or feedback program based on these 23 EM competencies/sub-competencies. PMID:28116012

A comparison of the dose from natural radionuclides and artificial radionuclides after the Fukushima nuclear accident

PubMed Central

Hosoda, Masahiro; Tokonami, Shinji; Omori, Yasutaka; Ishikawa, Tetsuo; Iwaoka, Kazuki

2016-01-01

Due to the Fukushima Daiichi Nuclear Power Plant (FDNPP) accident, the evacuees from Namie Town still cannot reside in the town, and some continue to live in temporary housing units. In this study, the radon activity concentrations were measured at temporary housing facilities, apartments and detached houses in Fukushima Prefecture in order to estimate the annual internal exposure dose of residents. A passive radon–thoron monitor (using a CR-39) and a pulse-type ionization chamber were used to evaluate the radon activity concentration. The average radon activity concentrations at temporary housing units, including a medical clinic, apartments and detached houses, were 5, 7 and 9 Bq m−3, respectively. Assuming the residents lived in these facilities for one year, the average annual effective doses due to indoor radon in each housing type were evaluated as 0.18, 0.22 and 0.29 mSv, respectively. The average effective doses to all residents in Fukushima Prefecture due to natural and artificial sources were estimated using the results of the indoor radon measurements and published data. The average effective dose due to natural sources for the evacuees from Namie Town was estimated to be 1.9 mSv. In comparison, for the first year after the FDNPP accident, the average effective dose for the evacuees due to artificial sources from the accident was 5.0 mSv. Although residents' internal and external exposures due to natural radionuclides cannot be avoided, it might be possible to lower external exposure due to the artificial radionuclides by changing some behaviors of residents. PMID:26838130

A monte carlo study of restricted diffusion: Implications for diffusion MRI of prostate cancer.

PubMed

Gilani, Nima; Malcolm, Paul; Johnson, Glyn

2017-04-01

Diffusion MRI is used frequently to assess prostate cancer. The prostate consists of cellular tissue surrounding fluid filled ducts. Here, the diffusion properties of the ductal fluid alone were studied. Monte Carlo simulations were used to investigate ductal residence times to determine whether ducts can be regarded as forming a separate compartment and whether ductal radius could determine the Apparent Diffusion Coefficient (ADC) of the ductal fluid. Random walks were simulated in cavities. Average residence times were estimated for permeable cavities. Signal reductions resulting from application of a Stejskal-Tanner pulse sequence were calculated in impermeable cavities. Simulations were repeated for cavities of different radii and different diffusion times. Residence times are at least comparable with diffusion times even in relatively high grade tumors. ADCs asymptotically approach theoretical limiting values. At large radii and short diffusion times, ADCs are similar to free diffusion. At small radii and long diffusion times, ADCs are reduced toward zero, and kurtosis approaches a value of -1.2. Restricted diffusion in cavities of similar sizes to prostate ducts may reduce ductal ADCs. This may contribute to reductions in total ADC seen in prostate cancer. Magn Reson Med 77:1671-1677, 2017. © 2016 International Society for Magnetic Resonance in Medicine. © 2016 International Society for Magnetic Resonance in Medicine.

Training in pathology informatics: implementation at the University of Pittsburgh.

PubMed

Harrison, James H; Stewart, Jimmie

2003-08-01

Pathology informatics is generally recognized as an important component of pathology training, but the scope, form, and goals of informatics training vary substantially between pathology residency programs. The Training and Education Committee of the Association for Pathology Informatics (API TEC) has developed a standard set of knowledge and skills objectives that are recommended for inclusion in pathology informatics training and may serve to standardize and formalize training programs in this area. The University of Pittsburgh (Pittsburgh, Pa) core rotation in pathology informatics includes most of these goals and is offered as an implementation model for pathology informatics training. The core rotation in pathology informatics is a 3-week, full-time rotation including didactic sessions and hands-on laboratories. Topics include general desktop computing and the Internet, but the primary focus of the rotation is vocabulary and concepts related to enterprise and pathology information systems, pathology practice, and research. The total contact time is 63 hours, and a total of 19 faculty and staff contribute. Pretests and posttests are given at the start and end of the rotation. Performance and course evaluation data were collected for 3 years (a total of 21 residents). The rotation implements 84% of the knowledge objectives and 94% of the skills objectives recommended by the API TEC. Residents scored an average of about 20% on the pretest and about 70% on the posttest for an average increase during the course of 50%. Posttest scores did not correlate with pretest scores or self-assessed computer skill level. The size of the pretest/posttest difference correlated negatively with the pretest scores and self-assessed computing skill level. Pretest scores were generally low regardless of whether residents were familiar with desktop computing and productivity applications, indicating that even residents who are computer "savvy" have limited knowledge of pathology informatics topics. Posttest scores showed that all residents' knowledge increased substantially during the course and that residents who were computing novices were not disadvantaged. In fact, novices tended to have higher pretest/posttest differences, indicating that the rotation effectively supported initially less knowledgeable residents in "catching up" to their peers and achieving an appropriate competency level. This rotation provides a formal training model that implements the API TEC recommendations with demonstrated success.

40 CFR 63.1365 - Test methods and initial compliance procedures.

Code of Federal Regulations, 2012 CFR

2012-07-01

... temperature of 760 °C, the design evaluation must document that these conditions exist. (ii) For a combustion... autoignition temperature of the organic HAP, must consider the vent stream flow rate, and must establish the design minimum and average temperature in the combustion zone and the combustion zone residence time. (B...

40 CFR 63.1365 - Test methods and initial compliance procedures.

Code of Federal Regulations, 2010 CFR

2010-07-01

... temperature of 760 °C, the design evaluation must document that these conditions exist. (ii) For a combustion... autoignition temperature of the organic HAP, must consider the vent stream flow rate, and must establish the design minimum and average temperature in the combustion zone and the combustion zone residence time. (B...

40 CFR 63.1365 - Test methods and initial compliance procedures.

Code of Federal Regulations, 2011 CFR

2011-07-01

... temperature of 760 °C, the design evaluation must document that these conditions exist. (ii) For a combustion... autoignition temperature of the organic HAP, must consider the vent stream flow rate, and must establish the design minimum and average temperature in the combustion zone and the combustion zone residence time. (B...

40 CFR 63.1365 - Test methods and initial compliance procedures.

Code of Federal Regulations, 2014 CFR

2014-07-01

... temperature of 760 °C, the design evaluation must document that these conditions exist. (ii) For a combustion... autoignition temperature of the organic HAP, must consider the vent stream flow rate, and must establish the design minimum and average temperature in the combustion zone and the combustion zone residence time. (B...

Percolation flux and Transport velocity in the unsaturated zone, Yucca Mountain, Nevada

USGS Publications Warehouse

Yang, I.C.

2002-01-01

The percolation flux for borehole USW UZ-14 was calculated from 14C residence times of pore water and water content of cores measured in the laboratory. Transport velocity is calculated from the depth interval between two points divided by the difference in 14C residence times. Two methods were used to calculate the flux and velocity. The first method uses the 14C data and cumulative water content data directly in the incremental intervals in the Paintbrush nonwelded unit and the Topopah Spring welded unit. The second method uses the regression relation for 14C data and cumulative water content data for the entire Paintbrush nonwelded unit and the Topopah Spring Tuff/Topopah Spring welded unit. Using the first method, for the Paintbrush nonwelded unit in boreholeUSW UZ-14 percolation flux ranges from 2.3 to 41.0 mm/a. Transport velocity ranges from 1.2 to 40.6 cm/a. For the Topopah Spring welded unit percolation flux ranges from 0.9 to 5.8 mm/a in the 8 incremental intervals calculated. Transport velocity ranges from 1.4 to 7.3 cm/a in the 8 incremental intervals. Using the second method, average percolation flux in the Paintbrush nonwelded unit for 6 boreholes ranges from 0.9 to 4.0 mm/a at the 95% confidence level. Average transport velocity ranges from 0.6 to 2.6 cm/a. For the Topopah Spring welded unit and Topopah Spring Tuff, average percolation flux in 5 boreholes ranges from 1.3 to 3.2 mm/a. Average transport velocity ranges from 1.6 to 4.0 cm/a. Both the average percolation flux and average transport velocity in the PTn are smaller than in the TS/TSw. However, the average minimum and average maximum values for the percolation flux in the TS/TSw are within the PTn average range. Therefore, differences in the percolation flux in the two units are not significant. On the other hand, average, average minimum, and average maximum transport velocities in the TS/TSw unit are all larger than the PTn values, implying a larger transport velocity for the TS/TSw although there is a small overlap.

Effect of Georgetown Lake on the water quality of Clear Creek, Georgetown, Colorado, 1997-98

USGS Publications Warehouse

Cuffin, Sally M.; Chafin, Daniel T.

2000-01-01

Georgetown Lake is a recreational reservoir located in the upper Clear Creek Basin, a designated Superfund site because of extensive metal mining in the past. Metals concentrations in Clear Creek increase as the stream receives runoff from mining-affected areas. In 1997, the U.S. Geological Survey, in cooperation with the U.S. Environmental Protection Agency, began a study to determine the effect of the reservoir on the transport of metals in Clear Creek. A bathymetric survey determined the capacity of the reservoir to be about 440 acre-feet of water, which remained constant during the study. Average water residence time in the reservoir is about 1?3 days during high flow. During low flow (10 cubic feet per second), average residence is about 22 days without ice cover and about 15 days with a 3-foot-thick ice cover. Sediment samples collected from the bottom of Georgetown Lake contained substantial concentrations of iron (average 25,500 milligrams per kilogram), aluminum (average 12,300 milligrams per kilogram), zinc (2,830 milligrams per kilogram), lead (618 milligrams per kilogram), manganese (548 milligrams per kilogram), and sulfide minerals (average 602 milligrams per kilogram as S). Sediment also contained abundant sulfate-reducing bacteria, indicating anoxic conditions. Algae and diatoms common to cold-water lakes were identified in sediment samples; one genus of algae is known to adapt to low-light conditions such as exist beneath ice cover. Vertical profiles of temperature, specific conductance, pH, and dissolved-oxygen concentrations were measured in the reservoir on July 28, 1997, when inflow to the reservoir was about 170 cubic feet per second and average residence time of water was about 1.3 days, and on February 13, 1998, when the reservoir was covered with about 3 feet of ice, inflow was about 15 cubic feet per second, and average residence time was about 12 days. The measurements on July 28, 1997, showed that the reservoir water was well mixed, although pH and dissolved oxygen concentrations were increased by photosynthesis near the bottom of the reservoir. Measurements on February 13, 1998, indicated thermal and chemical stratification with warmer water (about 4 degrees Celsius) beneath colder water and increases in pH and dissolved oxygen concentrations generally occurring near the top of the warmer layer. Concentrations of dissolved oxygen were saturated to oversaturated throughout the water column on both dates, although the concentrations were greater on February 13, 1998, because of colder temperature and photosynthesis. Median pH was about 0.5 unit higher on February 13, 1998, than on July 28, 1997, largely because the longer residence time on February 13, 1998, allowed greater cumulative effects of photosynthesis. Samples of inflow and outflow water were collected from August 1997 to August 1998. Dissolved cadmium and dissolved lead in inflow and outflow samples exceeded acute and chronic water-quality standards during some of the sampling period, whereas dissolved zinc exceeded both standards in inflow and outflow samples during the entire sampling period. Chromium, nickel, and silver were detected in a few samples at small concentrations. Arsenic, selenium, and thallium were not reported in any water samples. Georgetown Lake removes some metals from inflow water and releases others to outflow water. From August 1997 to August 1998, Georgetown Lake estimated outflow loads were about 21 percent less than the inflow load of cadmium and about 11 percent less than the inflow load of zinc. Estimated inflow loads were about 18 percent less than the outflow load of copper, about 13 percent less than the outflow load of iron, and about 27 percent less than the outflow load of manganese. Inflow and outflow loads of lead were essentially balanced. The outflow load of nitrite plus nitrate was about 14 percent less than the inflow load, probably because of plant uptake.

The Burden of the Fellowship Interview Process on General Surgery Residents and Programs.

PubMed

Watson, Shawna L; Hollis, Robert H; Oladeji, Lasun; Xu, Shin; Porterfield, John R; Ponce, Brent A

This study evaluated the effect of the fellowship interview process in a cohort of general surgery residents. We hypothesized that the interview process would be associated with significant clinical time lost, monetary expenses, and increased need for shift coverage. An online anonymous survey link was sent via e-mail to general surgery program directors in June 2014. Program directors distributed an additional survey link to current residents in their program who had completed the fellowship interview process. United States allopathic general surgery programs. Overall, 50 general surgery program directors; 72 general surgery residents. Program directors reported a fellowship application rate of 74.4%. Residents most frequently attended 8 to 12 interviews (35.2%). Most (57.7%) of residents reported missing 7 or more days of clinical training to attend interviews; these shifts were largely covered by other residents. Most residents (62.3%) spent over $4000 on the interview process. Program directors rated fellowship burden as an average of 6.7 on a 1 to 10 scale of disruption, with 10 being a significant disruption. Most of the residents (57.3%) were in favor of change in the interview process. We identified potential areas for improvement including options for coordinated interviews and improved content on program websites. The surgical fellowship match is relatively burdensome to residents and programs alike, and merits critical assessment for potential improvement. Published by Elsevier Inc.

Time-averaged fluxes of lead and fallout radionuclides to sediments in Florida Bay

USGS Publications Warehouse

Robbins, J.A.; Holmes, C.; Halley, R.; Bothner, Michael H.; Shinn, E.; Graney, J.; Keeler, G.; TenBrink, M.; Orlandini, K.A.; Rudnick, D.

2000-01-01

Recent, unmixed sediments from mud banks of central Florida Bay were dated using 210Pb/226Ra, and chronologies were verified by comparing sediment lead temporal records with Pb/Ca ratios in annual layers of coral (Montastrea annularis) located on the ocean side of the Florida Keys. Dates of sediment lead peaks (1978±2) accord with prior observations of a 6 year lag between the occurrence of maximum atmospheric lead in 1972 and peak coral lead in 1978. Smaller lags of 1–2 years occur between the maximum atmospheric radionuclide fallout and peaks in sediment temporal records of 137Cs and Pu. Such lags are consequences of system time averaging (STA) in which atmospherically delivered particle-associated constituents accumulate and mix in a (sedimentary?) reservoir before transferring to permanent sediments and coral. STA model calculations, using time-dependent atmospheric inputs, produced optimized profiles in excellent accord with measured sediment 137Cs, Pu, lead, and coral lead distributions. Derived residence times of these particle tracers (16±1, 15.7±0.7, 19±3, and 16±2 years, respectively) are comparable despite differences in sampling locations, in accumulating media, and in element loading histories and geochemical properties. For a 16 year weighted mean residence time, STA generates the observed 6 year lead peak lag. Evidently, significant levels of nondegradable, particle-associated contaminants can persist in Florida Bay for many decades following elimination of external inputs. Present results, in combination with STA model analysis of previously reported radionuclide profiles, suggest that decade-scale time averaging may occur widely in recent coastal marine sedimentary environments.

7 CFR 1777.12 - Eligibility.

Code of Federal Regulations, 2011 CFR

2011-01-01

..., on the date preapplication is received by the Agency, the: (1) Per capita income of the residents is not more than 70 percent of the most recent national average per capita income, as determined by the... recent national average unemployment rate, as determined by the Bureau of Labor Statistics. (b) Residents...

7 CFR 1777.12 - Eligibility.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., on the date preapplication is received by the Agency, the: (1) Per capita income of the residents is not more than 70 percent of the most recent national average per capita income, as determined by the... recent national average unemployment rate, as determined by the Bureau of Labor Statistics. (b) Residents...

A real-time computer model to assess resident work-hours scenarios.

PubMed

McDonald, Furman S; Ramakrishna, Gautam; Schultz, Henry J

2002-07-01

To accurately model residents' work hours and assess options to forthrightly meet Residency Review Committee-Internal Medicine (RRC-IM) requirements. The requirements limiting residents' work hours are clearly defined by the Accreditation Council for Graduate Medical Education (ACGME) and the RRC-IM: "When averaged over any four-week rotation or assignment, residents must not spend more than 80 hours per week in patient care duties."(1) The call for the profession to realistically address work-hours violations is of paramount importance.(2) Unfortunately, work hours are hard to calculate. We developed an electronic model of residents' work-hours scenarios using Microsoft Excel 97. This model allows the input of multiple parameters (i.e., call frequency, call position, days off, short-call, weeks per rotation, outpatient weeks, clinic day of the week, additional time due to clinic) and start and stop times for post-call, non-call, short-call, and weekend days. For each resident on a rotation, the model graphically demonstrates call schedules, plots clinic days, and portrays all possible and preferred days off. We tested the model for accuracy in several scenarios. For example, the model predicted average work hours of 85.1 hours per week for fourth-night-call rotations. This was compared with logs of actual work hours of 84.6 hours per week. Model accuracy for this scenario was 99.4% (95% CI 96.2%-100%). The model prospectively predicted work hours of 89.9 hours/week in the cardiac intensive care unit (CCU). Subsequent surveys found mean CCU work hours of 88, 1 hours per week. Model accuracy for this scenario was 98% (95% CI 93.2-100%). Thus validated, we then used the model to test proposed scenarios for complying with RRC-IM limits. The flexibility of the model allowed demonstration of the full range of work-hours scenarios in every rotation of our 36-month program. Demonstrations of status-quo work-hours scenarios were presented to faculty as well as real-time demonstrations of the feasibility, or unfeasibility, of their proposed solutions. The model clearly demonstrated that non-call (i.e., short-call) admissions without concomitant decreases in overnight call frequency resulted in substantial increases in total work hours. Attempts to "get the resident out" an hour or two earlier each day had negligible effects on total hours and were unrealistic paper solutions. For fourth-night-call rotations, the addition of a "golden weekend" (i.e., a fifth day off per month) was found to significantly reduce work hours. The electronic model allowed the development of creative schedules for previously third-night-call rotations that limit resident work hours without decreasing continuity of care by scheduling overnight call every sixth night alternating with sixth-night-short-call rotations. Our electronic model is sufficiently robust to accurately estimate work hours on multiple and varied rotations. This model clearly demonstrates that it is very difficult to meet the RRC-IM work-hours limitations under standard fourth-night-call schedules with only four days off per month. We are successfully using our model to test proposed alternative scenarios, to overcome faculty misconceptions about resident work-hours "solutions," and to make changes to our call schedules that both are realistic for residents to accomplish and truly diminish total resident work hours toward the requirements of the RRC-IM.

Student Expenses in Residency Interviewing

PubMed Central

Walling, Anne; Nilsen, Kari; Callaway, Paul; Grothusen, Jill; Gillenwater, Cole; King, Samantha; Unruh, Gregory

2017-01-01

Background The student costs of residency interviewing are of increasing concern but limited current information is available. Updated, more detailed information would assist students and residency programs in decisions about residency selection. The study objective was to measure the expenses and time spent in residency interviewing by the 2016 graduating class of the University of Kansas School of Medicine and assess the impact of gender, regional campus location, and primary care application. Methods All 195 students who participated in the 2016 National Residency Matching Program (NRMP) received a 33 item questionnaire addressing interviewing activity, expenses incurred, time invested and related factors. Main measures were self-reported estimates of expenses and time spent interviewing. Descriptive analyses were applied to participant characteristics and responses. Multivariate analysis of variance (MANOVA) and chi-square tests compared students by gender, campus (main/regional), and primary care/other specialties. Analyses of variance (ANOVA) on the dependent variables provided follow-up tests on significant MANOVA results. Results A total of 163 students (84%) completed the survey. The average student reported 38 (1–124) applications, 16 (1–54) invitations, 11 (1–28) completed interviews, and spent $3,500 ($20–$12,000) and 26 (1–90) days interviewing. No significant differences were found by gender. After MANOVA and ANOVA analyses, non-primary care applicants reported significantly more applications, interviews, and expenditures, but less program financial support. Regional campus students reported significantly fewer invitations, interviews, and days interviewing, but equivalent costs when controlled for primary care application. Cost was a limiting factor in accepting interviews for 63% and time for 53% of study respondents. Conclusions Students reported investing significant time and money in interviewing. After controlling for other variables, primary care was associated with significantly lowered expenses. Regional campus location was associated with fewer interviews and less time interviewing. Gender had no significant impact on any aspect studied. PMID:29472969

Effect of minimally invasive surgery fellowship on residents' operative experience.

PubMed

Altieri, Maria S; Frenkel, Catherine; Scriven, Richard; Thornton, Deborah; Halbert, Caitlin; Talamini, Mark; Telem, Dana A; Pryor, Aurora D

2017-01-01

There is an increased need for surgical trainees to acquire advanced laparoscopic skills as laparoscopy becomes the standard of care in many areas of general surgery. Since the introduction of minimally invasive surgery (MIS) fellowships, there has been a continuing debate as to whether these fellowships adversely affect general surgery resident exposure to laparoscopic cases. The aim of our study was to examine whether the introduction of an MIS fellowship negatively impacts general surgery residents' experience at a single academic center. We describe the changes following establishment of MIS fellowship at an academic center. Resident case log system from the Accreditation Council for Graduate Medical Education was queried to obtain all PGY 1-5 resident operative case logs. Two-year time period preceding and following the institution of an MIS fellowship at our institution in 2012 was compared. P values less than 0.05 were considered statistically significant. Following initiation of the MIS fellowship, an MIS service was established. The service comprised of a fellow, midlevel resident, and intern. Operative experience was examined. From 2010-2012 to 2012-2014, residents logged a total of 272 and 585 complex laparoscopic cases, respectively. There were 43 residents from 2010 to 2013 and 44 residents from 2013 to 2014. When the two time periods were compared, a trend of increased numbers for all procedures was noted, except laparoscopic GYN/genito-urinary procedures. Average percent increase in complex general surgery procedures was 249 ± 179.8 %. Following establishment of a MIS fellowship, reported cases by residents were higher or similar to those reported nationally for laparoscopic procedures. Institution of an MIS fellowship had a favorable effect on general surgery resident operative education at a single academic training center. Residents may benefit from the presence of a fellowship at an academic center because they are able to participate in an increased number of complex laparoscopic cases.

Chloride retention and release in a boreal forest soil: effects of soil water residence time and nitrogen and chloride loads.

PubMed

Bastviken, David; Sandén, Per; Svensson, Teresia; Ståhlberg, A Carina; Magounakis, Malin; Oberg, Gunilla

2006-05-01

The common assumption that chloride (Cl-) is conservative in soils and can be used as a groundwater tracer is currently being questioned, and an increasing number of studies indicate that Cl- can be retained in soils. We performed lysimeter experiments with soil from a coniferous forest in southeast Sweden to determine whether pore water residence time and nitrogen and Cl- loads affected Cl- retention. Over the first 42 days there was a net retention of Cl- with retention rates averaging 3.1 mg CI- m(-2) d(-1) (68% of the added Cl- retained over 42 days). Thereafter, a net release of Cl- at similar rates was observed for the remaining experimental period (85 d). Longer soil water residence time and higher Cl- load gave higher initial retention and subsequent release rates than shorter residence time and lower Cl- load did. Nitrogen load did not affect Cl transformation rates. This study indicates that simultaneous retention and release of Cl- can occur in soils, and that rates may be considerable relative to the load. The retention of Cl- observed was probably due to chlorination of soil organic matter or ion exchange. The cause of the shift between net retention and net release is unclear, but we hypothesize that the presence of O2 or the presence of microbially available organic matter regulates Cl- retention and release rates.

Depositional fluxes and residence time of atmospheric radioiodine (131I) from the Fukushima accident.

PubMed

Yang, Weifeng; Guo, Laodong

2012-11-01

Activities of radioiodine ((131)I) along with (210)Pb and (210)Po in time series precipitation samples were measured to determine the depositional fluxes of (131)I in the Southern United States and its removal rate and residence time in the atmosphere during the Fukushima nuclear accident. Radioiodine released from the Fukushima accident reached the Southern United States within 11 days, giving rise to a concurrent (131)I peak and anomalous (210)Po/(210)Pb ratios in the precipitation samples. The cumulative (131)I depositional flux was 4.6 ± 0.2 Bq m(-2) during the maximum fallout. The removal rate of (131)I out of the atmosphere, derived from a definite (131)I integral model, ranged from 0.03 to 0.14 d(-1) with an average of 0.08 ± 0.02 d(-1), which corresponds to a residence time of (131)I in the atmosphere of 12 ± 3 days, consistent with the resident timescale constrained by the (210)Po/(210)Pb disequilibrium technique. These results support our hypothesis that radioiodine was removed from the atmosphere by precipitation within two weeks. It seemed that regions reachable by (131)I transport within two weeks from Fukushima Japan would receive much more fallout, whereas places outside that distance would be relatively less polluted with radionuclides. Copyright © 2012 Elsevier Ltd. All rights reserved.

Direct Solvothermal Liquefaction of Pennisetum purpureum Biomass to Produce Biocrude Using Ethanol Solvent

NASA Astrophysics Data System (ADS)

Adriane Ochiai, Mikael; Marrod Cruz, Salvador; Oporto, Louiellyn; de Leon, Rizalinda

2018-03-01

Direct solvothermal liquefaction was used in converting the lignocellulosic biomass, Pennisetum purpureum or Napier grass using ethanol as solvent. Liquefaction of Napier grass resulted in a dark and viscous bio-crude product and exhibited promising yields (34.6377% to 48.6267%). It was determined that the effects of temperature and residence time were statistically significant with the residence time having the greatest positive effect on yield. High yields of bio-crude from Napier grass seem to occur when solvothermal temperature, residence time increased and as solids ratio decreased. However, elemental analysis showed that the bio-crude produced needs to undergo deoxygenation (O: 14.25 - 49.42%) before mixing with petroleum. For the higher heating value (HHV), the parameters observed in the study were statistically insignificant, however, temperature was determined to have the greatest positive effect on HHV. It was observed that high HHV bio-crude were produced at high temperatures, low solids ratio, and low residence times. The acquired averages for the HHV (20.0333 MJ/kg to 29.7744 MJ/kg) were all higher than the HHV of the Napier grass sample used in the study (12.9394 MJ/kg). It was observed in the study, that even though solids ratio has the least effect on both responses, the choice of solids ratio is dependent on its interaction effects with the other parameters as its effects contribute to the observed responses.

Numerical modeling of general circulation, thermohaline structure, and residence time in Gorgan Bay, Iran

NASA Astrophysics Data System (ADS)

Ranjbar, Mohammad Hassan; Hadjizadeh Zaker, Nasser

2018-01-01

Gorgan Bay is a semi-enclosed basin located in the southeast of the Caspian Sea, Iran. The bay is recognized as a resting place for migratory birds as well as a spawning habitat for native fish. However, apparently, no detailed research on its physical processes has previously been conducted. In this study, a 3D coupled hydrodynamic and solute transport model was used to investigate general circulation, thermohaline structure, and residence time in Gorgan Bay. Model outputs were validated against a set of field observations. Bottom friction and attenuation coefficient of light intensity were tuned in order to achieve optimum agreement with the observations. Results revealed that, due to the interaction between bathymetry and prevailing winds, a barotropic double-gyre circulation, dominating the general circulation, existed during all seasons in Gorgan Bay. Furthermore, temperature and salinity fluctuations in the bay were seasonal, due to the seasonal variability of atmospheric fluxes. Results also indicated that under the prevailing winds, the domain-averaged residence time in Gorgan Bay would be approximately 95 days. The rivers discharging into Gorgan Bay are considered as the main sources of nutrients in the bay. Since their mouths are located in the area with a residence time of over 100 days, Gorgan Bay could be at risk of eutrophication; it is necessary to adopt preventive measures against water quality degradation.

Meeting the 80-hour work week requirement: what did we cut?

PubMed

Chung, Raphael; Ahmed, Naveed; Chen, Peter

2004-01-01

To meet the new accreditation requirement, small programs with limited manpower must make hard decisions to safeguard quality. We devised a system to meet the requirement in our own environment, making the obligatory cuts in educational components as prioritized by the trainees. This study examined what aspect of training is impacted and the residents' perception of the resulting change. In a fully accredited program where the baseline work hours/week exceeded the new requirement by over 20% even with full deployment of physician's assistants, the strategies used included reducing external rotations, transitioning PGY-3 into senior responsibility, and integrating senior rotations to 2 hospitals into 1 (2 weeks/month), so that time in a lower volume hospital helped to bring the monthly average to target. Residents were surveyed at 6-month intervals for their perception of the change. Compared with baseline, the new system averaged 77 +/- 5 hours/week, significantly reduced from before (98 +/- 12, p < 0.01), but with greatly reduced continuity of care (28 +/- 10% vs. 88 +/- 8%, p < 0.001), reduced consultations seen (19 +/- 4 vs. 36 +/- 7 per week, p < 0.001), reduced conference attendance (5.7 vs. 3.5 per week, p < 0.001), and reduced operations (55 +/- 7 vs. 68 +/- 9 per week for the program). External rotations have been reduced by 3 months, and outpatient clinics merged from 5 to 2. Surveys showed improvement in fatigue-related issues for junior residents. Senior residents were dissatisfied with the reduced educational components. Reducing work hours cannot be accomplished without reducing educational components. Unlike junior residents, senior residents felt less fulfilled with the new system and do not benefit in physical fatigue.

Determining Nurse Aide Staffing Requirements to Provide Care Based on Resident Workload: A Discrete Event Simulation Model.

PubMed

Schnelle, John F; Schroyer, L Dale; Saraf, Avantika A; Simmons, Sandra F

2016-11-01

Nursing aides provide most of the labor-intensive activities of daily living (ADL) care to nursing home (NH) residents. Currently, most NHs do not determine nurse aide staffing requirements based on the time to provide ADL care for their unique resident population. The lack of an objective method to determine nurse aide staffing requirements suggests that many NHs could be understaffed in their capacity to provide consistent ADL care to all residents in need. Discrete event simulation (DES) mathematically models key work parameters (eg, time to provide an episode of care and available staff) to predict the ability of the work setting to provide care over time and offers an objective method to determine nurse aide staffing needs in NHs. This study had 2 primary objectives: (1) to describe the relationship between ADL workload and the level of nurse aide staffing reported by NHs; and, (2) to use a DES model to determine the relationship between ADL workload and nurse aide staffing necessary for consistent, timely ADL care. Minimum Data Set data related to the level of dependency on staff for ADL care for residents in over 13,500 NHs nationwide were converted into 7 workload categories that captured 98% of all residents. In addition, data related to the time to provide care for the ADLs within each workload category was used to calculate a workload score for each facility. The correlation between workload and reported nurse aide staffing levels was calculated to determine the association between staffing reported by NHs and workload. Simulations to project staffing requirements necessary to provide ADL care were then conducted for 65 different workload scenarios, which included 13 different nurse aide staffing levels (ranging from 1.6 to 4.0 total hours per resident day) and 5 different workload percentiles (ranging from the 5th to the 95th percentile). The purpose of the simulation model was to determine the staffing necessary to provide care within each workload percentile based on resident ADL care needs and compare the simulated staffing projections to the NH reported staffing levels. The percentage of scheduled care time that was omitted was estimated by the simulation model for each of the 65 workload scenarios using optimistic assumptions about staff productivity and efficiency. There was a low correlation between ADL workload and reported nurse aide staffing (Pearson = .11; P < .01), which suggests that most of the 13,500 NHs were not using ADL acuity to determine nurse aide staffing levels. Based on the DES model, the nurse aide staffing required for ADL care that would result in a rate of care omissions below 10% ranged from 2.8 hours/resident/day for NHs with a low workload (5th percentile) to 3.6 hours/resident/day for NHs with a high workload (95th percentile). In contrast, NHs reported staffing levels that ranged from an average of 2.3 to 2.5 hours/resident/day across all 5 workload percentiles. Higher workload NHs had the largest discrepancies between reported and predicted nurse aide staffing levels. The average nurse aide staffing levels reported by NHs falls below the level of staffing predicted as necessary to provide consistent ADL care to all residents in need. DES methodology can be used to determine nurse aide staffing requirements to provide ADL care and simulate management interventions to improve care efficiency and quality. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Email notification combined with off site signing substantially reduces resident approval to faculty verification time.

PubMed

Deitte, Lori A; Moser, Patricia P; Geller, Brian S; Sistrom, Chris L

2011-06-01

Attending radiologist signature time (AST) is a variable and modifiable component of overall report turnaround time. Delays in finalized reports have potential to undermine radiologists' value as consultants and adversely affect patient care. This study was performed to evaluate the impact of notebook computer distribution and daily automated e-mail notification on reducing AST. Two simultaneous interventions were initiated in the authors' radiology department in February 2010. These included the distribution of a notebook computer with preloaded software for each attending radiologist to sign radiology reports and daily automated e-mail notifications for unsigned reports. The digital dictation system archive and the radiology information system were queried for all radiology reports produced from January 2009 through August 2010. The time between resident approval and attending radiologist signature before and after the intervention was analyzed. Potential unintended "side effects" of the intervention were also studied. Resident-authored reports were signed, on average, 2.53 hours sooner after the intervention. This represented a highly significant (P = .003) decrease in AST with all else held equal. Postintervention reports were authored by residents at the same rate (about 70%). An unintended "side effect" was that attending radiologists were less likely to make changes to resident-authored reports after the intervention. E-mail notification combined with offsite signing can reduce AST substantially. Notebook computers with preloaded software streamline the process of accessing, editing, and signing reports. The observed decrease in AST reflects a positive change in the timeliness of report signature. Copyright © 2011 AUR. Published by Elsevier Inc. All rights reserved.

Preventing Delays in First-Case Starts on the Neurosurgery Service: A Resident-Led Initiative at an Academic Institution.

PubMed

Han, Seunggu J; Rolston, John D; Zygourakis, Corinna C; Sun, Matthew Z; McDermott, Michael W; Lau, Catherine Y; Aghi, Manish K

2016-01-01

On-time starts for the first case of the day are critical to maintaining efficiency in operating rooms (ORs). We studied whether a resident-led initiative to ensure on-time site marking and documentation of surgical consent could lead to improved first-case start time. In a resident-led initiative at a large 600-bed academic hospital with 25 ORs, we aimed to complete site marking and surgical consents half an hour before the scheduled start time for all first-case neurosurgical patients. We monitored the occurrence of delayed first starts and the length of delay during our initiative, and compared these cases to neurosurgical cases 3 months before the implementation of the initiative and to first-start nonneurosurgical cases. In the year of the initiative, both site marking and surgical consents were completed 30 minutes before the case start in 97% of neurosurgical cases. The average delay across all first-case starts was reduced to 7.17 minutes (N = 1271), compared with 9.67 minutes before the intervention (N = 345). During the study period, non-neurosurgical cases were delayed on average 10.3 minutes (N = 3592). There was a significant difference in latencies between the study period and the period before the initiative (p < 0.001), and also between neurosurgical cases and nonneurosurgical cases (p < 0.001). There was no reduction in delay times seen on the non-neurosurgical services in the study period when compared to the case 3 months before. Considering its effect across 1271 cases, this initiative over 1 year resulted in a total reduction of 52 hours and 57 minutes in delays. Through a resident-led quality improvement program, neurosurgical trainees successfully reduced delays in first-case starts on a surgical service. Engaging physician trainees in quality improvement and enhancing OR efficiency can be successfully achieved and can have a significant clinical and financial effect. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Extracapsular cataract extraction training: junior ophthalmology residents' self-reported satisfaction level with their proficiency and initial learning barrier.

PubMed

Ting, Daniel Shu Wei; Tan, Sarah; Lee, Shu Yen; Rosman, Mohamad; Aw, Ai Tee; Yeo, Ian Yew San

2015-07-01

To investigate residents' self-reported satisfaction level with their proficiency in extracapsular cataract extraction (ECCE) surgery and the initial barriers to learning the procedure. This is a single-centre prospective descriptive case series involving eight first-year ophthalmology residents in Singapore National Eye Center. We recorded the demographics, frequency of review by the residents of their own surgical videos and their satisfaction level with their proficiency at each of the ECCE steps using a 5-point Likert scale. All ECCE surgical videos between October 2013 and May 2014 were collected and analysed for the overall time taken for the surgery and the time taken to perform the individual steps of the procedure. The mean age of the residents was 27.6 ± 1.5 years and 62.5% (5/8) were women. More than half (62.5%, 5/8) reviewed their own surgical videos while 37.5% (3/8) discussed the surgical videos with their peers or supervisors. Of the ECCE steps, the residents were most dissatisfied with their proficiency in performing irrigation and aspiration (87.5%, 7/8), followed by suturing (62.5%, 5/8), intraocular lens insertion (62.5%, 5/8) and tin can capsulotomy (62.5%, 5/8). The average time taken for each ECCE case was 55.0 ± 12.2 min and, of all the steps, most time was spent on suturing (20.5 ± 6.8 min), followed by irrigation and aspiration (5.5 ± 3.6 min) and tin can capsulotomy (3.3 ± 1.8 min). The first-year ophthalmology residents were most dissatisfied with their proficiency in irrigation/aspiration, suturing and tin can capsulotomy. More training needs to be directed to these areas during teaching sessions in the operating room, wet laboratory or cataract simulation training sessions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

38 CFR 17.63 - Approval of community residential care facilities.

Code of Federal Regulations, 2011 CFR

2011-07-01

... residential care is not the responsibility of the United States Government or VA. (2) The resident or an... resident will be greater than the average cost of care for other residents, or if the resident chooses to... State and local regulations including construction, maintenance, and sanitation regulations; (2) Meet...

38 CFR 17.63 - Approval of community residential care facilities.

Code of Federal Regulations, 2012 CFR

2012-07-01

... residential care is not the responsibility of the United States Government or VA. (2) The resident or an... resident will be greater than the average cost of care for other residents, or if the resident chooses to... State and local regulations including construction, maintenance, and sanitation regulations; (2) Meet...

38 CFR 17.63 - Approval of community residential care facilities.

Code of Federal Regulations, 2013 CFR

2013-07-01

... residential care is not the responsibility of the United States Government or VA. (2) The resident or an... resident will be greater than the average cost of care for other residents, or if the resident chooses to... State and local regulations including construction, maintenance, and sanitation regulations; (2) Meet...

38 CFR 17.63 - Approval of community residential care facilities.

Code of Federal Regulations, 2014 CFR

2014-07-01

... residential care is not the responsibility of the United States Government or VA. (2) The resident or an... resident will be greater than the average cost of care for other residents, or if the resident chooses to... State and local regulations including construction, maintenance, and sanitation regulations; (2) Meet...

Feasibility: An important but neglected issue in patient hand hygiene.

PubMed

Knighton, Shanina C; McDowell, Cherese; Rai, Herleen; Higgins, Patricia; Burant, Christopher; Donskey, Curtis J

2017-06-01

Patient hand hygiene may be a useful strategy to prevent acquisition of pathogens and to reduce the risk for transmission by colonized patients. Several studies demonstrate that patients and long-term-care facility (LTCF) residents may have difficulty using hand hygiene products that are provided; however, none of them measure feasibility for patients to use different hand hygiene products. A convenience sample of 42 hospitalized patients and 46 LTCF residents was assessed for their ability to use 3 hand sanitizer products (8-oz pushdown pump bottle, 2-oz pocket-sized bottle with a reclosable lid, and alcohol-impregnated hand wipes). The time (seconds) required for accessing each product was compared among acute-care patients and LTCF residents. Participants provided feedback on which product they preferred and found easiest to use. Of 88 participants, 86 (97.7%) preferred the pushdown pump, 2 (2.3%) preferred the bottle with the reclosable lid, and none preferred the hand wipes. For both hospitalized patients and LTCF residents, the average time required to access the pushdown pump was significantly less than the time required to access the other products (pushdown pump, 0.45 seconds; bottle with reclosable lid, 3.86 seconds; and wipes, 5.66 seconds; P < .001). Feasibility and ease of use should be considered in the selection of hand hygiene products for patients and LTCF residents. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Divergent predictions of carbon storage between two global land models: attribution of the causes through traceability analysis

NASA Astrophysics Data System (ADS)

Rafique, Rashid; Xia, Jianyang; Hararuk, Oleksandra; Asrar, Ghassem R.; Leng, Guoyong; Wang, Yingping; Luo, Yiqi

2016-07-01

Representations of the terrestrial carbon cycle in land models are becoming increasingly complex. It is crucial to develop approaches for critical assessment of the complex model properties in order to understand key factors contributing to models' performance. In this study, we applied a traceability analysis which decomposes carbon cycle models into traceable components, for two global land models (CABLE and CLM-CASA') to diagnose the causes of their differences in simulating ecosystem carbon storage capacity. Driven with similar forcing data, CLM-CASA' predicted ˜ 31 % larger carbon storage capacity than CABLE. Since ecosystem carbon storage capacity is a product of net primary productivity (NPP) and ecosystem residence time (τE), the predicted difference in the storage capacity between the two models results from differences in either NPP or τE or both. Our analysis showed that CLM-CASA' simulated 37 % higher NPP than CABLE. On the other hand, τE, which was a function of the baseline carbon residence time (τ'E) and environmental effect on carbon residence time, was on average 11 years longer in CABLE than CLM-CASA'. This difference in τE was mainly caused by longer τ'E of woody biomass (23 vs. 14 years in CLM-CASA'), and higher proportion of NPP allocated to woody biomass (23 vs. 16 %). Differences in environmental effects on carbon residence times had smaller influences on differences in ecosystem carbon storage capacities compared to differences in NPP and τ'E. Overall, the traceability analysis showed that the major causes of different carbon storage estimations were found to be parameters setting related to carbon input and baseline carbon residence times between two models.

Divergent predictions of carbon storage between two global land models: Attribution of the causes through traceability analysis

DOE PAGES

Rafique, Rashid; Xia, Jianyang; Hararuk, Oleksandra; ...

2016-07-29

Representations of the terrestrial carbon cycle in land models are becoming increasingly complex. It is crucial to develop approaches for critical assessment of the complex model properties in order to understand key factors contributing to models' performance. In this study, we applied a traceability analysis which decomposes carbon cycle models into traceable components, for two global land models (CABLE and CLM-CASA') to diagnose the causes of their differences in simulating ecosystem carbon storage capacity. Driven with similar forcing data, CLM-CASA' predicted – 31 % larger carbon storage capacity than CABLE. Since ecosystem carbon storage capacity is a product of net primary productivitymore » (NPP) and ecosystem residence time ( τ E), the predicted difference in the storage capacity between the two models results from differences in either NPP or τ E or both. Our analysis showed that CLM-CASA'simulated 37 % higher NPP than CABLE. On the other hand, τ E, which was a function of the baseline carbon residence time ( τ' E) and environmental effect on carbon residence time, was on average 11 years longer in CABLE than CLM-CASA'. This difference in τ E was mainly caused by longer τ' E of woody biomass (23 vs. 14 years in CLM-CASA'), and higher proportion of NPP allocated to woody biomass (23 vs. 16 %). Differences in environmental effects on carbon residence times had smaller influences on differences in ecosystem carbon storage capacities compared to differences in NPP and τ' E. Altogether, the traceability analysis showed that the major causes of different carbon storage estimations were found to be parameters setting related to carbon input and baseline carbon residence times between two models.« less

Divergent predictions of carbon storage between two global land models: Attribution of the causes through traceability analysis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rafique, Rashid; Xia, Jianyang; Hararuk, Oleksandra

Representations of the terrestrial carbon cycle in land models are becoming increasingly complex. It is crucial to develop approaches for critical assessment of the complex model properties in order to understand key factors contributing to models' performance. In this study, we applied a traceability analysis which decomposes carbon cycle models into traceable components, for two global land models (CABLE and CLM-CASA') to diagnose the causes of their differences in simulating ecosystem carbon storage capacity. Driven with similar forcing data, CLM-CASA' predicted – 31 % larger carbon storage capacity than CABLE. Since ecosystem carbon storage capacity is a product of net primary productivitymore » (NPP) and ecosystem residence time ( τ E), the predicted difference in the storage capacity between the two models results from differences in either NPP or τ E or both. Our analysis showed that CLM-CASA'simulated 37 % higher NPP than CABLE. On the other hand, τ E, which was a function of the baseline carbon residence time ( τ' E) and environmental effect on carbon residence time, was on average 11 years longer in CABLE than CLM-CASA'. This difference in τ E was mainly caused by longer τ' E of woody biomass (23 vs. 14 years in CLM-CASA'), and higher proportion of NPP allocated to woody biomass (23 vs. 16 %). Differences in environmental effects on carbon residence times had smaller influences on differences in ecosystem carbon storage capacities compared to differences in NPP and τ' E. Altogether, the traceability analysis showed that the major causes of different carbon storage estimations were found to be parameters setting related to carbon input and baseline carbon residence times between two models.« less

An unforgettable event: a qualitative study of the 1997-98 El Niño in northern Peru.

PubMed

Bayer, Angela M; Danysh, Heather E; Garvich, Mijail; Gonzálvez, Guillermo; Checkley, William; Alvarez, María; Gilman, Robert H

2014-04-01

During the 1997-98 El Niño, Tumbes, Peru received 16 times the annual average rainfall. This study explores how Tumbes residents perceived the impact of the El Niño event on basic necessities, transport, health care, jobs and migration. Forty-five individuals from five rural communities, some of which were isolated from the rest of Tumbes during the event, participated in five focus groups; six of these individuals constructed nutrition diaries. When asked about events in the past 20 years, participants identified the 1997-98 El Niño as a major negative event. The El Niño disaster situation induced a decrease in access to transport and health care and the rise in infectious diseases was swiftly contained. Residents needed more time to rebuild housing; recover agriculture, livestock and income stability; and return to eating sufficient animal protein. Although large-scale assistance minimized effects of the disaster, residents needed more support. Residents' perspectives on their risk of flooding should be considered in generating effective assistance policies and programmes. © 2014 The Author(s). Disasters © Overseas Development Institute, 2014.

Attitudes of Nursing Facilities' Staff Toward Pharmacy Students' Interaction with its Residents.

PubMed

Adkins, Donna; Gavaza, Paul; Deel, Sharon

2017-06-01

All Appalachian College of Pharmacy second-year students undertake the longitudinal geriatric early pharmacy practice experiences (EPPE) 2 course, which involves interacting with geriatric residents in two nursing facilities over two semesters. The study investigated the nursing staff's perceptions about the rotation and the pharmacy students' interaction with nursing facility residents. Cross-sectional study. Academic setting. 63 nursing facility staff. A 10-item attitude survey administered to nursing staff. Nursing staff attitude toward pharmacy students' interaction with geriatric residents during the course. Sixty-three responses were received (84% response rate). Most respondents were female (95.2%), who occasionally interacted with pharmacy students (54.8%) and had worked at the facilities for an average of 6.8 years (standard deviation [SD] = 6.7) years. Staff reported that pharmacy students practiced interacting with geriatric residents and nursing facility staff, learned about different medications taken by residents as well as their life as a nursing facility resident. In addition, the student visits improved the mood of residents and staff's understanding of medicines, among others. Staff suggested that students spend more time with their residents in the facility as well as ask more questions of staff. The nursing facility staff generally had favorable attitudes about pharmacy students' visits in their nursing facility. Nursing facility staff noted that the geriatric rotation was a great learning experience for the pharmacy students.

Self-reporting of internal medicine house staff work hours.

PubMed

Saunders, David L; Kehoe, Kimberly C; Rinehart, Vivian H; Berg, Benjamin W

2005-01-01

The 80-hour workweek became a reality for residency programs nationwide on July 1, 2003. In this review of administrative data, we examine the self-reporting of work hours by a cohort of Internal Medicine residents. Data was collected from 27 residents in training at Tripler Army Medical Center over a 4 month period from September 1 to December 31 2002. House staff reported their hours on a daily basis by responding to an email message, as well as on a monthly basis utilizing the Army's UCAPERs (Uniform Chart of Account Personnel System) mandatory monthly workload tracking system. Data from the two separate reporting systems was compared for accuracy, completeness and internal consistency. Compliance with daily reporting was variable (67-97% with overall compliance rate of 86%) but lower when compared with the mandatory military monthly reporting system (95-100%). There were large differences in reporting of average weekly work hours among individual residents when monthly reporting was compared to daily reporting of data with higher averages with monthly data reporting. Weekly totals averaged nearly 12 hours higher when reported monthly compared to reporting on a daily basis (p < 0.0001). A total of 18 residents reported that they worked more than 80 hours per week during one month using monthly data, while only 7 reported that they averaged more than 80 hours with the daily reporting data. When average weekly hours reported on a daily basis were compared with the total number of inpatient days worked over the four month period using a simple regression model, there was a significant relationship with average hours increasing with increasing number of inpatient days worked (adjusted R square = 0. 19, p = 0.01). Little internal consistency was found in the comparison of daily versus monthly work hour reporting, indicating that self-reporting may not provide accurate data. Complying with the 80-hour workweek is crucial for residency programs to maintain accreditation, and thus programs will need a way to accurately capture consistent resident work hour data. Further studies are indicated to determine the most accurate way of assessing house staff work hours.

Emergency Medicine Resident Physicians’ Perceptions of Electronic Documentation and Workflow

PubMed Central

Neri, P.M.; Redden, L.; Poole, S.; Pozner, C.N.; Horsky, J.; Raja, A.S.; Poon, E.; Schiff, G.

2015-01-01

Summary Objective To understand emergency department (ED) physicians’ use of electronic documentation in order to identify usability and workflow considerations for the design of future ED information system (EDIS) physician documentation modules. Methods We invited emergency medicine resident physicians to participate in a mixed methods study using task analysis and qualitative interviews. Participants completed a simulated, standardized patient encounter in a medical simulation center while documenting in the test environment of a currently used EDIS. We recorded the time on task, type and sequence of tasks performed by the participants (including tasks performed in parallel). We then conducted semi-structured interviews with each participant. We analyzed these qualitative data using the constant comparative method to generate themes. Results Eight resident physicians participated. The simulation session averaged 17 minutes and participants spent 11 minutes on average on tasks that included electronic documentation. Participants performed tasks in parallel, such as history taking and electronic documentation. Five of the 8 participants performed a similar workflow sequence during the first part of the session while the remaining three used different workflows. Three themes characterize electronic documentation: (1) physicians report that location and timing of documentation varies based on patient acuity and workload, (2) physicians report a need for features that support improved efficiency; and (3) physicians like viewing available patient data but struggle with integration of the EDIS with other information sources. Conclusion We confirmed that physicians spend much of their time on documentation (65%) during an ED patient visit. Further, we found that resident physicians did not all use the same workflow and approach even when presented with an identical standardized patient scenario. Future EHR design should consider these varied workflows while trying to optimize efficiency, such as improving integration of clinical data. These findings should be tested quantitatively in a larger, representative study. PMID:25848411

The return of bedside rounds: an educational intervention.

PubMed

Gonzalo, Jed D; Chuang, Cynthia H; Huang, Grace; Smith, Christopher

2010-08-01

Bedside rounds have decreased in frequency on teaching services. Perceived barriers toward bedside rounds are inefficiency and patient and house staff lack of preference for this mode of rounding. To evaluate the impact of a bedside rounding intervention on the frequency of bedside rounding, duration of patient encounters and rounding sessions, and patient and resident attitudes toward bedside rounds. A pre- and postintervention design, with a bedside rounding workshop midway through two consecutive internal medicine rotations, with daily resident interviews, patient surveys, and an end-of-the-year survey given to all Medicine house staff. Medicine house staff and medicine patients. Frequency of bedside rounds, duration of new patient encounters and rounding sessions, and patient and house staff attitudes regarding bedside rounds. Forty-four residents completed the bedside rounding workshop. Comparing the preintervention and postintervention phases, bedside rounds increased from <1% to 41% (p < 0.001). The average duration of walk rounding encounters was 16 min, and average duration of bedside rounding encounters was 15 min (p = 0.42). Duration of rounds was 95 and 98 min, respectively (p = 0.52). Patients receiving bedside rounds preferred bedside rounds (99% vs. 83%, p = 0.03) and perceived more time spent at the bedside by their team (p < 0.001). One hundred twelve house staff (71%) responded, with 73% reporting that bedside rounds are better for patient care. House staff performing bedside rounds were less likely to believe that bedside rounds were more educational (53% vs. 78%, p = 0.01). Bedside rounding increased after an educational intervention, and the time to complete bedside rounding encounters was similar to alternative forms of rounding. Patients preferred bedside rounds and perceived more time spent at the bedside when receiving bedside rounds. Medicine residents performing bedside rounds were less likely to believe bedside rounds were more educational, but all house staff valued the importance of bedside rounding for the delivery of patient care.

The Return of Bedside Rounds: An Educational Intervention

PubMed Central

Gonzalo, Jed D.; Chuang, Cynthia H.; Huang, Grace

2010-01-01

Background Bedside rounds have decreased in frequency on teaching services. Perceived barriers toward bedside rounds are inefficiency and patient and house staff lack of preference for this mode of rounding. Objectives To evaluate the impact of a bedside rounding intervention on the frequency of bedside rounding, duration of patient encounters and rounding sessions, and patient and resident attitudes toward bedside rounds. Design A pre- and postintervention design, with a bedside rounding workshop midway through two consecutive internal medicine rotations, with daily resident interviews, patient surveys, and an end-of-the-year survey given to all Medicine house staff. Participants Medicine house staff and medicine patients. Measures Frequency of bedside rounds, duration of new patient encounters and rounding sessions, and patient and house staff attitudes regarding bedside rounds. Results Forty-four residents completed the bedside rounding workshop. Comparing the preintervention and postintervention phases, bedside rounds increased from <1% to 41% (p < 0.001). The average duration of walk rounding encounters was 16 min, and average duration of bedside rounding encounters was 15 min (p = 0.42). Duration of rounds was 95 and 98 min, respectively (p = 0.52). Patients receiving bedside rounds preferred bedside rounds (99% vs. 83%, p = 0.03) and perceived more time spent at the bedside by their team (p < 0.001). One hundred twelve house staff (71%) responded, with 73% reporting that bedside rounds are better for patient care. House staff performing bedside rounds were less likely to believe that bedside rounds were more educational (53% vs. 78%, p = 0.01). Conclusions Bedside rounding increased after an educational intervention, and the time to complete bedside rounding encounters was similar to alternative forms of rounding. Patients preferred bedside rounds and perceived more time spent at the bedside when receiving bedside rounds. Medicine residents performing bedside rounds were less likely to believe bedside rounds were more educational, but all house staff valued the importance of bedside rounding for the delivery of patient care. PMID:20386997

Interrelationships between romance, life quality, and medical training of female residents.

PubMed

Wang, Yu-Jung; Hsu, Kan-Lin; Chang, Chin-Sung; Wu, Chih-Hsing

2012-08-01

For the past 30 years, there has been a steady increase in the number of female physicians, but the relationship between their romantic lives and their pattern of training has been inadequately reported. This study was designed to investigate the interrelationships between medical training, quality of life, and the attitudes that female residents have toward romance. Of the 106 female medical residents at our medical center in 2009, a total of 78 residents (73.6%) were enrolled for the study. Structured questionnaires (Cronbach α = 0.878), which included questions about female resident quality of life, attitude toward spousal choice, and the impact of programmed professional medical training, were self-administered through an anonymous process. Female residents, especially ward-care specialists, were determined to have excessively long working hours (84.6% > 88 work hours/week), insufficient and irregular sleep (44.9%), and inadequate personal time (73.1% < 24 hours/week) on average. Of the 48 residents with ongoing romances, 87.5% (n = 40) of romantic partners were physicians and 58.3% (n = 28) initiated their relationships when they were medical students, but exhibited no preferential dating of senior medical students or physicians. Factors affecting the choice of spouses included time limitations, a limited circle of friends, differences in values, and work-related stress. Those presumptive factors influencing romance between the assumed partner being a doctor or a "nondoctor" were significantly different with regard to lack of time (p = 0.002), values (p < 0.001), work-related stress (p < 0.001), and family background (p = 0.004). Romance and quality of life were significantly influenced by the pattern of medical training in female residents. Setting duty-hour limits and initiating a new hobby were determined to be potentially beneficial to their quality of life and attitudes toward romance. Copyright © 2012. Published by Elsevier B.V.

A single-institution experience: the integrated vascular surgery residency's effect on fellowship and general surgery resident case volume and diversity.

PubMed

Carroll, Megan I; Downes, Kathryne; Miladinovic, Branko; Illig, Karl A; Armstrong, Paul A; Back, Martin R; Johnson, Brad L; Shames, Murray L

2014-01-01

To determine whether the formation of an integrated vascular surgery residency (0 + 5) has negatively impacted the case volume and diversity of the vascular surgery fellows (5 + 2) and chief general surgeons at the same institution. Operative data from the vascular integrated (0 + 5), independent (5 + 2), and general surgery residencies at a single institution were retrospectively reviewed and analyzed to determine vascular surgery case volumes from 2006-2012. National operative data (Residency Review Committee) were used for comparison of diversity and volume. Standard statistical methods were applied. During this period, the 5 + 2 fellows at our institution performed on average 741 (range, 554-1002) primary cases and 1091 (range, 844-1479) combined primary and secondary cases for the 2-year fellowship. Our integrated residency began in July 2007. Our fellows' primary case volumes remained relatively stable between 2006 and 2011, with a 4% increase in the number of cases, although their total (primary and secondary) case volumes fell 15%; by comparison, the equivalent national 50th percentile rates rose 16% during this time frame. Our institution's general surgery residents performed an average of 116 (range, 56-221) vascular cases individually during their 5-year residency from 2005-2011. From 2006-2011, the total case volume fell only 5%, while the national 50th percentile rate fell 24%. Across all years, however, resident and fellow volumes both continue to be above Accreditation Council for Graduate Medical Education minimum requirements, and the major vascular case volume at our institution in all groups studied remained statistically greater than or equal to the national 50th percentile of cases. Our first integrated resident to graduate finished in June 2012 with 931 total vascular cases and 249 general surgery cases for a total operative experience of 1180 cases during the 5-year residency. Finally, after an 8-year period (2003-2010) in which none of our general surgery residents pursued vascular training, 1 resident in each of the 2011, 2012, and 2013 graduating years has now done so. At our institution, the introduction of a 0 + 5 vascular residency has correlated with a modest drop (15%) in overall case volume for the 5 + 2 fellows, but the number of primary cases have actually increased slightly and they continue to meet or exceed Accreditation Council for Graduate Medical Education requirements and national 50th percentile rates. General surgery residents' vascular volumes, by contrast, have remained stable, and interest in vascular surgery by residents has increased. Our integrated vascular residents are projected to exceed the fellows' 50th percentile case volume and diversity targets during their residency experience. Copyright © 2014 Elsevier Inc. All rights reserved.

Surgical resident evaluations of portable laparoscopic box trainers incorporated into a simulation-based minimally invasive surgery curriculum.

PubMed

Zapf, Matthew A C; Ujiki, Michael B

2015-02-01

Box trainers have been shown to be an effective tool for teaching laparoscopic skills; however, residents are challenged to find practice time. Portable trainers theoretically allow for extended hands on practice out of the hospital. We aimed to report resident experience with laparoscopic home box trainers. Over 2 years, all residents rotating through a minimally invasive service were given a portable trainer and access to a surgical simulation lab for practice. Each trainer contained a collapsible frame, a webcam with USB port, trocars, and laparoscopic instruments (needle driver, shears, Maryland and straight dissecting graspers) as well as Fundamentals of Laparoscopic Surgery skills testing materials. Residents were asked to log hours, usages, and their experience anonymously. Twenty-three residents received a portable trainer. Fifty percent of the participants found the trainer useful or very useful, 25% said it was not useful, and 25% did not access the trainer. Those that used the trainer during their rotation did so 3.1 ± 3.0 times for 2.9 ± 3.0 hours/week. After completing their rotation, 5 of 12 residents used their trainer for an average of 10.2 ± 9.4 hours. Forty-two percent of the responders liked the accessibility of the home box trainers, while 25% criticized the camera-computer interface. Portable box trainers are useful and can effectively supplement a laboratory-based surgical simulation curriculum; however, personal possession of a portable simulator does not result in voluntarily long-term practice. © The Author(s) 2014.

Sleep education in pediatric residency programs: a cross-cultural look.

PubMed

Mindell, Jodi A; Bartle, Alex; Ahn, Youngmin; Ramamurthy, Mahesh Babu; Huong, Huynh Thi Duy; Kohyama, Jun; Li, Albert M; Ruangdaraganon, Nichara; Sekartini, Rini; Teng, Arthur; Goh, Daniel Y T

2013-04-03

The objective of this study was to assess the prevalence of education about sleep and sleep disorders in pediatric residency programs and to identify barriers to providing such education. Surveys were completed by directors of 152 pediatric residency programs across 10 countries (Hong Kong, India, Indonesia, Japan, Singapore, South Korea, Thailand, United States-Canada, and Vietnam). Overall, the average amount of time spent on sleep education is 4.4 hours (median = 2.0 hours), with 23% responding that their pediatric residency program provides no sleep education. Almost all programs (94.8%) offer less than 10 hours of instruction. The predominant topics covered include sleep-related development, as well as normal sleep, sleep-related breathing disorders, parasomnias, and behavioral insomnia of childhood. These results indicate that there is still a need for more efforts to include sleep-related education in all pediatric residency programs, as well as coverage of the breadth of sleep-related topics. Such education would be consistent with the increased recognition of the importance of sleep and under-diagnosis of sleep disorders in children and adolescents.

Implementing a Narrative Medicine Curriculum During the Internship Year: An Internal Medicine Residency Program Experience.

PubMed

Wesley, Tiffany; Hamer, Diana; Karam, George

2018-04-18

Narrative medicine develops professional and communication skills that align with Accreditation Council for Graduate Medical Education competencies. However, little is known about a narrative medicine curriculum's impact on physicians in training during residency. Implementing a narrative medicine curriculum during residency can be challenging because of time constraints and limited opportunity for nonclinical education. Six sessions were implemented throughout one academic year to expose first-year internal medicine residents (interns) to narrative medicine. Attendance and participation were documented. At the end of the year, interns completed an open-ended survey to gauge their perception of their experience with the sessions. In total, 17 interns attended at least 1 narrative medicine session, and each session averaged 5.4 attendees. Thirteen eligible interns completed the survey. Thematic analysis identified 3 predominant themes: Mindfulness, physician well-being, and professionalism. Overall, the narrative medicine sessions were well attended and the curriculum was well received. This intervention demonstrates the value of a narrative medicine curriculum during medical resident training. Large prospective studies are necessary to identify the long-term benefits of such a curriculum.

Sleep education in pediatric residency programs: a cross-cultural look

PubMed Central

2013-01-01

Background The objective of this study was to assess the prevalence of education about sleep and sleep disorders in pediatric residency programs and to identify barriers to providing such education. Methods Surveys were completed by directors of 152 pediatric residency programs across 10 countries (Hong Kong, India, Indonesia, Japan, Singapore, South Korea, Thailand, United States-Canada, and Vietnam). Results Overall, the average amount of time spent on sleep education is 4.4 hours (median = 2.0 hours), with 23% responding that their pediatric residency program provides no sleep education. Almost all programs (94.8%) offer less than 10 hours of instruction. The predominant topics covered include sleep-related development, as well as normal sleep, sleep-related breathing disorders, parasomnias, and behavioral insomnia of childhood. Conclusions These results indicate that there is still a need for more efforts to include sleep-related education in all pediatric residency programs, as well as coverage of the breadth of sleep-related topics. Such education would be consistent with the increased recognition of the importance of sleep and under-diagnosis of sleep disorders in children and adolescents. PMID:23552445

Partial migration: growth varies between resident and migratory fish.

PubMed

Gillanders, Bronwyn M; Izzo, Christopher; Doubleday, Zoë A; Ye, Qifeng

2015-03-01

Partial migration occurs in many taxa and ecosystems and may confer survival benefits. Here, we use otolith chemistry data to determine whether fish from a large estuarine system were resident or migratory, and then examine whether contingents display differences in modelled growth based on changes in width of otolith growth increments. Sixty-three per cent of fish were resident based on Ba : Ca of otoliths, with the remainder categorized as migratory, with both contingents distributed across most age/size classes and both sexes, suggesting population-level bet hedging. Migrant fish were in slightly better condition than resident fish based on Fulton's K condition index. Migration type (resident versus migratory) was 56 times more likely to explain variation in growth than a model just incorporating year- and age-related growth trends. While average growth only varied slightly between resident and migratory fish, year-to-year variation was significant. Such dynamism in growth rates likely drives persistence of both life-history types. The complex relationships in growth between contingents suggest that management of species exhibiting partial migration is challenging, especially in a world subject to a changing climate. © 2015 The Author(s) Published by the Royal Society. All rights reserved.

Assessment of a Novel Point-of-Care Ultrasound Curriculum's Effect on Competency Measures in Family Medicine Graduate Medical Education.

PubMed

Bornemann, Paul

2017-06-01

Point-of-care ultrasound has been shown to decrease the use of expensive diagnostic studies and improve quality outcome measures. Currently, there is a large desire for training in family medicine residencies, but very few programs have established curricula. We sought to develop a family medicine residency curriculum and evaluate it with tools we developed. We wanted our curriculum to be easy to adopt by other residency programs, even if they did not have many well-trained ultrasound faculty. We developed a curriculum in the form of a 4-week rotation in a family medicine residency program. It consisted of self-study videos, hands-on training, and image review. We followed residents in postgraduate years 1 to 3 over a 12-month period. We developed tools, including a knowledge exam, to test image interpretation and clinical decision making, an observed structured clinical exam to assess scanning skills, and a survey to assess perceptions of point-of-care ultrasound in family medicine. The assessments were administered before and after each resident's rotation. Seventeen residents completed the rotation. The average knowledge test score improved significantly, from 62 to 84%. The average observed structured clinical exam scores also improved significantly, from 41 to 85%. The average perception survey scores improved slightly from 4.4 to 4.6. We developed a point-of-care ultrasound curriculum for family medicine residency programs that improves measures of resident attitude, skills, and knowledge. This curriculum can be adopted by residency programs with few faculty members who are experienced in ultrasound. © 2017 by the American Institute of Ultrasound in Medicine.

Competency Assessment in Family Medicine Residency: Observations, Knowledge-Based Examinations, and Advancement.

PubMed

Mainous, Arch G; Fang, Bo; Peterson, Lars E

2017-12-01

The Family Medicine (FM) Milestones are competency-based assessments of residents in key dimensions relevant to practice in the specialty. Residency programs use the milestones in semiannual reviews of resident performance from the time of entry into the program to graduation. Using a national sample, we investigated the relationship of FM competency-based assessments to resident progress and the complementarity of milestones with knowledge-based assessments in FM residencies. We used midyear and end-of-year milestone ratings for all FM residents in Accreditation Council for Graduate Medical Education-accredited programs during academic years 2014-2015 and 2015-2016. The milestones contain 22 items across 6 competencies. We created a summative index across the milestones. The American Board of Family Medicine database provided resident demographics and in-training examination (ITE) scores. We linked information to the milestone data. The sample encompassed 6630 FM residents. The summative milestone index increased, on average, for each cohort (postgraduate year 1 [PGY-1] to PGY-2 and PGY-2 to PGY-3) at each assessment. The correlation between the milestone index that excluded the medical knowledge milestone and ITE scores was r  = .195 ( P  < .001) for PGY-1 to PGY-2 cohort and r  = .254 ( P  < .001) for PGY-2 to PGY-3 cohort. For both cohorts, ITE scores and composite milestone assessments were higher for residents who advanced than for those who did not. Competency-based assessment using the milestones for FM residents seems to be a viable multidimensional tool to assess the successful progression of residents.

Competency Assessment in Senior Emergency Medicine Residents for Core Ultrasound Skills.

PubMed

Schmidt, Jessica N; Kendall, John; Smalley, Courtney

2015-11-01

Quality resident education in point-of-care ultrasound (POC US) is becoming increasingly important in emergency medicine (EM); however, the best methods to evaluate competency in graduating residents has not been established. We sought to design and implement a rigorous assessment of image acquisition and interpretation in POC US in a cohort of graduating residents at our institution. We evaluated nine senior residents in both image acquisition and image interpretation for five core US skills (focused assessment with sonography for trauma (FAST), aorta, echocardiogram (ECHO), pelvic, central line placement). Image acquisition, using an observed clinical skills exam (OSCE) directed assessment with a standardized patient model. Image interpretation was measured with a multiple-choice exam including normal and pathologic images. Residents performed well on image acquisition for core skills with an average score of 85.7% for core skills and 74% including advanced skills (ovaries, advanced ECHO, advanced aorta). Residents scored well but slightly lower on image interpretation with an average score of 76%. Senior residents performed well on core POC US skills as evaluated with a rigorous assessment tool. This tool may be developed further for other EM programs to use for graduating resident evaluation.

Groundwater flowpaths and residence times inferred by 14C, 36Cl and 4He isotopes in the Continental Intercalaire aquifer (North-Western Africa)

NASA Astrophysics Data System (ADS)

Petersen, J. O.; Deschamps, P.; Hamelin, B.; Fourré, E.; Gonçalvès, J.; Zouari, K.; Guendouz, A.; Michelot, J.-L.; Massault, M.; Dapoigny, A.; ASTER Team

2018-05-01

In a semi-arid to arid climate context, dependency on groundwater resources may lead to overexploitation and deterioration of water quality. The Continental Intercalaire (CI) aquifer is one such continental-scale aquifer (more than a million of km2), which is mainly confined, poorly recharged but intensely abstracted. To date, the management of this resource relies on hydrogeological modelling and key parameters such as recharge/discharge rate and groundwater dynamics. We use a combination of residence time indicators (14C, 36Cl, 4He) and stable isotopes of water (2H and 18O) to give greater constraint on the groundwater residence time in the CI. In previous studies, 14C measurements and steady state modelling indicate a residence time of less than 100 ka whereas in others, 36Cl measurements and transient scenarios modelling suggest a longer residence time (>500 ka). In this study, most of the 14C measurements are below the limit of detection, establishing residence times greater than 40 ka and confirming the necessity of strict sampling protocols to exclude all air and AMS measurements when low 14C concentrations are expected. In the Tunisian recharge area, detectable 14C indicate sporadic recharge episodes (3-7 ka and 29-43 ka), whereas 4He and 36Cl concentrations in central areas suggest very old (<2 Ma) groundwaters. In these central areas, chlorine concentration can reach more than 2 g/l. Since 36Cl concentrations are up to 4 time less than the initial input, we are confident there is no excessive deep 36Cl production. We characterise five distinct flowpaths reaching the Tunisian discharge area using their isotopic signatures. According to our mixing model, the average contribution from the main recharge area, the Algerian Atlas Mountains, is around 88%. This value is close to hydrogeological models. Conversely, the contribution from the Dahar Mountains is lower than in the hydrogeological modelling (2% against 10%) whereas the Tinhert shows a greater contribution (10% against 1%). Increase of abstraction from the CI can potentially activate the circulation of old brackish groundwaters and dramatically decrease the water quality in the whole system.

A 360 degrees evaluation of a night-float system for general surgery: a response to mandated work-hours reduction.

PubMed

Goldstein, Michael J; Kim, Eugene; Widmann, Warren D; Hardy, Mark A

2004-01-01

New York State Code 405 and societal/political pressure have led the RRC and ACGME to mandate strict limitations on resident work hours. In an attempt to meet these limitations, we have switched from the previous Q3 call schedule to a specialized night float (NF) system, the continuity-care system (CCS). The purpose of this CCS is to maximize resident duty time spent on direct patient care, operative experience, and outpatient clinics, while reducing duty hours spent on performing routine tasks and call coverage. The implementation of the CCS is the fundamental step in the restructuring of our residency program. In addition to a change in the call system, we added physician assistants to aid in performing some service tasks. We performed a 360 degrees evaluation of this work in progress. In May 2002, the standard Q3 call system was abolished on the general surgery services at the New York Presbyterian Hospital, Columbia campus. Two dedicated teams were created to provide day and night coverage, a day continuity-care team (DCT) and a night continuity-care team (NCT). The DCTs, consisting of PGY1-5 residents, provide daily in-house coverage from 6 AM to 5 PM with no regular weekday night-call responsibilities. The DCT residents provide Friday night, Saturday, and daytime Sunday call coverage 3 to 4 days per month. The NCT, consisting of 5 PGY1-5 residents, provides nightly continuous care, 5 PM to 6 AM, Sunday through Thursday, with no other weekend call responsibilities. This system creates a schedule with less than 80 duty hours per week, on average, with one 24-hour period off a week, one complete weekend off per month, and no more than 24 hours of consecutive duty time. After 1 year of use, the system was evaluated by a 360 degrees method in which residents, residents' spouses, nurses, and faculty were surveyed using a Likert-type scale. Statistical significance was calculated using the Student t-test. Patient satisfaction was measured both by internal review of a patient complaint database as well as by the Press Ganey patient satisfaction surveys. Twenty-one residents, 10 residents' spouses, 11 general surgery faculty, and 16 nurses were surveyed. Statistically significant findings included reduced resident fatigue noted by all groups (residents, p = 0.01; resident spouses, p = 0.05; faculty, p < 0.0001; nurses, p < 0.0001). Further, residents reported more time for sleep at home (p = 0.0005) and more time for independent reading (p = 0.01). Residents' spouses reported increased availability for family events (p = 0.01). Nurses reported increased availability of residents (p = 0.0002), shorter times to physician identification of patient problems (p = 0.0086), improved resident-nursing communications (p = 0.0096), and increased ease of nursing duties (p < 0.0001). Faculty were the only responders who felt that continuity of patient care suffered with the new system (p = 0.02). The Press Ganey review showed improvement in the quality of care rendered as perceived by patients. The institution of a specialized NF or CCS for in-house coverage of general surgical services in a large metropolitan university hospital has had initial success in meeting the mandated changes in resident work hours. The CCS reduced resident fatigue, improved quality of resident life, and improved patient care as judged by patients and nurse.

Residential traffic density and childhood leukemia risk.

PubMed

Von Behren, Julie; Reynolds, Peggy; Gunier, Robert B; Rull, Rudolph P; Hertz, Andrew; Urayama, Kevin Y; Kronish, Daniel; Buffler, Patricia A

2008-09-01

Exposures to carcinogenic compounds from vehicle exhaust may increase childhood leukemia risk, and the timing of this exposure may be important. We examined the association between traffic density and childhood leukemia risk for three time periods: birth, time of diagnosis, and lifetime average, based on complete residential history in a case-control study. Cases were rapidly ascertained from participating hospitals in northern and central California between 1995 and 2002. Controls were selected from birth records, individually matched on age, sex, race, and Hispanic ethnicity. Traffic density was calculated by estimating total vehicle miles traveled per square mile within a 500-foot (152 meter) radius area around each address. We used conditional logistic regression analyses to account for matching factors and to adjust for household income. We included 310 cases of acute lymphocytic leukemias (ALL) and 396 controls in our analysis. The odds ratio for ALL and residential traffic density above the 75th percentile, compared with subjects with zero traffic density, was 1.17 [95% confidence interval (95% CI), 0.76-1.81] for residence at diagnosis and 1.11 (95% CI, 0.70-1.78) for the residence at birth. For average lifetime traffic density, the odds ratio was 1.24 (95% CI, 0.74-2.08) for the highest exposure category. Living in areas of high traffic density during any of the exposure time periods was not associated with increased risk of childhood ALL in this study.

Geographic disparities in patient travel for dialysis in the United States.

PubMed

Stephens, J Mark; Brotherton, Samuel; Dunning, Stephan C; Emerson, Larry C; Gilbertson, David T; Harrison, David J; Kochevar, John J; McClellan, Ann C; McClellan, William M; Wan, Shaowei; Gitlin, Matthew

2013-01-01

To estimate travel distance and time for US hemodialysis patients and to compare travel of rural versus urban patients. Dialysis patient residences were estimated from ZIP code-level patient counts as of February 2011 allocated within the ZIP code proportional to census tract-level population, obtained from the 2010 U.S. Census. Dialysis facility addresses were obtained from Medicare public-use files. Patients were assigned to an "original" and "replacement" facility, assuming patients used the facility closest to home and would select the next closest facility as a replacement, if a replacement facility was required. Driving distances and times were calculated between patient residences and facility locations using GIS software. The mean one-way driving distance to the original facility was 7.9 miles; for rural patients average distances were 2.5 times farther than for urban patients (15.9 vs. 6.2 miles). Mean driving distance to a replacement facility was 10.6 miles, with rural patients traveling on average 4 times farther than urban patients to a replacement facility (28.8 vs. 6.8 miles). Rural patients travel much longer distances for dialysis than urban patients. Accessing alternative facilities, if required, would greatly increase rural patient travel, while having little impact on urban patients. Increased travel could have clinical implications as longer travel is associated with increased mortality and decreased quality of life. © 2013 National Rural Health Association.

A Prospective Multicenter Evaluation of the Value of the On-Call Orthopedic Resident.

PubMed

Jackson, J Benjamin; Vincent, Scott; Davies, James; Phelps, Kevin; Cornett, Chris; Grabowski, Greg; Scannell, Brian; Stotts, Alan; Bice, Miranda

2018-02-01

Funding for graduate medical education is at risk despite the services provided by residents. We quantified the potential monetary value of services provided by on-call orthopedic surgery residents. We conducted a prospective, cross-sectional, multicenter cohort study design. Over a 90-day period in 2014, we collected data on consults by on-call orthopedic surgery residents at 4 tertiary academic medical centers in the United States. All inpatient and emergency department consults evaluated by first-call residents during the study period were eligible for inclusion. Based on their current procedural terminology codes, procedures and evaluations for each consult were assigned a relative value unit and converted into a monetary value to determine the value of services provided by residents. The primary outcome measures were the total dollar value of each consult and the percentage of resident salaries that could be funded by the generated value of the resident consult services. In total, 2644 consults seen by 33 residents from the 4 institutions were included for analysis. These yielded an average value of $81,868 per center for the 90-day study period, that is, $327,471 annually. With a median resident stipend of $53,992, the extrapolated average percentage of resident stipends that could be funded by these consult revenues was 73% of the stipends of the residents who took call or 36% of the stipends of the overall resident cohort. The potential monetary value generated by on-call orthopedic surgery residents is substantial.

Western Screech-Owl (Megascops kennicottii)

Treesearch

Frederick R. Gehlbach; Scott H. Stoleson

2010-01-01

The Western Screech-Owl (Megascops kennicottii) is a permanent resident and the largest of New Mexico's eight small owls. At an average 116 g (4.1 oz), it is 1.3 times more massive than the Whiskered Screech-Owl (M. trichopsis) but similar to the Eastern Screech-Owl (M. asio), the state's other two small owls with dark-streaked, white-flecked gray plumage...

Opportunities for promoting youth physical activity: an examination of youth summer camps.

PubMed

Hickerson, Benjamin D; Henderson, Karla A

2014-01-01

Youth summer camp programs have the potential to provide opportunities for physical activity, but little to no research has been conducted to determine activity levels of campers. This study aimed to examine physical activity occurring in day and resident summer camps and how activity levels differed in these camps based upon demographic characteristics. Pedometer data were collected during hours of camp operation from 150 day campers and 114 resident campers between the ages of 8 and 12 years old. Independent t tests were used to compare physical activity by sex, race, and Body Mass Index. Campers at day camps averaged 11,916 steps per camp day, while resident campers averaged 19,699 steps per camp day. Day campers averaged 1586 steps per hour over 7.5 hour days and resident campers averaged 1515 steps per hour over 13 hour days. Male sex, Caucasian race, and normal Body Mass Index were significant correlates of more physical activity. Youth summer camps demonstrate the potential to provide ample opportunities for physical activity during the summer months. Traditional demographic disparities persisted in camps, but the structure of camp programs should allow for changes to increase physical activity for all participants.

A review of radioactive isotopes and other residence time tracers in understanding groundwater recharge: Possibilities, challenges, and limitations

NASA Astrophysics Data System (ADS)

Cartwright, Ian; Cendón, Dioni; Currell, Matthew; Meredith, Karina

2017-12-01

Documenting the location and magnitude of groundwater recharge is critical for understanding groundwater flow systems. Radioactive tracers, notably 14C, 3H, 36Cl, and the noble gases, together with other tracers whose concentrations vary over time, such as the chlorofluorocarbons or sulfur hexafluoride, are commonly used to estimate recharge rates. This review discusses some of the advantages and problems of using these tracers to estimate recharge rates. The suite of tracers allows recharge to be estimated over timescales ranging from a few years to several hundred thousand years, which allows both the long-term and modern behaviour of groundwater systems to be documented. All tracers record mean residence times and mean recharge rates rather than a specific age and date of recharge. The timescale over which recharge rates are averaged increases with the mean residence time. This is an advantage in providing representative recharge rates but presents a problem in comparing recharge rates derived from these tracers with those from other techniques, such as water table fluctuations or lysimeters. In addition to issues relating to the sampling and interpretation of specific tracers, macroscopic dispersion and mixing in groundwater flow systems limit how precisely groundwater residence times and recharge rates may be estimated. Additionally, many recharge studies have utilised existing infrastructure that may not be ideal for this purpose (e.g., wells with long screens that sample groundwater several kilometres from the recharge area). Ideal recharge studies would collect sufficient information to optimise the use of specific tracers and minimise the problems of mixing and dispersion.

Demographics, Interests, and Quality of Life of Canadian Neurosurgery Residents.

PubMed

Iorio-Morin, Christian; Ahmed, Syed Uzair; Bigder, Mark; Dakson, Ayoub; Elliott, Cameron; Guha, Daipayan; Kameda-Smith, Michelle; Lavergne, Pascal; Makarenko, Serge; Taccone, Michael S; Tso, Michael K; Wang, Bill; Winkler-Schwartz, Alexander; Fortin, David

2018-03-01

Neurosurgical residents face a unique combination of challenges, including long duty hours, technically challenging cases, and uncertain employment prospects. We sought to assess the demographics, interests, career goals, self-rated happiness, and overall well-being of Canadian neurosurgery residents. A cross-sectional survey was developed and sent through the Canadian Neurosurgery Research Collaborative to every resident enrolled in a Canadian neurosurgery program as of April 1, 2016. We analyzed 76 completed surveys of 146 eligible residents (52% response rate). The median age was 29 years, with 76% of respondents being males. The most popular subspecialties of interest for fellowship were spine, oncology, and open vascular neurosurgery. The most frequent self-reported number of worked hours per week was the 80- to 89-hour range. The majority of respondents reported a high level of happiness as well as stress. Sense of accomplishment and fatigue were reported as average to high and overall quality of life was low for 19%, average for 49%, and high for 32%. Satisfaction with work-life balance was average for 44% of respondents and was the only tested domain in which significant dissatisfaction was identified (18%). Overall, respondents were highly satisfied with their choice of specialty, choice of program, surgical exposure, and work environment; however, intimidation was reported in 36% of respondents and depression by 17%. Despite a challenging residency and high workload, the majority of Canadian neurosurgery residents are happy and satisfied with their choice of specialty and program. However, work-life balance, employability, resident intimidation, and depression were identified as areas of active concern.

Online vs live methods for teaching difficult airway management to anesthesiology residents.

PubMed

Bello, Giuseppe; Pennisi, Mariano Alberto; Maviglia, Riccardo; Maggiore, Salvatore Maurizio; Bocci, Maria Grazia; Montini, Luca; Antonelli, Massimo

2005-04-01

To compare the effectiveness of traditional and online teaching methods for educating anesthesiology residents in the principles and practice of difficult airway management. Prospective, randomized, controlled trial. University hospital. Two randomly selected groups, each containing 28 physicians enrolled from among residents in Anesthesiology and Intensive Care Medicine in Italy. Residents in Group 1 took a traditional 5-h course on the principles and practice of airway management, which included lectures, slide projection, and dummy demonstrations. The same material was presented to Group 2 in an exclusively online format, which could be individually accessed for a period of 36 h. In the online course, student-instructor interaction was provided through threaded discussion forums during three 30-min real-time question-and-answer sessions. Differences in baseline and post-course scores on written tests and practical skills tests were measured. Knowledge gains in Group 2 were slightly, but not significantly, greater compared with Group 1 both in written (P=0.228) and practical skills (P=0.376) tests. Semi-quantitative ratings of learner satisfaction were significantly higher in the online group (P=0.014). Almost all online students (93%) were logged in for at least 45 of the 90 min of real-time question-and-answer sessions. The four instructors spent an average of 144+/-10 min preparing answers and interacting with online students. Online teaching formats may be a valid alternative for teaching residents the principles and practice of difficult airway management. Interaction with instructors seems to be an important element, but it may require substantial time commitments by instructors.

Comparative-Effectiveness of Simulation-Based Deliberate Practice Versus Self-Guided Practice on Resident Anesthesiologists' Acquisition of Ultrasound-Guided Regional Anesthesia Skills.

PubMed

Udani, Ankeet Deepak; Harrison, T Kyle; Mariano, Edward R; Derby, Ryan; Kan, Jack; Ganaway, Toni; Shum, Cynthia; Gaba, David M; Tanaka, Pedro; Kou, Alex; Howard, Steven K

2016-01-01

Simulation-based education strategies to teach regional anesthesia have been described, but their efficacy largely has been assumed. We designed this study to determine whether residents trained using the simulation-based strategy of deliberate practice show greater improvement of ultrasound-guided regional anesthesia (UGRA) skills than residents trained using self-guided practice in simulation. Anesthesiology residents new to UGRA were randomized to participate in either simulation-based deliberate practice (intervention) or self-guided practice (control). Participants were recorded and assessed while performing simulated peripheral nerve blocks at baseline, immediately after the experimental condition, and 3 months after enrollment. Subject performance was scored from video by 2 blinded reviewers using a composite tool. The amount of time each participant spent in deliberate or self-guided practice was recorded. Twenty-eight participants completed the study. Both groups showed within-group improvement from baseline scores immediately after the curriculum and 3 months following study enrollment. There was no difference between groups in changed composite scores immediately after the curriculum (P = 0.461) and 3 months following study enrollment (P = 0.927) from baseline. The average time in minutes that subjects spent in simulation practice was 6.8 minutes for the control group compared with 48.5 minutes for the intervention group (P < 0.001). In this comparative effectiveness study, there was no difference in acquisition and retention of skills in UGRA for novice residents taught by either simulation-based deliberate practice or self-guided practice. Both methods increased skill from baseline; however, self-guided practice required less time and faculty resources.

Size- and shape-dependent effects of microplastic particles on adult daggerblade grass shrimp (Palaemonetes pugio).

PubMed

Gray, Austin D; Weinstein, John E

2017-11-01

The incidence of microplastics in marine environments has been increasing over the past several decades. The objective of the present study was to characterize the size- and shape-dependent effects of microplastic particles (spheres, fibers, and fragments) on the adult daggerblade grass shrimp (Palaemonetes pugio). Grass shrimp were exposed to 11 sizes of plastic: spheres (30, 35, 59, 75, 83, 116, and 165 μm), fragments (34 and 93 μm), and fibers (34 and 93 μm) at a concentration of 2000 particles/400 mL (= 50 000 particles/L) for 3 h. Following exposure, grass shrimp were monitored for survival, ingested and ventilated microplastics, and residence time. Mortality ranged from 0% to 55%. Spheres and fragments <50 μm were not acutely toxic. Mortality rates in experiments with spheres and fragments >50 μm ranged from 5% to 40%. Mortality was significantly higher in the exposure to 93-μm fibers than other sizes tested (p < 0.001). The shape of the particle had a significant influence on the number of particles ingested by the shrimp (p < 0.001). The residence time of particles in the gut ranged from 27 to 75 h, with an average of 43.0 ± 13.8 h. Within the gills, the residence time ranged from 27 to 45 h, with an average of 36.9 ± 5.4 h. The results suggest that microplastic particles of various sizes and shapes can be ingested and ventilated by adult daggerblade grass shrimp, resulting in acute toxicity. Environ Toxicol Chem 2017;36:3074-3080. © 2017 SETAC. © 2017 SETAC.

Quantifying riverine and storm-surge flood risk by single-family residence: application to Texas.

PubMed

Czajkowski, Jeffrey; Kunreuther, Howard; Michel-Kerjan, Erwann

2013-12-01

The development of catastrophe models in recent years allows for assessment of the flood hazard much more effectively than when the federally run National Flood Insurance Program (NFIP) was created in 1968. We propose and then demonstrate a methodological approach to determine pure premiums based on the entire distribution of possible flood events. We apply hazard, exposure, and vulnerability analyses to a sample of 300,000 single-family residences in two counties in Texas (Travis and Galveston) using state-of-the-art flood catastrophe models. Even in zones of similar flood risk classification by FEMA there is substantial variation in exposure between coastal and inland flood risk. For instance, homes in the designated moderate-risk X500/B zones in Galveston are exposed to a flood risk on average 2.5 times greater than residences in X500/B zones in Travis. The results also show very similar average annual loss (corrected for exposure) for a number of residences despite their being in different FEMA flood zones. We also find significant storm-surge exposure outside of the FEMA designated storm-surge risk zones. Taken together these findings highlight the importance of a microanalysis of flood exposure. The process of aggregating risk at a flood zone level-as currently undertaken by FEMA-provides a false sense of uniformity. As our analysis indicates, the technology to delineate the flood risks exists today. © 2013 Society for Risk Analysis.

Use of Team-Based Learning Pedagogy for Internal Medicine Ambulatory Resident Teaching.

PubMed

Balwan, Sandy; Fornari, Alice; DiMarzio, Paola; Verbsky, Jennifer; Pekmezaris, Renee; Stein, Joanna; Chaudhry, Saima

2015-12-01

Team-based learning (TBL) is used in undergraduate medical education to facilitate higher-order content learning, promote learner engagement and collaboration, and foster positive learner attitudes. There is a paucity of data on the use of TBL in graduate medical education. Our aim was to assess resident engagement, learning, and faculty/resident satisfaction with TBL in internal medicine residency ambulatory education. Survey and nominal group technique methodologies were used to assess learner engagement and faculty/resident satisfaction. We assessed medical learning using individual (IRAT) and group (GRAT) readiness assurance tests. Residents (N = 111) involved in TBL sessions reported contributing to group discussions and actively discussing the subject material with other residents. Faculty echoed similar responses, and residents and faculty reported a preference for future teaching sessions to be offered using the TBL pedagogy. The average GRAT score was significantly higher than the average IRAT score by 22%. Feedback from our nominal group technique rank ordered the following TBL strengths by both residents and faculty: (1) interactive format, (2) content of sessions, and (3) competitive nature of sessions. We successfully implemented TBL pedagogy in the internal medicine ambulatory residency curriculum, with learning focused on the care of patients in the ambulatory setting. TBL resulted in active resident engagement, facilitated group learning, and increased satisfaction by residents and faculty. To our knowledge this is the first study that implemented a TBL program in an internal medicine residency curriculum.

Knee, Shoulder, and Fundamentals of Arthroscopic Surgery Training: Validation of a Virtual Arthroscopy Simulator.

PubMed

Tofte, Josef N; Westerlind, Brian O; Martin, Kevin D; Guetschow, Brian L; Uribe-Echevarria, Bastián; Rungprai, Chamnanni; Phisitkul, Phinit

2017-03-01

To validate the knee, shoulder, and virtual Fundamentals of Arthroscopic Training (FAST) modules on a virtual arthroscopy simulator via correlations with arthroscopy case experience and postgraduate year. Orthopaedic residents and faculty from one institution performed a standardized sequence of knee, shoulder, and FAST modules to evaluate baseline arthroscopy skills. Total operation time, camera path length, and composite total score (metric derived from multiple simulator measurements) were compared with case experience and postgraduate level. Values reported are Pearson r; alpha = 0.05. 35 orthopaedic residents (6 per postgraduate year), 2 fellows, and 3 faculty members (2 sports, 1 foot and ankle), including 30 male and 5 female residents, were voluntarily enrolled March to June 2015. Knee: training year correlated significantly with year-averaged knee composite score, r = 0.92, P = .004, 95% confidence interval (CI) = 0.84, 0.96; operation time, r = -0.92, P = .004, 95% CI = -0.96, -0.84; and camera path length, r = -0.97, P = .0004, 95% CI = -0.98, -0.93. Knee arthroscopy case experience correlated significantly with composite score, r = 0.58, P = .0008, 95% CI = 0.27, 0.77; operation time, r = -0.54, P = .002, 95% CI = -0.75, -0.22; and camera path length, r = -0.62, P = .0003, 95% CI = -0.8, -0.33. Shoulder: training year correlated strongly with average shoulder composite score, r = 0.90, P = .006, 95% CI = 0.81, 0.95; operation time, r = -0.94, P = .001, 95% CI = -0.97, -0.89; and camera path length, r = -0.89, P = .007, 95% CI = -0.95, -0.80. Shoulder arthroscopy case experience correlated significantly with average composite score, r = 0.52, P = .003, 95% CI = 0.2, 0.74; strongly with operation time, r = -0.62, P = .0002, 95% CI = -0.8, -0.33; and camera path length, r = -0.37, P = .044, 95% CI = -0.64, -0.01, by training year. FAST: training year correlated significantly with 3 combined FAST activity average composite scores, r = 0.81, P = .0279, 95% CI = 0.65, 0.90; operation times, r = -0.86, P = .012, 95% CI = -0.93, -0.74; and camera path lengths, r = -0.85, P = .015, 95% CI = -0.92, -0.72. Total arthroscopy cases performed did not correlate significantly with overall FAST performance. We found significant correlations between both training year and knee and shoulder arthroscopy experience when compared with performance as measured by composite score, camera path length, and operation time during a simulated diagnostic knee and shoulder arthroscopy, respectively. Three FAST activities demonstrated significant correlations with training year but not arthroscopy case experience as measured by composite score, camera path length, and operation time. We attempt to validate an arthroscopy simulator that could be used to supplement arthroscopy skills training for orthopaedic residents. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

The effects of fatigue on robotic surgical skill training in Urology residents.

PubMed

Mark, James R; Kelly, Douglas C; Trabulsi, Edouard J; Shenot, Patrick J; Lallas, Costas D

2014-09-01

This study reports on the effect of fatigue on Urology residents using the daVinci surgical skills simulator (dVSS). Seven Urology residents performed a series of selected exercises on the dVSS while pre-call and post-call. Prior to dVSS performance a survey of subjective fatigue was taken and residents were tested with the Epworth Sleepiness Scale (ESS). Using the metrics available in the dVSS software, the performance of each resident was evaluated. The Urology residents slept an average of 4.07 h (range 2.5-6 h) while on call compared to an average of 5.43 h while not on call (range 3-7 h, p = 0.08). Post-call residents were significantly more likely to be identified as fatigued by the Epworth Sleepiness Score than pre-call residents (p = 0.01). Significant differences were observed in fatigued residents performing the exercises, Tubes and Match Board 2 (p = 0.05, 0.02). Additionally, there were significant differences in the total number of critical errors during the training session (9.29 vs. 3.14, p = 0.04). Fatigue in post-call Urology residents leads to poorer performance on the dVSS simulator. The dVSS may become a useful instrument in the education of fatigued residents and a tool to identify fatigue in trainees.

Optimal bounds and extremal trajectories for time averages in dynamical systems

NASA Astrophysics Data System (ADS)

Tobasco, Ian; Goluskin, David; Doering, Charles

2017-11-01

For systems governed by differential equations it is natural to seek extremal solution trajectories, maximizing or minimizing the long-time average of a given quantity of interest. A priori bounds on optima can be proved by constructing auxiliary functions satisfying certain point-wise inequalities, the verification of which does not require solving the underlying equations. We prove that for any bounded autonomous ODE, the problems of finding extremal trajectories on the one hand and optimal auxiliary functions on the other are strongly dual in the sense of convex duality. As a result, auxiliary functions provide arbitrarily sharp bounds on optimal time averages. Furthermore, nearly optimal auxiliary functions provide volumes in phase space where maximal and nearly maximal trajectories must lie. For polynomial systems, such functions can be constructed by semidefinite programming. We illustrate these ideas using the Lorenz system, producing explicit volumes in phase space where extremal trajectories are guaranteed to reside. Supported by NSF Award DMS-1515161, Van Loo Postdoctoral Fellowships, and the John Simon Guggenheim Foundation.

Benchmarks for Support and Outcomes for Internal Medicine-Pediatrics Residency Programs: A 5-Year Review.

PubMed

Aronica, Michael; Williams, Ronald; Dennar, Princess E; Hopkins, Robert H

2015-12-01

Combined internal medicine and pediatrics (medicine-pediatrics) residencies were Accreditation Council for Graduate Medical Education (ACGME) accredited separately from their corresponding categorical residencies in June 2006. We investigated how ACGME accreditation of medicine-pediatrics programs has affected the levels of support (both financial and personnel), the National Resident Matching Program (NRMP) match rate, performance on the board examination, and other graduate outcomes. From 2009 through 2013 we sent an annual SurveyMonkey online survey to members of the Medicine-Pediatrics Program Directors Association. Questions pertained to program characteristics, program director support, recruitment, ambulatory training, and graduate data. More than 79% of responders completed the entire survey for each year (sample size was 60 program directors). Compared to the time prior to accreditation of the specialty, there was an increase in program directors who are dually trained (89% versus 93%), an increase in program director salary ($134,000 before accreditation versus $185,000 in 2013, P < .05), and an increase in the average full-time equivalent support (0.32 before accreditation versus 0.42 in 2013, P < .05). There was also an increase in programs with associate program directors (35% versus 78%), programs with chief residents (71% versus 91%), and an increase in program budgets controlled by program directors (52% versus 69%). The 2013 NRMP match rates increased compared to those of 2005 (99% versus 49%). Performance on the American Board of Pediatrics examination was comparable to that for pediatrics residents. Since accreditation, a larger number of residents are choosing careers in hospital medicine. Our data show widespread improved support for medicine-pediatrics programs since the 2006 start of ACGME accreditation.

Benchmarks for Support and Outcomes for Internal Medicine-Pediatrics Residency Programs: A 5-Year Review

PubMed Central

Aronica, Michael; Williams, Ronald; Dennar, Princess E.; Hopkins, Robert H.

2015-01-01

Background Combined internal medicine and pediatrics (medicine-pediatrics) residencies were Accreditation Council for Graduate Medical Education (ACGME) accredited separately from their corresponding categorical residencies in June 2006. Objective We investigated how ACGME accreditation of medicine-pediatrics programs has affected the levels of support (both financial and personnel), the National Resident Matching Program (NRMP) match rate, performance on the board examination, and other graduate outcomes. Methods From 2009 through 2013 we sent an annual SurveyMonkey online survey to members of the Medicine-Pediatrics Program Directors Association. Questions pertained to program characteristics, program director support, recruitment, ambulatory training, and graduate data. More than 79% of responders completed the entire survey for each year (sample size was 60 program directors). Results Compared to the time prior to accreditation of the specialty, there was an increase in program directors who are dually trained (89% versus 93%), an increase in program director salary ($134,000 before accreditation versus $185,000 in 2013, P < .05), and an increase in the average full-time equivalent support (0.32 before accreditation versus 0.42 in 2013, P < .05). There was also an increase in programs with associate program directors (35% versus 78%), programs with chief residents (71% versus 91%), and an increase in program budgets controlled by program directors (52% versus 69%). The 2013 NRMP match rates increased compared to those of 2005 (99% versus 49%). Performance on the American Board of Pediatrics examination was comparable to that for pediatrics residents. Since accreditation, a larger number of residents are choosing careers in hospital medicine. Conclusions Our data show widespread improved support for medicine-pediatrics programs since the 2006 start of ACGME accreditation. PMID:26692969

Development of a curriculum and training program in Woman Veterans Health for Internal Medical Residents.

PubMed

Ceylony, Manju; Porhomayon, Jahan; Pourafkari, Leili; Nader, Nader D

2017-09-26

Internal Medicine residents must develop competency as Primary Care Providers, but a gap exists in their curriculum and training with regard to women's reproductive health. With increasing need in VA due to new influx of women veterans it poses problems in recruitment of competent physicians trained in Women's health. An intensive, one-month women's reproductive health curriculum with hands on experience for Internal Medicine residents was provided. Curriculum was taught to the residents who rotated at the Women's Health Clinic for one month. Pre-test and post-test exams were administered. Increase in knowledge of residents in providing gender specific evaluations and management was objectively assessed by changes in post-test scores. Data were analyzed for statistically significant improvement in written tests scores. Total of 47 Internal Medicine residents rotated through Women's Health Center during the evaluation period. All residents completed both pre-test and post-test exams. The average time to complete the pre-test was 20.5 ± 5.4 min and 19.5 ± 4.8 min for post-test. There was no correlation between the time to complete the pre-test exam and the post-test exam. The total score was significantly improved from 8.5 ± 1.6 to 13.2 ± 1.8 (p < 0.0001). This study shows how to equip physicians in training with information on women's health that enables them to provide safe and gender appropriate care in primary care settings. This practice will reduce the need for frequent referrals for specialized care and thus provide cost saving for patient and health care on the whole.

SU-E-E-07: When the Old Ways Are the Best Ways: In Defense of Didactic Training

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sensakovic, W

2014-06-01

Purpose: Physics education for residents has taken on a more prominent role due to the new ABR examination format. We present a curriculum for a new radiology residency entering its second year. This curriculum favors an extensive traditional didactic teaching approach. The curriculum is designed to minimize the amount of independent learning that is necessary outside the classroom Methods and Materials: idactic training repeats yearly for all four years of residency and consists of two 1-hour lectures per week and several in-class tests. The impact of physics on clinical practice is introduced gradually throughout the residency using specific clinical cases.more » The extensive time spent with the residents allows lectures to be taught at a deep (almost physicist) level and reduces the necessity of learning base concepts outside of lecture. This frees the resident to use resources (e.g., AAPM/RSNA physics modules) to cement concepts through repetition or to learn a slightly confusing concept from a different teaching perspective. Consistent testing reduces the traditional resident studying technique of physics “cramming.” Results: On average, the first year residents scored in the 98th percentile on the American College of Radiology Diagnostic Radiology In-Service Training Exam (ACR DXIT). Feedback from the new first year residents was very positive and suggestions are constantly solicited and incorporated. For example, based on resident feedback, short-format quizzes each lecture were eliminated and replaced interactive questions during lecture. Residents felt they have advanced rapidly and have a better understanding of radiologic physics, though they have expressed concern that the 1-hour lecture block may not be optimal for learning physics. Conclusion: An extensive, physicist-led series of didactic lectures is effective in the teaching of physics to residents.« less

What Shape is Your Resident in? Using a Radar Plot to Guide a Milestone Clinical Competency Discussion.

PubMed

Harrington, David T; Miner, Thomas J; Ng, Thomas; Charpentier, Kevin P; Richardson, Pam; Cioffi, William G

2015-01-01

One of the challenges for program directors (PDs) is to sort and weight the tidal wave of assessments that training programs create in the modern Milestone era. We evaluated whether the use of a radar plot (RP) would be helpful in sorting data and providing a graphic representation of each resident's progress. Using at least 2 different types of assessments for each of the 16 surgical Milestones, the data were ranked and weighted by a predetermined method embedded in a computerized workbook (Excel). This process created a unique 16-spoked RP for each resident (Fig. below). The RP allowed the faculty to see areas of weakness (shown by concavity) and allowed an overall grade calculated as a ratio of the area of the smooth outer circle (faculty expectations, triangles) and the resident's unique radar shape (resident performance, squares). To help us validate our new tool, we looked at whether residents with recent remedial issues "looked" different from residents without remedial issues. Of our 30 categorical residents, 8 had significant areas of concavities, suggesting possible areas of improvement. Of these 8 residents, 4 had been on a remediation program in the last 18 months. The average ratio of performance/expectations was 0.709. The 4 residents on recent remediation had a ratio of 0.616 when compared with 0.723 for the residents without remedial issues (p < 0.009). Many exciting challenges await PDs, as we evolve to a competency-based evaluation system. The use of an evaluation summary tool using RPs may aid PDs in leading clinical competency discussions and in monitoring a resident's progress over time. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

An Economic Analysis of a Safe Resident Handling Program in Nursing Homes

PubMed Central

Lahiri, Supriya; Latif, Saira; Punnett, Laura

2018-01-01

Background Occupational injuries, especially back problems related to resident handling, are common in nursing home employees and their prevention may require substantial up-front investment. This study evaluated the economics of a safe resident handling program (SRHP), in a large chain of skilled nursing facilities, from the corporation's perspective. Methods The company provided data on program costs, compensation claims, and turnover rates (2003-2009). Workers' compensation and turnover costs before and after the intervention were compared against investment costs using the “net-cost model”. Results Among 110 centers, the overall benefit-to-cost ratio was 1.7–3.09 and the payback period was 1.98–1.06 year (using alternative turnover cost estimates). The average annualized net savings per bed for the 110 centers (using company based turnover cost estimates) was $143, with a 95% confidence interval of $22–$264. This was very similar to the average annualized net savings per full time equivalent (FTE) staff member, which was $165 (95% confidence interval $22–$308). However, at 49 centers costs exceeded benefits. Conclusions Decreased costs of worker injury compensation claims and turnover appear at least partially attributable to the SRHP. Future research should examine center-specific factors that enhance program success, and improve measures of turnover costs and healthcare productivity. PMID:23203729

An economic analysis of a safe resident handling program in nursing homes.

PubMed

Lahiri, Supriya; Latif, Saira; Punnett, Laura

2013-04-01

Occupational injuries, especially back problems related to resident handling, are common in nursing home employees and their prevention may require substantial up-front investment. This study evaluated the economics of a safe resident handling program (SRHP), in a large chain of skilled nursing facilities, from the corporation's perspective. The company provided data on program costs, compensation claims, and turnover rates (2003-2009). Workers' compensation and turnover costs before and after the intervention were compared against investment costs using the "net-cost model." Among 110 centers, the overall benefit-to-cost ratio was 1.7-3.09 and the payback period was 1.98-1.06 year (using alternative turnover cost estimates). The average annualized net savings per bed for the 110 centers (using company based turnover cost estimates) was $143, with a 95% confidence interval of $22-$264. This was very similar to the average annualized net savings per full time equivalent (FTE) staff member, which was $165 (95% confidence interval $22-$308). However, at 49 centers costs exceeded benefits. Decreased costs of worker injury compensation claims and turnover appear at least partially attributable to the SRHP. Future research should examine center-specific factors that enhance program success, and improve measures of turnover costs and healthcare productivity. Copyright © 2012 Wiley Periodicals, Inc.

Trends in hospital admissions involving suicidal behaviour in the Northern Territory, 2001-2013.

PubMed

Leckning, Bernard A; Li, Shu Qin; Cunningham, Teresa; Guthridge, Steven; Robinson, Gary; Nagel, Tricia; Silburn, Sven

2016-06-01

To investigate trends in hospital admissions involving suicidal behaviour in the Northern Territory (NT) resident population over the period 2001-2013. Estimates of age-standardised rates and average changes in the annual rate of hospital admissions involving suicidal behaviour were calculated by socio-demographic characteristics and types of suicidal behaviour. Overall rates for Indigenous admissions were 2.7 times higher than non-Indigenous admissions and had increased by almost twice as much. While male and female rates of admission were similar for both Indigenous and non-Indigenous residents, the average annual change in rates was greater for Indigenous females (13.4%) compared to males (8.8%) and for non-Indigenous males (7.7%) compared to females (5.2%). Younger and middle-aged Indigenous admissions experienced increasing rates of admissions, whilst trends were similar across age groups for non-Indigenous admissions. Admissions with a diagnosis of suicidal ideation increased the most across all groups. Trends in intentional self-harm admissions differed according to Indigenous status and sex. There have been substantial increases in hospital admissions involving suicidal behaviour in the NT, most markedly for Indigenous residents. Indigenous females and youth appear to be at increasing risk. The steep increase in suicidal ideation across all groups warrants further investigation. © The Royal Australian and New Zealand College of Psychiatrists 2016.

Nighttime oxygen desaturation and symptoms of sleep-disordered breathing in long-stay nursing home residents.

PubMed

Martin, Jennifer L; Mory, Aaron K; Alessi, Cathy A

2005-01-01

Sleep-disordered breathing (SDB) is common in older adults and has been implicated as a cause of decreased quality of life and even death. Sparse data exist on SDB in the nursing home setting. The authors evaluated SDB (using attended nocturnal pulse oximetry) in nursing home residents with daytime sleepiness and nighttime sleep disturbance. Pulse oximetry was used to estimate the prevalence of nighttime oxygen desaturation in 109 long-stay nursing home residents (mean [standard deviation] age = 86.2 [9.2] years; 74% women). Pulse oximetry findings were compared to a structured observational measurement of symptoms of SDB, the Observational Sleep Assessment Instrument. Seventy-one participants had concurrent wrist actigraphy to estimate total sleep time during oximetry recording. Using the oxygen desaturation index (ODI; average number of oxygen desaturations 4% or more below the baseline level per hour), the authors found that 40% of the residents had abnormal ODI (ODI more than 5, which is suggestive of SDB). Of all observational variables assessed, only loud breathing during sleep was significantly correlated with ODI (r =.284; p =.003). When ODI was adjusted for estimated total sleep time, higher adjusted ODI was associated with higher body mass index (kg/m(2)). Abnormal ODI is common in nursing home residents. Observed loud breathing at night and high body mass index may suggest that further assessment of SDB is indicated. Future research should determine the importance of SDB and abnormal nocturnal oxygen desaturation on functioning and quality of life in nursing home residents.

Three-dimensional brain arteriovenous malformation models for clinical use and resident training.

PubMed

Dong, Mengqi; Chen, Guangzhong; Li, Jianyi; Qin, Kun; Ding, Xiaowen; Peng, Chao; Zhou, Dong; Lin, Xiaofeng

2018-01-01

To fabricate three-dimensional (3D) models of brain arteriovenous malformation (bAVM) and report our experience with customized 3D printed models of patients with bAVM as an educational and clinical tool for patients, doctors, and surgical residents. Using computerized tomography angiography (CTA) or digital subtraction angiography (DSA) images, the rapid prototyping process was completed with specialized software and "in-house" 3D printing service. Intraoperative validation of model fidelity was performed by comparing to DSA images of the same patient during the endovascular treatment process. 3D bAVM models were used for preoperative patient education and consultation, surgical planning, and resident training. 3D printed bAVM models were successful made. By neurosurgeons' evaluation, the printed models precisely replicated the actual bAVM structure of the same patients (n = 7, 97% concordance, range 95%-99% with average of < 2 mm variation). The use of 3D models was associated shorter time for preoperative patient education and consultation, higher acceptable of the procedure for patients and relatives, shorter time between obtaining intraoperative DSA data and the start of endovascular treatment. Thirty surgical residents from residency programs tested the bAVM models and provided feedback on their resemblance to real bAVM structures and the usefulness of printed solid model as an educational tool. Patient-specific 3D printed models of bAVM can be constructed with high fidelity. 3D printed bAVM models were proven to be helpful in preoperative patient consultation, surgical planning, and resident training. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

A novel approach to increase residents' involvement in reporting adverse events.

PubMed

Scott, David R; Weimer, Melissa; English, Clea; Shaker, Lynn; Ward, William; Choi, Dongseok; Cedfeldt, Andrea; Girard, Donald

2011-06-01

In the wake of the Patient Safety and Quality Improvement Act of 2005, national attention has increasingly focused on adverse-event reporting as a means of identifying systems changes to improve patient safety. However, physicians and residents have demonstrated meager involvement in this effort. In 2008-2009, the authors measured participation in adverse-event reporting by 680 residents at Oregon Health & Science University before and after implementing a quality improvement initiative, which consisted of a financial incentive and multifaceted educational campaign. The primary measure of success was an increase in the average monthly adverse-event reports submitted by residents to greater than 5% of the institution's overall report submissions. The average number of adverse events reported by residents increased from 1.6% to 9.0% of the institution's overall event reports, representing a 5.6-fold increase during the initiative (P < .001). The relative percentage of resident-submitted reports defined as "near-misses" increased from 6% to 27% during the initiative (P < .001). The novel approach of integrating a retirement benefit and educational campaign to increase residents' involvement in adverse-event reporting was successful. In addition to increasing residents' contributions to adverse-event reporting to levels higher than any documented in the current literature, there was also a remarkable increase in the relative frequency of near-miss reporting by residents.

Canadian Plastic Surgery Resident Work Hour Restrictions: Practices and Perceptions of Residents and Program Directors.

PubMed

McInnes, Colin W; Vorstenbosch, Joshua; Chard, Ryan; Logsetty, Sarvesh; Buchel, Edward W; Islur, Avinash

2018-02-01

The impact of resident work hour restrictions on training and patient care remains a highly controversial topic, and to date, there lacks a formal assessment as it pertains to Canadian plastic surgery residents. To characterize the work hour profile of Canadian plastic surgery residents and assess the perspectives of residents and program directors regarding work hour restrictions related to surgical competency, resident wellness, and patient safety. An anonymous online survey developed by the authors was sent to all Canadian plastic surgery residents and program directors. Basic summary statistics were calculated. Eighty (53%) residents and 10 (77%) program directors responded. Residents reported working an average of 73 hours in hospital per week with 8 call shifts per month and sleep 4.7 hours/night while on call. Most residents (88%) reported averaging 0 post-call days off per month and 61% will work post-call without any sleep. The majority want the option of working post-call (63%) and oppose an 80-hour weekly maximum (77%). Surgical and medical errors attributed to post-call fatigue were self-reported by 26% and 49% of residents, respectively. Residents and program directors expressed concern about the ability to master surgical skills without working post-call. The majority of respondents oppose duty hour restrictions. The reason is likely multifactorial, including the desire of residents to meet perceived expectations and to master their surgical skills while supervised. If duty hour restrictions are aggressively implemented, many respondents feel that an increased duration of training may be necessary.

Operative experience in an orthopaedic surgery residency program: the effect of work-hour restrictions.

PubMed

Baskies, Michael A; Ruchelsman, David E; Capeci, Craig M; Zuckerman, Joseph D; Egol, Kenneth A

2008-04-01

The implementation of Section 405 of the New York State Public Health Code and the adoption of similar policies by the Accreditation Council for Graduate Medical Education in 2002 restricted resident work hours to eighty hours per week. The effect of these policies on operative volume in an orthopaedic surgery residency training program is a topic of concern. The purpose of this study was to evaluate the effect of the work-hour restrictions on the operative experiences of residents in a large university-based orthopaedic surgery residency training program in an urban setting. We analyzed the operative logs of 109 consecutive orthopaedic surgery residents (postgraduate years 2 through 5) from 2000 through 2006, representing a consecutive interval of years before and after the adoption of the work-hour restrictions. Following the implementation of the new work-hour policies, there was no significant difference in the operative volume for postgraduate year-2, 3, or 4 residents. However, the average operative volume for a postgraduate year-5 resident increased from 274.8 to 348.4 cases (p = 0.001). In addition, on analysis of all residents as two cohorts (before 2002 and after 2002), the operative volume for residents increased by an average of 46.6 cases per year (p = 0.02). On the basis of the findings of this study, concerns over the potential adverse effects of the resident work-hour polices on operative volume for orthopaedic surgery residents appear to be unfounded.

Clinical decision-making among new graduate nurses attending residency programs in Saudi Arabia.

PubMed

Al-Dossary, Reem Nassar; Kitsantas, Panagiota; Maddox, P J

2016-02-01

This study examined the impact of residency programs on clinical decision-making of new Saudi graduate nurses who completed a residency program compared to new Saudi graduate nurses who did not participate in residency programs. This descriptive study employed a convenience sample (N=98) of new graduate nurses from three hospitals in Saudi Arabia. A self-administered questionnaire was used to collect data. Clinical decision-making skills were measured using the Clinical Decision Making in Nursing Scale. Descriptive statistics, independent t-tests, and multiple linear regression analysis were utilized to examine the effect of residency programs on new graduate nurses' clinical decision-making skills. On average, resident nurses had significantly higher levels of clinical decision-making skills than non-residents (t=23.25, p=0.000). Enrollment in a residency program explained 86.9% of the variance in total clinical decision making controlling for age and overall grade point average. The findings of this study support evidence in the nursing literature conducted primarily in the US and Europe that residency programs have a positive influence on new graduate nurses' clinical decision-making skills. This is the first study to examine the impact of residency programs on clinical decision-making among new Saudi graduate nurses who completed a residency program. The findings of this study underscore the need for the development and implementation of residency programs for all new nurses. Copyright © 2015 Elsevier Inc. All rights reserved.

Behind the Match Process: Is There Any Financial Difference Lurking Below the Specialty of Choice?

PubMed

Oladeji, Lasun O; Raley, James A; Smith, Stephen; Perez, Jorge L; McGwin, Gerald; Ponce, Brent A

2016-12-01

The Match was developed in response to a chaotic residency selection process. While the match has remained relatively unchanged since it was introduced, the number of medical school graduates has increased at a rate outpacing the number of residency positions leading to a more competitive process for applicants. In May 2014, an 18-question mixed-response questionnaire was distributed to fourth year allopathic medical students via an E-mail distribution list for student affairs representatives. The individual surveys were accessible via SurveyMonkey and available for completion over the course of a 4-week period. Approximately 65.1 per cent of students performed at least one audition rotation and documented average expenditures of $2494 on housing, food, and transportation. The average applicant applied to 32 programs and attended 12 interviews while spending $4420 on the interview trail. Applicants for surgical programs applied to approximately 42 programs and attended 13 interviews compared with primary care applicants who averaged 23 programs (P < 0.001) and attended 12 interviews (P = 0.002). Surgical applicants averaged 20 days on the interview trail while spending $5500 ($423/interview) on housing, food, and transportation compared with primary care applicants averaged 19 days away from home (P < 0.05) and spending $3400 ($283/interview) on these same items (P < 0.001). The findings in our study indicate that the "Match process" contributes to the financial burden of graduating medical students and it is more expensive and time consuming for the candidates interested in surgical specialties.

26 CFR 1.163-10T - Qualified residence interest (temporary).

Code of Federal Regulations, 2011 CFR

2011-04-01

... mortgage interest received in trade or business from individuals) reports the average balance of a secured... general. (ii)Example. (g)Selection of method. (h)Average balance. (1)Average balance defined. (2)Average...)Examples. (5)Average balance computed using average of beginning and ending balance. (i)In general. (ii...

Open abdominal surgical training differences experienced by integrated vascular and general surgery residents.

PubMed

Tanious, Adam; Wooster, Mathew; Jung, Andrew; Nelson, Peter R; Armstrong, Paul A; Shames, Murray L

2017-10-01

As the integrated vascular residency program reaches almost a decade of maturity, a common area of concern among trainees is the adequacy of open abdominal surgical training. It is our belief that although their overall exposure to open abdominal procedures has decreased, integrated vascular residents have an adequate and focused exposure to open aortic surgery during training. National operative case log data supplied by the Accreditation Council for Graduate Medical Education were compiled for both graduating integrated vascular surgery residents (IVSRs) and graduating categorical general surgery residents (GSRs) for the years 2012 to 2014. Mean total and open abdominal case numbers were compared between the IVSRs and GSRs, with more in-depth exploration into open abdominal procedures by organ system. Overall, the mean total 5-year case volume of IVSRs was 1168 compared with 980 for GSRs during the same time frame (P < .0001). IVSRs reported nearly double the number of surgeon-chief cases compared with GSRs (452 vs 239; P < .0001). GSRs reported more than double the number of open abdominal procedures compared with IVSRs (205 vs 83; P < .0001). Sixty-five percent of the open abdominal experience for IVSRs was focused on procedures involving the aorta and its branches, with an average of 54 open aortic cases recorded throughout their training. The largest single contributor to open surgical experience for a GSR was alimentary tract surgery, representing 57% of all open abdominal cases. GSRs completed an average of 116 open alimentary tract surgeries during their training. Open abdominal surgery represented an average of 7.1% of the total vascular case volume for the vascular residents, whereas open abdominal surgery represented 21% of a GSR's total surgical experience. IVSRs reported almost double the number of total cases during their training, with double chief-level cases. Sixty-five percent of open abdominal surgeries performed by IVSRs involved the aorta or its renovisceral branches. Whereas open abdominal surgery represented 7.1% of an IVSR's surgical training, GSRs had a far broader scope of open abdominal procedures, completing nearly double those of IVSRs. The differences in open abdominal procedures pertain to the differing diseases treated by GSRs and IVSRs. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Exposure assessment of natural uranium from drinking water.

PubMed

Jakhu, Rajan; Mehra, Rohit; Mittal, H M

2016-12-08

The uranium concentration in the drinking water of the residents of the Jaipur and Ajmer districts of Rajasthan has been measured for exposure assessment. The daily intake of uranium from the drinking water for the residents of the study area is found to vary from 0.4 to 123.9 μg per day. For the average uranium ingestion rate of 35.2 μg per day for a long term exposure period of 60 years, estimations have been made for the retention of uranium in different body organs and its excretion with time using ICRP's biokinetic model of uranium. Radioactive and chemical toxicity of uranium has been reported and discussed in detail in the present manuscript.

Consideration of driver home county prohibition and alcohol-related vehicle crashes.

PubMed

Schulte Gary, Sarah Lynn; Aultman-Hall, Lisa; McCourt, Matt; Stamatiadis, Nick

2003-09-01

This study examines the characteristics of alcohol-related crashes in wet versus dry counties in the state of Kentucky, USA and incorporates the location of driver residences through use of geographic information system (GIS) analysis. Between 1991 and 1997, 39344 alcohol-related crashes by Kentucky residents on Kentucky State roads were reported. The location of the crash and the home ZIP code from the driver's address were used to consider distance from home in the GIS. Analysis of the crash data revealed that a similar proportion of crashes in wet and dry counties are alcohol-related but that a higher proportion of dry counties residents are involved in an alcohol-related crash. However, when the distance from home variable is considered, several results suggest that dry county residents may be driving further when consuming alcohol. In part due to the rural nature of dry counties, drivers from dry counties have both alcohol-related and non-alcohol related crashes farther from their homes than residents from wet counties. Alcohol-related crashes by dry county residents in wet counties are the greatest average distance from home while crashes by wet county residents in wet counties are the smallest average distance. Drivers from dry counties over 21 years of age have alcohol-related crashes significantly farther from home than those under 21 who would not legally be admitted to drinking establishments in the wet counties. Furthermore, residents from dry counties that do not border wet counties have alcohol-related crashes on average farther from home than the border county residents. These last three results provide circumstantial evidence that some dry county drivers may be driving to wet counties to consume alcohol thus increasing impaired driving exposure. In conclusion, by considering crash location and driver residence, these findings indicate that county-level prohibition is not necessarily effective in improving highway safety.

Internal Medicine Residents Do Not Accurately Assess Their Medical Knowledge

ERIC Educational Resources Information Center

Jones, Roger; Panda, Mukta; Desbiens, Norman

2008-01-01

Background: Medical knowledge is essential for appropriate patient care; however, the accuracy of internal medicine (IM) residents' assessment of their medical knowledge is unknown. Methods: IM residents predicted their overall percentile performance 1 week (on average) before and after taking the in-training exam (ITE), an objective and well…

A cross-sectional study of differences in 6-min walk distance in healthy adults residing at high altitude versus sea level

PubMed Central

2014-01-01

Background We sought to determine if adult residents living at high altitude have developed sufficient adaptation to a hypoxic environment to match the functional capacity of a similar population at sea level. To test this hypothesis, we compared the 6-min walk test distance (6MWD) in 334 residents living at sea level vs. at high altitude. Methods We enrolled 168 healthy adults aged ≥35 years residing at sea level in Lima and 166 individuals residing at 3,825 m above sea level in Puno, Peru. Participants completed a 6-min walk test, answered a sociodemographics and clinical questionnaire, underwent spirometry, and a blood test. Results Average age was 54.0 vs. 53.8 years, 48% vs. 43% were male, average height was 155 vs. 158 cm, average blood oxygen saturation was 98% vs. 90%, and average resting heart rate was 67 vs. 72 beats/min in Lima vs. Puno. In multivariable regression, participants in Puno walked 47.6 m less (95% CI -81.7 to -13.6 m; p < 0.01) than those in Lima. Other variables besides age and height that were associated with 6MWD include change in heart rate (4.0 m per beats/min increase above resting heart rate; p < 0.001) and percent body fat (-1.4 m per % increase; p = 0.02). Conclusions The 6-min walk test predicted a lowered functional capacity among Andean high altitude vs. sea level natives at their altitude of residence, which could be explained by an incomplete adaptation or a protective mechanism favoring neuro- and cardioprotection over psychomotor activity. PMID:24484777

Implementing a Narrative Medicine Curriculum During the Internship Year: An Internal Medicine Residency Program Experience

PubMed Central

Wesley, Tiffany; Hamer, Diana; Karam, George

2018-01-01

Introduction Narrative medicine develops professional and communication skills that align with Accreditation Council for Graduate Medical Education competencies. However, little is known about a narrative medicine curriculum’s impact on physicians in training during residency. Implementing a narrative medicine curriculum during residency can be challenging because of time constraints and limited opportunity for nonclinical education. Methods Six sessions were implemented throughout one academic year to expose first-year internal medicine residents (interns) to narrative medicine. Attendance and participation were documented. At the end of the year, interns completed an open-ended survey to gauge their perception of their experience with the sessions. Results In total, 17 interns attended at least 1 narrative medicine session, and each session averaged 5.4 attendees. Thirteen eligible interns completed the survey. Thematic analysis identified 3 predominant themes: Mindfulness, physician well-being, and professionalism. Discussion Overall, the narrative medicine sessions were well attended and the curriculum was well received. This intervention demonstrates the value of a narrative medicine curriculum during medical resident training. Large prospective studies are necessary to identify the long-term benefits of such a curriculum. PMID:29702059

Assessing Chemical Retention Process Controls in Ponds

NASA Astrophysics Data System (ADS)

Torgersen, T.; Branco, B.; John, B.

2002-05-01

Small ponds are a ubiquitous component of the landscape and have earned a reputation as effective chemical retention devices. The most common characterization of pond chemical retention is the retention coefficient, Ri= ([Ci]inflow-[Ci] outflow)/[Ci]inflow. However, this parameter varies widely in one pond with time and among ponds. We have re-evaluated literature reported (Borden et al., 1998) monthly average retention coefficients for two ponds in North Carolina. Employing a simple first order model that includes water residence time, the first order process responsible for species removal have been separated from the water residence time over which it acts. Assuming the rate constant for species removal is constant within the pond (arguable at least), the annual average rate constant for species removal is generated. Using the annual mean rate constant for species removal and monthly water residence times results in a significantly enhanced predictive capability for Davis Pond during most months of the year. Predictive ability remains poor in Davis Pond during winter/unstratified periods when internal loading of P and N results in low to negative chemical retention. Predictive ability for Piedmont Pond (which has numerous negative chemical retention periods) is improved but not to the same extent as Davis Pond. In Davis Pond, the rate constant for sediment removal (each month) is faster than the rate constant for water and explains the good predictability for sediment retention. However, the removal rate constant for P and N is slower than the removal rate constant for sediment (longer water column residence time for P,N than for sediment). Thus sedimentation is not an overall control on nutrient retention. Additionally, the removal rate constant for P is slower than for TOC (TOC is not the dominate removal process for P) and N is removed slower than P (different in pond controls). For Piedmont Pond, sediment removal rate constants are slower than the removal rate constant for water indicating significant sediment resuspension episodes. It appears that these sediment resuspension events are aperiodic and control the loading and the chemical retention capability of Piedmont Pond for N,P,TOC. These calculated rate constants reflect the differing internal loading processes for each component and suggest means and mechanisms for the use of ponds in water quality management.

Introductory lecture series for first-year radiology residents: implementation, investment and assessment.

PubMed

Chapman, Teresa; Chew, Felix S

2013-03-01

A lecture series aimed at providing new radiology residents a rapid course on the fundamental concepts of professionalism, safety, and interpretation of diagnostic imaging was established. Evaluation of the course's educational value was attempted through surveys. Twenty-six live 45-minute lectures presented by 16 or 17 faculty members were organized exclusively for the first class of radiology residents, held over a 2-month period at the beginning of certain weekdays. Online surveys were conducted after the course to gather feedback from residents. Average resident rotation evaluation scores were measured over the first semester for the two classes before and after this new course implementation. The lecture series was successfully organized and implemented. A total of 33 residents sat through the course over three summers. Faculty reported a reasonable number of preparation hours, and 100% of residents indicated they valued the course. Comparison of class average evaluation scores before and after the existence of this 2-month course did not significantly change. This collection of introductory lectures on professionalism, safety, and diagnostic imaging, delivered early in the first year of the radiology residency, requires a reasonable number of invested preparation hours by the faculty but results in a universal increase in resident confidence. However, we were unable to demonstrate an objective improvement in resident performance on clinical rotations. Copyright © 2013 AUR. Published by Elsevier Inc. All rights reserved.

Prevalence and Trajectories of Psychiatric Symptoms Among Sober Living House Residents.

PubMed

Polcin, Doug; Korcha, Rachael; Gupta, Shalika; Subbaraman, Meenakshi Sabina; Mericle, Amy A

2016-01-01

Sober living houses are alcohol- and drug-free recovery residences that help individuals with substance use disorders maintain long-term abstinence. Given the prevalence of co-occurring mental disorders among individuals entering substance use treatment, it is likely that many such residents are also contending with psychiatric symptoms, and it is unclear how these symptoms may affect their sobriety. This study sought to describe the prevalence and trajectories of different types of symptoms among sober living house residents and examine how these symptoms affect substance use outcomes. Data for this study were collected as part of a larger study on outcomes among sober living house residents in Northern California. The current study examined data from 300 residents in two housing groups; residents were interviewed upon entry and re-interviewed at 6-, 12-, and 18-month follow-ups. Psychiatric symptoms were assessed using the Brief Symptom Inventory (BSI). General estimating equations tested changes in BSI global psychological distress and clinical symptom scales over time and examined the relationship between scale scores and substance use in longitudinal models controlling for demographics, length of stay, and psychiatric service utilization. The average age of residents was 38.5 years (SD = 10.1) and they were mostly male (80%) and Caucasian (65%). Retention rates were high, with 90% (n = 269) participating in at least one follow-up interview. Overall psychological distress (Wald χ(2) = 7.99, df = 3, p = .046), symptoms of depression (Wald χ(2) = 13.57, df = 3, p = .004), and phobic anxiety (Wald χ(2) = 7.89, df = 3, p = .048) significantly improved over time. In all models examining the relationship between BSI scale scores and substance use, rates of abstinence and days of use among those who reported using substances also improved over time. Overall distress (OR = 0.48, p < .001) as well as higher scores on the somatization (OR = 0.56, p < .001), depression (OR = 0.53, p < .001), hostility (OR = 0.71, p = .006), and phobic anxiety (OR = 0.74, p = .012) subscales were significantly associated with a decreased likelihood of abstinence. Symptoms of somatization (B = 0.092, SE = 0.029, p = .002) were associated with an increase in the number of days substances were used among those who reported use. Psychological symptoms among sober living house residents improve over time, but they are risk factors for relapse, suggesting that additional support provided to residents with psychiatric symptoms could improve substance use outcomes.

ECG interpretation skills of South African Emergency Medicine residents

PubMed Central

Wallis, Lee; Maritz, David

2010-01-01

Background The use and interpretation of electrocardiograms (ECGs) are widely accepted as an essential core skill in Emergency Medicine. It is imperative that emergency physicians are expert in ECG interpretation when they exit their training programme. Aim It is unknown whether South African Emergency Medicine trainees are getting the necessary skills in ECG interpretation during the training programme. Currently there are no clear criteria to assess emergency physicians’ competency in ECG interpretation in South Africa. Methods A prospective cross-sectional study of Emergency Medicine residents and recently qualified emergency physicians was conducted between August 2008 and February 2009 using a focused questionnaire. Results At the time of the study, there were 55 eligible trainees in South Africa. A total of 55 assessments were distributed; 50 were returned (91%) and 49 were fully completed (89%). In this study, we found the overall average score of ECG interpretation was 46.4% [95% confidence interval (CI) 41.5–51.2%]. The junior group had an overall average of 42.2% (95% CI 36.9–47.5%), whereas the senior group managed 52.5% (95% CI 43.4–61.5%). Conclusion In this prospective cross-sectional study of Emergency Medicine residents and recently qualified emergency physicians, we found that there was improvement in the interpretation of ECGs with increased seniority. There exists, however, a low level of accuracy for many of the critical ECG diagnoses. The average score of 46.4% obtained in this study is lower than the scores obtained by other international studies from countries where Emergency Medicine is a well-established speciality. PMID:21373298

Outbreaks of influenza-like illness in long-term care facilities in Winnipeg, Canada.

PubMed

Mahmud, Salaheddin M; Thompson, Laura H; Nowicki, Deborah L; Plourde, Pierre J

2013-11-01

Outbreaks of influenza-like illness (ILI) are common in long-term care facilities (LTCFs) and result in significant morbidity and mortality among residents. We describe patterns of reported ILI outbreaks in LTCFs in Winnipeg, Canada, and examine LTCF and outbreak characteristics that influence the clinical outcomes of these outbreaks. We analyzed the electronic records of all ILI outbreaks reported by LTCFs in Winnipeg from 2003 to 2011. Outbreak duration, ILI attack rates among staff and residents, and residents' death rates were calculated by presumed viral etiology, staff vaccination rates, type of influenza chemoprophylaxis used, and time to notification to public health. Of a total of 154 reported outbreaks, most (N=80) were attributed to influenza, and these outbreaks tended to have higher attack and death rates among LTCF residents compared with outbreaks caused by other respiratory viruses (12) or those of unknown etiology (62). About 92% of residents and 38% of staff of the average LTCFs were vaccinated. Chemoprophylaxis was used in 57·5% of influenza outbreaks. Regardless of presumed viral etiology, outbreaks reported within 3 days of onset ended sooner and had lower attack and mortality rates among residents. Influenza-like illness outbreaks still occur among highly immunized LTCF residents, so in addition to vaccination of staff and residents, it is important to maintain competent infection control practices. Early identification and notification to public health authorities and possibly early initiation of control measures could improve clinical outcomes of ILI outbreaks. © 2012 John Wiley & Sons Ltd.

The impact of residential status on cognitive decline among older adults in China: Results from a longitudinal study.

PubMed

Xu, Hanzhang; Dupre, Matthew E; Gu, Danan; Wu, Bei

2017-05-15

Residential status has been linked to numerous determinants of health and well-being. However, the influence of residential status on cognitive decline remains unclear. The purpose of this research was to assess the changes of cognitive function among older adults with different residential status (urban residents, rural-to-urban residents, rural residents, and urban-to-rural residents), over a 12-year period. We used five waves of data (2002, 2005, 2008/2009, 2011/2012, and 2014) from the Chinese Longitudinal Healthy Longevity Survey with 17,333 older adults age 65 and over who were interviewed up to five times. Cognitive function was measured by the Mini Mental State Examination (MMSE). Multilevel models were used regarding the effects of residential status after adjusting for demographic characteristics, socioeconomic factors, family support, health behaviors, and health status. After controlling for covariates, significant differences in cognitive function were found across the four groups: rural-to-urban and rural residents had a higher level of cognition than urban residents at baseline. On average, cognitive function decreased over the course of the study period. Rural-to-urban and rural residents demonstrated a faster decline in cognitive function than urban residents. This study suggests that residential status has an impact on the rate of changes in cognition among older adults in China. Results from this study provide directions for future research that addresses health disparities, particularly in countries that are undergoing significant socioeconomic transitions.

Improving residency training in arthroscopic knee surgery with use of a virtual-reality simulator. A randomized blinded study.

PubMed

Cannon, W Dilworth; Garrett, William E; Hunter, Robert E; Sweeney, Howard J; Eckhoff, Donald G; Nicandri, Gregg T; Hutchinson, Mark R; Johnson, Donald D; Bisson, Leslie J; Bedi, Asheesh; Hill, James A; Koh, Jason L; Reinig, Karl D

2014-11-05

There is a paucity of articles in the surgical literature demonstrating transfer validity (transfer of training). The purpose of this study was to assess whether skills learned on the ArthroSim virtual-reality arthroscopic knee simulator transferred to greater skill levels in the operating room. Postgraduate year-3 orthopaedic residents were randomized into simulator-trained and control groups at seven academic institutions. The experimental group trained on the simulator, performing a knee diagnostic arthroscopy procedure to a predetermined proficiency level based on the average proficiency of five community-based orthopaedic surgeons performing the same procedure on the simulator. The residents in the control group continued their institution-specific orthopaedic education and training. Both groups then performed a diagnostic knee arthroscopy procedure on a live patient. Video recordings of the arthroscopic surgery were analyzed by five pairs of expert arthroscopic surgeons blinded to the identity of the residents. A proprietary global rating scale and a procedural checklist, which included visualization and probing scales, were used for rating. Forty-eight (89%) of the fifty-four postgraduate year-3 residents from seven academic institutions completed the study. The simulator-trained group averaged eleven hours of training on the simulator to reach proficiency. The simulator-trained group performed significantly better when rated according to our procedural checklist (p = 0.031), including probing skills (p = 0.016) but not visualization skills (p = 0.34), compared with the control group. The procedural checklist weighted probing skills double the weight of visualization skills. The global rating scale failed to reach significance (p = 0.061) because of one extreme outlier. The duration of the procedure was not significant. This lack of a significant difference seemed to be related to the fact that residents in the control group were less thorough, which shortened their time to completion of the arthroscopic procedure. We have demonstrated transfer validity (transfer of training) that residents trained to proficiency on a high-fidelity realistic virtual-reality arthroscopic knee simulator showed a greater skill level in the operating room compared with the control group. We believe that the results of our study will stimulate residency program directors to incorporate surgical simulation into the core curriculum of their residency programs. Copyright © 2014 by The Journal of Bone and Joint Surgery, Incorporated.

Relationship Between Citation-Based Scholarly Activity of United States Radiation Oncology Residents and Subsequent Choice of Academic Versus Private-Practice Career.

PubMed

McClelland, Shearwood; Mitin, Timur; Wilson, Lynn D; Thomas, Charles R; Jaboin, Jerry J

2018-05-01

To assess h-index data and their association with radiation oncology resident choice of academic versus private-practice career, using a recent resident graduating class. A list of 2016 radiation oncology resident graduates (163 residents from 76 Accreditation Council for Graduate Medical Education-certified programs) and their postresidency career choice (academic vs private practice) was compiled. The Scopus bibliometric citation database was then searched to collect h-index data for each resident. Demographics included in analyses were gender and PhD degree status. Mean h-index score for all resident graduates was 4.15. Residents with a PhD had significantly higher h-index scores (6.75 vs 3.42; P < .01), whereas there was no statistically significant difference in h-index scores between male and female residents (4.38 vs 3.36; P = .06). With regard to career choice, residents choosing academic careers had higher h-index scores than those choosing private practice (5.41 vs 2.96; P < .01). There was no significant difference in mean h-index scores between male and female residents regardless of private-practice (3.15 vs 2.19; P = .25) or academic (5.80 vs 4.30; P = .13) career choice. The average radiation oncology resident graduate published a minimum of 4 manuscripts cited at least 4 times. Graduates with a PhD are significantly more likely to have higher h-index scores, as are residents who choose academic over private-practice careers. There is no significant difference in h-index score between male and female residents, regardless of career choice. These results offer up-to-date benchmarks for evaluating radiation oncology resident productivity and have potential utility in predicting postresidency career choices. Copyright © 2018 Elsevier Inc. All rights reserved.

Regional oxygen reduction and denitrification rates in groundwater from multi-model residence time distributions, San Joaquin Valley, USA

USGS Publications Warehouse

Green, Christopher T.; Jurgens, Bryant; Zhang, Yong; Starn, Jeffrey; Singleton, Michael J.; Esser, Bradley K.

2016-01-01

Rates of oxygen and nitrate reduction are key factors in determining the chemical evolution of groundwater. Little is known about how these rates vary and covary in regional groundwater settings, as few studies have focused on regional datasets with multiple tracers and methods of analysis that account for effects of mixed residence times on apparent reaction rates. This study provides insight into the characteristics of residence times and rates of O2 reduction and denitrification (NO3− reduction) by comparing reaction rates using multi-model analytical residence time distributions (RTDs) applied to a data set of atmospheric tracers of groundwater age and geochemical data from 141 well samples in the Central Eastern San Joaquin Valley, CA. The RTD approach accounts for mixtures of residence times in a single sample to provide estimates of in-situ rates. Tracers included SF6, CFCs, 3H, He from 3H (tritiogenic He),14C, and terrigenic He. Parameter estimation and multi-model averaging were used to establish RTDs with lower error variances than those produced by individual RTD models. The set of multi-model RTDs was used in combination with NO3− and dissolved gas data to estimate zero order and first order rates of O2 reduction and denitrification. Results indicated that O2 reduction and denitrification rates followed approximately log-normal distributions. Rates of O2 and NO3− reduction were correlated and, on an electron milliequivalent basis, denitrification rates tended to exceed O2 reduction rates. Estimated historical NO3− trends were similar to historical measurements. Results show that the multi-model approach can improve estimation of age distributions, and that relatively easily measured O2 rates can provide information about trends in denitrification rates, which are more difficult to estimate.

Regional oxygen reduction and denitrification rates in groundwater from multi-model residence time distributions, San Joaquin Valley, USA

DOE Office of Scientific and Technical Information (OSTI.GOV)

Green, Christopher T.; Jurgens, Bryant C.; Zhang, Yong

Rates of oxygen and nitrate reduction are key factors in determining the chemical evolution of groundwater. Little is known about how these rates vary and covary in regional groundwater settings, as few studies have focused on regional datasets with multiple tracers and methods of analysis that account for effects of mixed residence times on apparent reaction rates. This study provides insight into the characteristics of residence times and rates of O 2 reduction and denitrification (NO 3 – reduction) by comparing reaction rates using multi-model analytical residence time distributions (RTDs) applied to a data set of atmospheric tracers of groundwatermore » age and geochemical data from 141 well samples in the Central Eastern San Joaquin Valley, CA. The RTD approach accounts for mixtures of residence times in a single sample to provide estimates of in-situ rates. Tracers included SF 6, CFCs, 3H, He from 3H (tritiogenic He), 14C, and terrigenic He. Parameter estimation and multi-model averaging were used to establish RTDs with lower error variances than those produced by individual RTD models. The set of multi-model RTDs was used in combination with NO 3 – and dissolved gas data to estimate zero order and first order rates of O 2 reduction and denitrification. Results indicated that O 2 reduction and denitrification rates followed approximately log-normal distributions. Rates of O 2 and NO 3 – reduction were correlated and, on an electron milliequivalent basis, denitrification rates tended to exceed O 2 reduction rates. Estimated historical NO 3 – trends were similar to historical measurements. Here, results show that the multi-model approach can improve estimation of age distributions, and that relatively easily measured O 2 rates can provide information about trends in denitrification rates, which are more difficult to estimate.« less

Regional oxygen reduction and denitrification rates in groundwater from multi-model residence time distributions, San Joaquin Valley, USA

DOE PAGES

Green, Christopher T.; Jurgens, Bryant C.; Zhang, Yong; ...

2016-05-14

Rates of oxygen and nitrate reduction are key factors in determining the chemical evolution of groundwater. Little is known about how these rates vary and covary in regional groundwater settings, as few studies have focused on regional datasets with multiple tracers and methods of analysis that account for effects of mixed residence times on apparent reaction rates. This study provides insight into the characteristics of residence times and rates of O 2 reduction and denitrification (NO 3 – reduction) by comparing reaction rates using multi-model analytical residence time distributions (RTDs) applied to a data set of atmospheric tracers of groundwatermore » age and geochemical data from 141 well samples in the Central Eastern San Joaquin Valley, CA. The RTD approach accounts for mixtures of residence times in a single sample to provide estimates of in-situ rates. Tracers included SF 6, CFCs, 3H, He from 3H (tritiogenic He), 14C, and terrigenic He. Parameter estimation and multi-model averaging were used to establish RTDs with lower error variances than those produced by individual RTD models. The set of multi-model RTDs was used in combination with NO 3 – and dissolved gas data to estimate zero order and first order rates of O 2 reduction and denitrification. Results indicated that O 2 reduction and denitrification rates followed approximately log-normal distributions. Rates of O 2 and NO 3 – reduction were correlated and, on an electron milliequivalent basis, denitrification rates tended to exceed O 2 reduction rates. Estimated historical NO 3 – trends were similar to historical measurements. Here, results show that the multi-model approach can improve estimation of age distributions, and that relatively easily measured O 2 rates can provide information about trends in denitrification rates, which are more difficult to estimate.« less

New residence times of the Holocene reworked shells on the west coast of Bohai Bay, China

NASA Astrophysics Data System (ADS)

Shang, Zhiwen; Wang, Fu; Li, Jianfen; Marshall, William A.; Chen, Yongsheng; Jiang, Xingyu; Tian, Lizhu; Wang, Hong

2016-01-01

Shelly cheniers and shell-rich beds found intercalated in near-shore marine muds and sandy sediments can be used to indicate the location of ancient shorelines, and help to estimate the height of sea level. However, dating the deposition of material within cheniers and shell-rich beds is not straightforward because much of this material is transported and re-worked, creating an unknown temporal off-set, i.e., the residence time, between the death of a shell and its subsequent entombment. To quantify the residence time during the Holocene on a section of the northern Chinese coastline a total 47 shelly subsamples were taken from 17 discrete layers identified on the west coast of Bohai Bay. This material was AMS 14C dated and the calibrated ages were systematically compared. The subsamples were categorized by type as articulated and disarticulated bivalves, gastropod shells, and undifferentiated shell-hash. It was found that within most individual layers the calibrated ages of the subsamples got younger relative to the amount of apparent post-mortem re-working the material had been subject to. For examples, the 14C ages of the bivalve samples trended younger in this order: shell-hash → split shells → articulated shells. We propose that the younger subsample age determined within an individual layer will be the closest to the actual depositional age of the material dated. Using this approach at four Holocene sites we find residence times which range from 100 to 1260 cal yrs, with two average values of 600 cal yrs for the original 14C dates older than 1 ka cal BP and 100 cal yrs for the original 14C dates younger than 1 ka cal BP, respectively. Using this semi-empirical estimation of the shell residence times we have refined the existing chronology of the Holocene chenier ridges on the west coast of Bohai Bay.

Simulation-based educational curriculum for fluoroscopically guided lumbar puncture improves operator confidence and reduces patient dose.

PubMed

Faulkner, Austin R; Bourgeois, Austin C; Bradley, Yong C; Hudson, Kathleen B; Heidel, R Eric; Pasciak, Alexander S

2015-05-01

Fluoroscopically guided lumbar puncture (FGLP) is a commonly performed procedure with increased success rates relative to bedside technique. However, FGLP also exposes both patient and staff to ionizing radiation. The purpose of this study was to determine if the use of a simulation-based FGLP training program using an original, inexpensive lumbar spine phantom could improve operator confidence and efficiency, while also reducing patient dose. A didactic and simulation-based FGLP curriculum was designed, including a 1-hour lecture and hands-on training with a lumbar spine phantom prototype developed at our institution. Six incoming post-graduate year 2 (PGY-2) radiology residents completed a short survey before taking the course, and each resident practiced 20 simulated FGLPs using the phantom before their first clinical procedure. Data from the 114 lumbar punctures (LPs) performed by the six trained residents (prospective cohort) were compared to data from 514 LPs performed by 17 residents who did not receive simulation-based training (retrospective cohort). Fluoroscopy time (FT), FGLP success rate, and indication were compared. There was a statistically significant reduction in average FT for the 114 procedures performed by the prospective study cohort compared to the 514 procedures performed by the retrospective cohort. This held true for all procedures in aggregate, LPs for myelography, and all procedures performed for a diagnostic indication. Aggregate FT for the prospective group (0.87 ± 0.68 minutes) was significantly lower compared to the retrospective group (1.09 ± 0.65 minutes) and resulted in a 25% reduction in average FT (P = .002). There was no statistically significant difference in the number of failed FGLPs between the two groups. Our simulation-based FGLP curriculum resulted in improved operator confidence and reduced FT. These changes suggest that resident procedure efficiency was improved, whereas patient dose was reduced. The FGLP training program was implemented by radiology residents and required a minimal investment of time and resources. The LP spine phantom used during training was inexpensive, durable, and effective. In addition, the phantom is compatible with multiple modalities including fluoroscopy, computed tomography, and ultrasound and could be easily adapted to other applications such as facet injections or joint arthrograms. Copyright © 2015 AUR. Published by Elsevier Inc. All rights reserved.

The early effects of code 405 work rules on attitudes of orthopaedic residents and attending surgeons.

PubMed

Zuckerman, Joseph D; Kubiak, Eric N; Immerman, Igor; Dicesare, Paul

2005-04-01

The impact of strict enforcement of Section 405 of the New York State Public Health Code to restrict resident work to eighty hours per week and the adoption of a similar policy by the Accreditation Council on Graduate Medical Education in 2002 for orthopaedic residency training have not been evaluated. Adoption of these rules has created accreditation as well as staffing problems and has generated controversy in the surgical training community. The purposes of this study were (1) to evaluate the attitudes of orthopaedic residents and attending surgeons toward the Code 405 work-hour regulations and the effect of those regulations on the perceived quality of residency training, quality of life, and patient care and (2) to quantify the effect of the work-hour restrictions on the actual number of hours worked. We administered a thirty-four-question Likert-style questionnaire to forty-eight orthopaedic surgery residents (postgraduate years [PGY]-2 through 5) and a similar twenty-nine-question Likert-style questionnaire to thirty-nine orthopaedic attending surgeons. All questionnaires were collected anonymously and analyzed. Additionally, resident work hours before and after strict enforcement of the Code 405 regulations were obtained from resident time sheets. The average weekly work hours decreased from 89.25 to 74.25 hours for PGY-2 residents and from 86.5 to 73.25 hours for PGY-3 residents, and they increased from 61.5 to 68.5 hours for PGY-4 residents. Residents at all levels felt that they had increased time available for reading. There was general agreement between attending and resident surgeons that their operating experience had been negatively impacted. Senior residents thought that their education had been negatively affected, while junior residents thought that their operating experience in general had been negatively affected. Senior residents and attending surgeons felt that continuity of care had been negatively impacted. All agreed that quality of life for the residents had improved and that residents were more rested. On the basis of the survey data, the implementation of the new work-hour restrictions was found to result in a decrease in the number of hours worked per week for PGY-2 and PGY-3 residents and in an increase in work hours for PGY-4 residents. This could explain the definite difference between the attitudes expressed by the senior residents and those of the junior residents. Senior residents felt that their education was negatively impacted by the work rules, while junior residents expressed a more neutral view. However, senior residents did not believe that their operative experience was as negatively impacted as did junior residents. Although junior and senior residents and attending surgeons agreed that resident quality of life had improved, we were not able to determine whether this offset the perceived negative impact on education, continuity of care, and operative experience.

Of duty hour violations and shift work: changing the educational paradigm.

PubMed

Kohlbrenner, Amanda; Dirks, Rachel; Davis, James; Wolfe, Mary; Maser, Christina

2016-06-01

Successful surgical education balances learning opportunities with Accreditation Council on Graduate Medical Education (ACGME) duty hour requirements. We instituted a night shift system and hypothesized that implementation would decrease duty hour violations while maintaining quality education. A system of alternating teams working 12-hour shifts was instituted and was assessed via an electronic survey distributed at 2, 6, and 12 months after implementation. Resident duty hour violations and resident case volume were evaluated for 1 year before and 2 years after implementation of the night shift system. Survey data revealed a decrease in the perception that residents had problems meeting duty hour restrictions from 44% to 14% at 12 months (P = .012). Total violations increased 26% in the 1st year, subsequently decreasing by 62%, with shift length violations decreasing by 90%. Resident availability for didactics was improved, and average operative cases per academic year increased by 65%. Night shift systems are feasible and help meet duty hour requirements. Our program decreased violations while increasing operative volume and didactic time. Copyright © 2015 Elsevier Inc. All rights reserved.

Geometrical effects on the electron residence time in semiconductor nano-particles.

PubMed

Koochi, Hakimeh; Ebrahimi, Fatemeh

2014-09-07

We have used random walk (RW) numerical simulations to investigate the influence of the geometry on the statistics of the electron residence time τ(r) in a trap-limited diffusion process through semiconductor nano-particles. This is an important parameter in coarse-grained modeling of charge carrier transport in nano-structured semiconductor films. The traps have been distributed randomly on the surface (r(2) model) or through the whole particle (r(3) model) with a specified density. The trap energies have been taken from an exponential distribution and the traps release time is assumed to be a stochastic variable. We have carried out (RW) simulations to study the effect of coordination number, the spatial arrangement of the neighbors and the size of nano-particles on the statistics of τ(r). It has been observed that by increasing the coordination number n, the average value of electron residence time, τ̅(r) rapidly decreases to an asymptotic value. For a fixed coordination number n, the electron's mean residence time does not depend on the neighbors' spatial arrangement. In other words, τ̅(r) is a porosity-dependence, local parameter which generally varies remarkably from site to site, unless we are dealing with highly ordered structures. We have also examined the effect of nano-particle size d on the statistical behavior of τ̅(r). Our simulations indicate that for volume distribution of traps, τ̅(r) scales as d(2). For a surface distribution of traps τ(r) increases almost linearly with d. This leads to the prediction of a linear dependence of the diffusion coefficient D on the particle size d in ordered structures or random structures above the critical concentration which is in accordance with experimental observations.

Volatile organic compound measurements at Trinidad Head, California, during ITCT 2K2: Analysis of sources, atmospheric composition, and aerosol residence times

NASA Astrophysics Data System (ADS)

Millet, Dylan B.; Goldstein, Allen H.; Allan, James D.; Bates, Timothy S.; Boudries, Hacene; Bower, Keith N.; Coe, Hugh; Ma, Yilin; McKay, Megan; Quinn, Patricia K.; Sullivan, Amy; Weber, Rodney J.; Worsnop, Douglas R.

2004-12-01

We report hourly in-situ observations of C1-C8 speciated volatile organic compounds (VOCs) obtained at Trinidad Head CA in April and May 2002 as part of the NOAA Intercontinental Transport and Chemical Transformation study. Factor analysis of the VOC data set was used to define the dominant processes driving atmospheric chemical composition at the site, and to characterize the sources for measured species. Strong decreases in background concentration were observed for several of the VOCs during the experiment due to seasonal changes in OH concentration. CO was the most important contributor to the total measured OH reactivity at the site at all times. Oxygenated VOCs were the primary component of both the total VOC burden and of the VOC OH reactivity, and their relative importance was enhanced under conditions when local source contributions were minimal. VOC variability exhibited a strong dependence on residence time (slnX = 1.55τ-0.44, r2 = 0.98; where slnX is the standard deviation of the natural logarithm of the mixing ratio), and this relationship was used, in conjunction with measurements of 222Rn, to estimate the average OH concentration during the study period (6.1 × 105 molec/cm3). We also employed the variability-lifetime relationship defined by the VOC data set to estimate submicron aerosol residence times as a function of chemical composition. Two independent measures of aerosol chemical composition yielded consistent residence time estimates. Lifetimes calculated in this manner were between 3-7 days for aerosol nitrate, organics, sulfate, and ammonium. The lifetime estimate for methane sulfonic acid (˜12 days) was slightly outside of this range. The lifetime of the total aerosol number density was estimated at 9.8 days.

Impact of a dermatology wiki website on dermatology education.

PubMed

Karimkhani, Chante; Boyers, Lindsay N; Ellis, Lixia Z; Brice, Sylvia; Chen, David L; Dunnick, Cory A; Dellavalle, Robert P

2015-01-15

The Dermatology Education Wiki (dermwiki) website serves as a resource platform for medical students and residents. The readily accessible interface provides dermatology articles, survival guides, didactic lectures, and links to faculty talks as well as research opportunities. To assess medical student and resident satisfaction with the dermwiki website. Fourth-year medical students taking a dermatology elective were provided with a temporary password to access relevant dermwiki information. A satisfaction survey was created to assess whether medical students found the website helpful. Second- and third-year dermatology residents were also surveyed to compare satisfaction scores prior to and after the introduction of the dermwiki website. End-of-rotation medical student exam scores were tabulated and compared to the average scores from years prior to the development of the dermwiki website. Medical students rated the dermatology elective with the dermwiki website higher than rotations without a wiki (8.12 vs 7.31). Students planning to go into dermatology were more satisfied with the dermwiki website, reported accessing the website more frequently (11 times vs 9.5 times), and reported more time spent studying (12.2 hours vs 6.7 hours) than students not going into dermatology. End-of-rotation medical student exam scores did not differ from those prior to the development of the demwiki website. Ten second- and third-year dermatology residents unanimously stated that they were more satisfied with the program after the institution of the dermwiki website. Overall, addition of the dermwiki website to the dermatology elective curriculum has improved medical student and resident satisfaction scores. The improvement is greater among students planning to enter the field of dermatology. This study serves as a model for the incorporation of internet-based interactive tools to transform and supplement the learning environment.

Gardening for Health: Patterns of Gardening and Fruit and Vegetable Consumption Among the Navajo.

PubMed

Ornelas, India J; Osterbauer, Katie; Woo, Lisa; Bishop, Sonia K; Deschenie, Desiree; Beresford, Shirley A A; Lombard, Kevin

2018-05-19

American Indians, including Navajo, are disproportionately affected by obesity and diabetes, in part due to diet-related health behaviors. The purpose of this study was to assess the patterns of gardening and fruit and vegetable (FV) consumption among residents in two communities on the Navajo Nation in order to inform a community gardening intervention. We analyzed survey data collected from participants in the Yéego Gardening study conducted in two communities in the Navajo Nation (N = 169). We found that 51% of the sample gardened, and on average participants gardened 8.9 times per month. Lack of time (53%) and financial barriers, such as gas for transportation or irrigation (51 and 49%, respectively), were reported as barriers to gardening. Most participants reported low levels of self-efficacy (80%) and behavioral capability (82%) related to gardening. Those with higher levels of gardening self-efficacy and behavioral capability reported more frequent gardening. Average daily FV consumption was 2.5 servings. Most participants reported high levels of self-efficacy to eat FV daily (64%) and high behavioral capability to prepare FV (66%). There was a positive association between FV consumption and gardening, with those gardening more than 4 times per month eating about 1 more serving of FV per day than those gardening 4 or fewer times per month. Further research is needed to better understand how gardening can increase fruit and vegetable availability and consumption among residents of the Navajo Nation.

Resident Duty Hours: Enhancing Sleep, Supervision, and Safety

ERIC Educational Resources Information Center

Ulmer, Cheryl, Ed.; Wolman, Dianne Miller, Ed.; Johns, Michael M. E., Ed.

2009-01-01

Medical residents in hospitals are often required to be on duty for long hours. In 2003 the organization overseeing graduate medical education adopted common program requirements to restrict resident workweeks, including limits to an average of 80 hours over 4 weeks and the longest consecutive period of work to 30 hours in order to protect…

Outcome trajectories for assisted living and nursing facility residents in Oregon.

PubMed Central

Frytak, J R; Kane, R A; Finch, M D; Kane, R L; Maude-Griffin, R

2001-01-01

OBJECTIVE: To compare assisted living residents and nursing home residents on outcome trajectories for three outcomes: ability to perform activities of daily living (ADLs), psychological well-being, and pain and discomfort. DATA SOURCES/STUDY SETTING: A representative sample of one-third of the census from 38 participating assisted living facilities (N = 605) and two-fifths of the census from 31 participating nursing facilities (N = 610). STUDY DESIGN: A longitudinal design using hierarchical linear models to examine how setting (being in an assisted living setting or in a nursing home) affected growth trajectories for each outcome studied when adjusting for other resident characteristics. DATA COLLECTION: Residents or their proxies were interviewed and chart reviews done at baseline, six months, and one year. All baseline data were collected between August 1995 and May 1996. PRINCIPAL FINDINGS: We found differences in case mix between assisted living and nursing facility residents but no differences in outcome trajectories for ADLs, psychological well-being, and pain and discomfort. For ADLs and pain and discomfort on average, residents in both settings experienced change over the study period. For psychological well-being, residents experienced no change on average. CONCLUSIONS: The lack of difference in growth trajectories for ADLs, pain and discomfort, and psychological well-being between the two settings was noteworthy. PMID:11324746

Resident Fuel Levels: Reframing, Assessing, and Addressing Well-Being.

PubMed

Scielzo, Shannon Amerilda; Weigle, David C; Kazi, Salahuddin Dino

2018-04-01

To optimize resident learning, programs need to readily assess resident well-being. There is a lack of easy-to-use, acceptable instruments for this task. We created a well-being "fuel gauge," and assessed the acceptability and feasibility of this weekly electronic communication pipeline for residents to report and discuss their well-being. A well-being fuel gauge assessment was administered weekly over the course of 1 academic year (July 2016 to June 2017) in a large internal medicine residency program. The well-being gauge asked residents to report their fuel levels using a 1 to 5 Likert-type scale (1, empty ; 3, half tank ; and 5, full tank ). Residents who provided low scores (1 or 2) were contacted by program leadership, and the program director sent weekly e-mail updates that addressed residents' comments on their well-being fuel gauge. Of 163 residents, 149 (91%) provided data on their well-being fuel gauge, with a 53% average weekly response rate. Fifty-four percent of residents (80 of 149) reported a low score over the course of the year, and 4 residents only used the assessment to report a low score. Comments on average consisted of 280 characters (SD = 357) and were lengthier and more prevalent with lower fuel gauge scores. We analyzed the relationship between scores and comments. The well-being fuel gauge was well accepted by most residents and was easy to administer and to oversee by program directors. It facilitated ongoing monitoring of well-being and follow-up to address factors contributing to low well-being.

Infrared spectral and carbon isotopic characteristics of micro- and macro-diamonds from the Panda kimberlite (Central Slave Craton, Canada)

NASA Astrophysics Data System (ADS)

Melton, G. L.; Stachel, T.; Stern, R. A.; Carlson, J.; Harris, J. W.

2013-09-01

One hundred and twenty-one micro-diamonds (< 1 mm) and 90 macro-diamonds (2.5 mm to 3.4 mm) from the Panda kimberlite (Ekati mine, Central Slave Craton, Canada) were analyzed for nitrogen content, nitrogen aggregation state (%B) and platelet and hydrogen peak areas (cm- 2). Micro-diamond nitrogen concentrations range from < 10 at. ppm to 1696 at. ppm (median = 805 at. ppm) and the median aggregation state is 23%B. Macro-diamonds range from < 10 at. ppm to 1260 at. ppm (median = 187 at. ppm) nitrogen and have a median nitrogen aggregation of 26%B. Platelet and hydrogen peaks were observed in 37% and 79% of the micro-diamonds and 79% and 56% of the macro-diamonds, respectively. Nitrogen based time averaged residence temperatures indicate that micro- and macro-diamonds experienced similar thermal mantle residence histories, both populations displaying bimodal residence temperature distributions with a gap between 1130 °C and 1160 °C (at 3.5 Ga residence). In addition, SIMS carbon isotopic analyses for the micro-diamonds were obtained: δ13C compositions range from - 6.9‰ to + 1.8‰ (median = - 4.3‰). CL imaging reveals distinct growth layers that in some samples differ by > 2‰, but mostly vary by < 0.5‰. Comparison of only the “gem-quality” samples (n = 49 micro- and 90 macro-diamonds) between the two diamond sets, indicates a statistically significant shift of + 1.3‰ in average δ13C from macro- to micro-diamonds and this shift documents distinct diamond forming fluids, fractionation process or growth histories. A broad transition to heavier isotopic values is also observed in connection to decreasing mantle residence temperatures. The bimodal mantle residence temperature distribution may coincide with the transition from highly depleted shallow to more fertile deep lithospheric mantle observed beneath the Central Slave Craton. The increase in δ13C with decreasing residence temperature (proxy for decreasing depth) is interpreted to reflect diamond formation from a carbonate-bearing metasomatic fluid/melt that isotopically evolves as it percolates upward through the lithosphere.

Evaluating RVUs as a measure of workload for use in assessing fatigue

NASA Astrophysics Data System (ADS)

Krupinski, Elizabeth A.; MacKinnon, Lea; Hasselbach, Karl; Taljanovic, Mihra

2015-03-01

Physician work is not well defined and does not take into account all of the activities and tasks involved in interpreting cases. We observed 3 MSK radiologists reading 100 cases. We recorded types of cases, whether residents/fellows were present, total time per case, time spent teaching, and time for interruptions. There were residents/fellows present for 65% of the cases. On average, when residents/fellows were present it took significantly longer to read a case. Overall, prior studies were accessed for 25% of the cases, with radiographs and CT accessing them more than MRI and US. Time per case was significantly longer when prior studies were included. In terms of interruptions, 9.24% of the time was taken up by calls to/from other clinicians, talking to technologists, discussing case protocols, and technical problems. All interruptions occurred during a case review. We downloaded RVU data for the 3 radiologists and correlated them with the actual times per case. The overall correlation was 0.215. For a given RVU, the actual amount of time spent on the case varies. Radiologists spend more time per case than assigned RVUs account for. This underestimation contributes to expectations of increased workloads, leading potentially to more and more cases being read in shorter amounts of time leading to increased fatigue and stress that could lead to increases in error rates. In order to better address fatigue and stress in the radiology department we need to better understand the pressures radiologists face and possibly reevaluate the RVU system.

Leadership and business education in orthopaedic residency training programs.

PubMed

Kiesau, Carter D; Heim, Kathryn A; Parekh, Selene G

2011-01-01

Leadership and business challenges have become increasingly present in the practice of medicine. Orthopaedic residency programs are at the forefront of educating and preparing orthopaedic surgeons. This study attempts to quantify the number of orthopaedic residency programs in the United States that include leadership or business topics in resident education program and to determine which topics are being taught and rate the importance of various leadership characteristics and business topics. A survey was sent to all orthopaedic department chairpersons and residency program directors in the United States via e-mail. The survey responses were collected using a survey collection website. The respondents rated the importance of leadership training for residents as somewhat important. The quality of character, integrity, and honesty received the highest average rating among 19 different qualities of good leaders in orthopaedics. The inclusion of business training in resident education was also rated as somewhat important. The topic of billing and coding received the highest average rating among 14 different orthopaedically relevant business topics. A variety of topics beyond the scope of clinical practice must be included in orthopaedic residency educational curricula. The decreased participation of newly trained orthopaedic surgeons in leadership positions and national and state orthopaedic organizations is concerning for the future of orthopaedic surgery. Increased inclusion of leadership and business training in resident education is important to better prepare trainees for the future.

An evaluation of the availability, accessibility, and quality of online content of vascular surgery training program websites for residency and fellowship applicants.

PubMed

Huang, Bryant Y; Hicks, Taylor D; Haidar, Georges M; Pounds, Lori L; Davies, Mark G

2017-12-01

Vascular surgery residency and fellowship applicants commonly seek information about programs from the Internet. Lack of an effective web presence curtails the ability of programs to attract applicants, and in turn applicants may be unable to ascertain which programs are the best fit for their career aspirations. This study was designed to evaluate the presence, accessibility, comprehensiveness, and quality of vascular surgery training websites (VSTW). A list of accredited vascular surgery training programs (integrated residencies and fellowships) was obtained from four databases for vascular surgery education: the Accreditation Council for Graduate Medical Education, Electronic Residency Application Service, Fellowship and Residency Electronic Interactive Database, and Society for Vascular Surgery. Programs participating in the 2016 National Resident Matching Program were eligible for study inclusion. Accessibility of VSTW was determined by surveying the Accreditation Council for Graduate Medical Education, Electronic Residency Application Service, and Fellowship and Residency Electronic Interactive Database for the total number of programs listed and for the presence or absence of website links. VSTW were analyzed for the availability of recruitment and education content items. The quality of VSTW was determined as a composite of four dimensions: content, design, organization, and user friendliness. Percent agreements and kappa statistics were calculated for inter-rater reliability. Eighty-nine of the 94 fellowship (95%) and 45 of the 48 integrated residencies (94%) programs participating in the 2016 Match had a VSTW. For program recruitment, evaluators found an average of 12 of 32 content items (35.0%) for fellowship programs and an average of 12 of 32 (37%) for integrated residencies. Only 47.1% of fellowship programs (53% integrated residencies) specified the number of positions available for the 2016 Match, 20% (13% integrated residencies) indicated alumni career placement, 34% (38% integrated residencies) supplied interview dates, and merely 17% (18% integrated residencies) detailed the selection process. For program education, fellowship websites provided an average of 5.1 of 15 content items (34.0%), and integrated residency websites provided 5 of 14 items (34%). Of the fellowship programs, 66% (84.4% integrated residencies) provided a rotation schedule, 65% (56% integrated residencies) detailed operative experiences, 38% (38% integrated residencies) posted conference schedules, and just 16% (28.9% integrated residencies) included simulation training. The web presence of vascular surgery training programs lacks sufficient accessibility, content, organization, design, and user friendliness to allow applicants to access information that informs them sufficiently. There are opportunities to more effectively use VSTW for the benefit of training programs and prospective applicants. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Isotopic incorporation rates and discrimination factors in mantis shrimp crustaceans.

PubMed

deVries, Maya S; Del Rio, Carlos Martínez; Tunstall, Tate S; Dawson, Todd E

2015-01-01

Stable isotope analysis has provided insights into the trophic ecology of a wide diversity of animals. Knowledge about isotopic incorporation rates and isotopic discrimination between the consumer and its diet for different tissue types is essential for interpreting stable isotope data, but these parameters remain understudied in many animal taxa and particularly in aquatic invertebrates. We performed a 292-day diet shift experiment on 92 individuals of the predatory mantis shrimp, Neogonodactylus bredini, to quantify carbon and nitrogen incorporation rates and isotope discrimination factors in muscle and hemolymph tissues. Average isotopic discrimination factors between mantis shrimp muscle and the new diet were 3.0 ± 0.6 ‰ and 0.9 ± 0.3 ‰ for carbon and nitrogen, respectively, which is contrary to what is seen in many other animals (e.g. C and N discrimination is generally 0-1 ‰ and 3-4 ‰, respectively). Surprisingly, the average residence time of nitrogen in hemolymph (28.9 ± 8.3 days) was over 8 times longer than that of carbon (3.4 ± 1.4 days). In muscle, the average residence times of carbon and nitrogen were of the same magnitude (89.3 ± 44.4 and 72.8 ± 18.8 days, respectively). We compared the mantis shrimps' incorporation rates, along with rates from four other invertebrate taxa from the literature, to those predicted by an allometric equation relating carbon incorporation rate to body mass that was developed for teleost fishes and sharks. The rate of carbon incorporation into muscle was consistent with rates predicted by this equation. Our findings provide new insight into isotopic discrimination factors and incorporation rates in invertebrates with the former showing a different trend than what is commonly observed in other animals.

Development and validation of sunlight exposure measurement questionnaire (SEM-Q) for use in adult population residing in Pakistan

PubMed Central

2012-01-01

Background Vitamin D deficiency has been identified as a major public health problem worldwide. Sunlight is the main source of vitamin D and its measurement using dosimeters is expensive and difficult for use in population-based studies. Hence, the aim of this study was to develop and validate questionnaires to assess sunlight exposure in healthy individuals residing in Karachi, Pakistan. Methods Two questionnaires with seven important items for sunlight exposure assessment were developed. Fifty four healthy adults were enrolled based on their reported sunlight exposure (high = 17, moderate = 18, low = 19) from Aga Khan University, Karachi. Over four days, study participants were asked to wear a dosimeter between sunrise and sunset and report time spent and activities undertaken in the sun for questionnaire validation. Algorithm for item weightage was created as an average score based on ultraviolet B percentage received. Blood samples were obtained for serum vitamin D. Results The mean time (minutes) spent in sun over 4 days (±SD) was 69.5 (±32) for low, 83.5 (±29.7) for moderate and 329 (±115) for high exposure group. The correlation between average time (minutes) spent in sun over 4 days and mean change in absorbance of UV dosimeters for 4 days was 0.60 (p < 0.01). Correlation between average score and vitamin D levels was found to be 0.36 (p = 0.01) for short term questionnaire score, 0.43 (p = 0.01) for long term questionnaire score in summers and 0.48 (p = 0.01) in winters. Conclusions The sunlight exposure measurement questionnaires were valid tools for use in large epidemiological studies to quantify sunlight exposure. PMID:22682277

Development and validation of sunlight exposure measurement questionnaire (SEM-Q) for use in adult population residing in Pakistan.

PubMed

Humayun, Quratulain; Iqbal, Romaina; Azam, Iqbal; Khan, Aysha Habib; Siddiqui, Amna Rehana; Baig-Ansari, Naila

2012-06-08

Vitamin D deficiency has been identified as a major public health problem worldwide. Sunlight is the main source of vitamin D and its measurement using dosimeters is expensive and difficult for use in population-based studies. Hence, the aim of this study was to develop and validate questionnaires to assess sunlight exposure in healthy individuals residing in Karachi, Pakistan. Two questionnaires with seven important items for sunlight exposure assessment were developed. Fifty four healthy adults were enrolled based on their reported sunlight exposure (high = 17, moderate = 18, low = 19) from Aga Khan University, Karachi. Over four days, study participants were asked to wear a dosimeter between sunrise and sunset and report time spent and activities undertaken in the sun for questionnaire validation. Algorithm for item weightage was created as an average score based on ultraviolet B percentage received. Blood samples were obtained for serum vitamin D. The mean time (minutes) spent in sun over 4 days (±SD) was 69.5 (±32) for low, 83.5 (±29.7) for moderate and 329 (±115) for high exposure group. The correlation between average time (minutes) spent in sun over 4 days and mean change in absorbance of UV dosimeters for 4 days was 0.60 (p < 0.01). Correlation between average score and vitamin D levels was found to be 0.36 (p = 0.01) for short term questionnaire score, 0.43 (p = 0.01) for long term questionnaire score in summers and 0.48 (p = 0.01) in winters. The sunlight exposure measurement questionnaires were valid tools for use in large epidemiological studies to quantify sunlight exposure.

Isotopic Incorporation Rates and Discrimination Factors in Mantis Shrimp Crustaceans

PubMed Central

deVries, Maya S.; del Rio, Carlos Martínez; Tunstall, Tate S.; Dawson, Todd E.

2015-01-01

Stable isotope analysis has provided insights into the trophic ecology of a wide diversity of animals. Knowledge about isotopic incorporation rates and isotopic discrimination between the consumer and its diet for different tissue types is essential for interpreting stable isotope data, but these parameters remain understudied in many animal taxa and particularly in aquatic invertebrates. We performed a 292-day diet shift experiment on 92 individuals of the predatory mantis shrimp, Neogonodactylus bredini, to quantify carbon and nitrogen incorporation rates and isotope discrimination factors in muscle and hemolymph tissues. Average isotopic discrimination factors between mantis shrimp muscle and the new diet were 3.0 ± 0.6 ‰ and 0.9 ± 0.3 ‰ for carbon and nitrogen, respectively, which is contrary to what is seen in many other animals (e.g. C and N discrimination is generally 0–1 ‰ and 3–4 ‰, respectively). Surprisingly, the average residence time of nitrogen in hemolymph (28.9 ± 8.3 days) was over 8 times longer than that of carbon (3.4 ± 1.4 days). In muscle, the average residence times of carbon and nitrogen were of the same magnitude (89.3 ± 44.4 and 72.8 ± 18.8 days, respectively). We compared the mantis shrimps’ incorporation rates, along with rates from four other invertebrate taxa from the literature, to those predicted by an allometric equation relating carbon incorporation rate to body mass that was developed for teleost fishes and sharks. The rate of carbon incorporation into muscle was consistent with rates predicted by this equation. Our findings provide new insight into isotopic discrimination factors and incorporation rates in invertebrates with the former showing a different trend than what is commonly observed in other animals. PMID:25835953

Milestone Ratings and Supervisory Role Categorizations Swim Together, but is the Water Muddy?

PubMed

Schumacher, Daniel J; Bartlett, Kathleen W; Elliott, Sean P; Michelson, Catherine; Sharma, Tanvi; Garfunkel, Lynn C; King, Beth; Schwartz, Alan

2018-06-17

This single specialty, multi-institutional study aimed to determine: 1) the association between milestone ratings for individual competencies and average milestone ratings (AMRs) and 2) the association between AMRs and recommended supervisory role categorizations made by individual clinical competency committee (CCC) members. During the 2015-16 academic year, CCC members at 14 pediatric residencies reported milestone ratings for 21 competencies and recommended supervisory role categories (may not supervise, may supervise in some settings, may supervise in all settings) for residents they reviewed. An exploratory factor analysis of competencies was conducted. The associations between individual competencies, the AMR, and supervisory role categorizations were determined by computing bivariate correlations. The relationship between AMRs and recommended supervisory role categorizations was examined using an ordinal mixed logistic regression model. 68/155 CCC members completed both milestone assignments and supervision categorizations for 451 residents. Factor analysis of individual competencies controlling for clustering of residents in raters and sites resulted in a single-factor solution (cumulative variance 0.75). All individual competencies had large positive correlations with the AMR (correlation coefficient: 0.84-0.93), except for two professionalism competencies (Prof1: 0.63 and Prof4: 0.65). When combined across training year and time points, the AMR and supervisory role categorization had a moderately positive correlation (0.56). This exploratory study identified a modest correlation between average milestone ratings and supervisory role categorization. Convergence of competencies on a single factor deserves further exploration, with possible rater effects warranting attention. Copyright © 2018. Published by Elsevier Inc.

Bacterial, viral and turbidity removal by intermittent slow sand filtration for household use in developing countries: experimental investigation and modeling.

PubMed

Jenkins, Marion W; Tiwari, Sangam K; Darby, Jeannie

2011-11-15

A two-factor three-block experimental design was developed to permit rigorous evaluation and modeling of the main effects and interactions of sand size (d(10) of 0.17 and 0.52 mm) and hydraulic head (10, 20, and 30 cm) on removal of fecal coliform (FC) bacteria, MS2 bacteriophage virus, and turbidity, under two batch operating modes ('long' and 'short') in intermittent slow sand filters (ISSFs). Long operation involved an overnight pause time between feeding of two successive 20 L batches (16 h average batch residence time (RT)). Short operation involved no pause between two 20 L batch feeds (5h average batch RT). Conditions tested were representative of those encountered in developing country field settings. Over a ten week period, the 18 experimental filters were fed river water augmented with wastewater (influent turbidity of 5.4-58.6 NTU) and maintained with the wet harrowing method. Linear mixed modeling allowed systematic estimates of the independent marginal effects of each independent variable on each performance outcome of interest while controlling for the effects of variations in a batch's actual residence time, days since maintenance, and influent turbidity. This is the first study in which simultaneous measurement of bacteria, viruses and turbidity removal at the batch level over an extended duration has been undertaken with a large number of replicate units to permit rigorous modeling of ISSF performance variability within and across a range of likely filter design configurations and operating conditions. On average, the experimental filters removed 1.40 log fecal coliform CFU (SD 0.40 log, N=249), 0.54 log MS2 PFU (SD 0.42 log, N=245) and 89.0 percent turbidity (SD 6.9 percent, N=263). Effluent turbidity averaged 1.24 NTU (SD 0.53 NTU, N=263) and always remained below 3 NTU. Under the best performing design configuration and operating mode (fine sand, 10 cm head, long operation, initial HLR of 0.01-0.03 m/h), mean 1.82 log removal of bacteria (98.5%) and mean 0.94 log removal of MS2 viruses (88.5%) were achieved. Results point to new recommendations regarding filter design, manufacture, and operation for implementing ISSFs in local settings in developing countries. Sand size emerged as a critical design factor on performance. A single layer of river sand used in this investigation demonstrated removals comparable to those reported for 2 layers of crushed sand. Pause time and increased residence time each emerged as highly beneficial for improving removal performance on all four outcomes. A relatively large and significant negative effect of influent turbidity on MS2 viral removal in the ISSF was measured in parallel with a much smaller weaker positive effect of influent turbidity on FC bacterial removal. Disturbance of the schmutzdecke by wet harrowing showed no effect on virus removal and a modest reductive effect on the bacterial and turbidity removal as measured 7 days or more after the disturbance. For existing coarse sand ISSFs, this research indicates that a reduction in batch feed volume, effectively reducing the operating head and increasing the pore:batch volume ratio, could improve their removal performance by increasing batch residence time. Copyright © 2011 Elsevier Ltd. All rights reserved.

Coupling of anodic oxidation and adsorption by granular activated carbon for chemical oxygen demand removal from 4,4'-diaminostilbene-2,2'-disulfonic acid wastewater.

PubMed

Wang, Lizhang; Zhao, Yuemin

2010-01-01

Experiments were performed to reduce chemical oxygen demand (COD) from 4,4'-diaminostilbene-2,2'-disulfonic (DSD) acid manufacturing wastewater using electrochemical oxidation coupled with adsorption by granular activated carbon. The COD removal is affected by the residence time and applied voltage. When the residence time is increased, lower value of COD effluent could be obtained, however, the average current efficiency (ACE) decreased rapidly, and so does the applied voltage. In addition, aeration could effectively enhance COD removal efficiency and protect anodes from corrosion. Furthermore, the acidic condition is beneficial to the rapid decrease of COD and the values of pH effluent are independent of the initial solution pH. The optimization conditions obtained from these experiments are applied voltage of 4.8 V, residence time of 180 min and air-liquid ratio of 4.2 with the COD effluent of about 690 mg L⁻¹. In these cases, the ACE and energy consumption are 388% and 4.144 kW h kg⁻¹ COD, respectively. These perfect results from the experiments illustrate that the combined process is a considerable alternative for the treatment of industrial wastewater containing high concentration of organic pollutants and salinity.

Implementation of formal learning objectives during a physical medicine and rehabilitation sports medicine rotation.

PubMed

Smith, Jay; Laskowski, Edward R; Newcomer-Aney, Karen L; Thompson, Jeffrey M; Schaefer, Michael P; Morfe, Erasmus G

2005-04-01

To develop and implement formal learning objectives during a physical medicine and rehabilitation sports medicine rotation and characterize resident experiences with the objectives over a 16-mo period. Prospective, including learning objective development, implementation, and postrotation survey. A total of 69 learning objectives were developed by physical medicine and rehabilitation staff physician consensus, including 39 core objectives. Eighteen residents completed 4-wk sports medicine rotations from January 2003 through April 2004. Residents completed an average of 31 total objectives (45%; range, 3-52), of which 24 (62%; range, 3-35) were core. Residents completed the highest percentage of knee (60%), shoulder (57%), and ankle-foot (57%) objectives and reported that objectives related to these areas were most effective to facilitate learning. In general, residents reported that objective content was good and that the objectives delineated important concepts to learn during the rotation. Seventeen of 18 residents indicated that the objectives should be permanently implemented into the sports rotation and that similar objectives should be developed for other rotations. Based on our experience and the recommendations of residents, the average resident should be able to complete approximately 30 objectives during a typical 4-wk rotation. Successful implementation of specific, consensus-derived learning objectives is possible within the context of a busy clinical practice. Our initial physician staff and resident experience with the objectives suggests that this model may be useful as a supplementary educational tool in physical medicine and rehabilitation residency programs.

First Author Research Productivity of United States Radiation Oncology Residents: 2002-2007

DOE Office of Scientific and Technical Information (OSTI.GOV)

Morgan, Peter B.; Sopka, Dennis M.; Kathpal, Madeera

2009-08-01

Purpose: Participation in investigative research is a required element of radiation oncology residency in the United States. Our purpose was to quantify the first author research productivity of recent U.S. radiation oncology residents during their residency training. Methods and Materials: We performed a computer-based search of PubMed and a manual review of the proceedings of the annual meetings of the American Society for Therapeutic Radiology and Oncology to identify all publications and presented abstracts with a radiation oncology resident as the first author between 2002 and 2007. Results: Of 1,098 residents trained at 81 programs, 50% published {>=}1 article (range,more » 0-9), and 53% presented {>=}1 abstract (range, 0-3) at an American Society for Therapeutic Radiology and Oncology annual meeting. The national average was 1.01 articles published and 1.09 abstracts presented per resident during 4 years of training. Of 678 articles published, 82% represented original research and 18% were review articles. Residents contributed 15% of all abstracts at American Society for Therapeutic Radiology and Oncology annual meetings, and the resident contribution to orally presented abstracts increased from 12% to 21% during the study period. Individuals training at programs with >6 residents produced roughly twice as many articles and abstracts. Holman Research Pathway residents produced double the national average of articles and abstracts. Conclusion: Although variability exists among individuals and among training programs, U.S. radiation oncology residents routinely participate in investigative research suitable for publication or presentation at a scientific meeting. These data provide national research benchmarks that can assist current and future radiation oncology residents and training programs in their self-assessment and research planning.« less

Buffer capacity, ecosystem feedbacks, and seawater chemistry under global change

NASA Astrophysics Data System (ADS)

Jury, C. P.; Thomas, F. I.; Atkinson, M. J.; Jokiel, P. L.; Onuma, M. A.; Kaku, N.; Toonen, R. J.

2013-12-01

Ocean acidification (OA) results in reduced seawater pH and aragonite saturation state (Ωarag), but also reduced seawater buffer capacity. As buffer capacity decreases, diel variation in seawater chemistry increases. However, a variety of ecosystem feedbacks can modulate changes in both average seawater chemistry and diel seawater chemistry variation. Here we model these effects for a coastal, reef flat ecosystem. We show that an increase in offshore pCO2 and temperature (to 900 μatm and +3°C) can increase diel pH variation by as much as a factor of 2.5 and can increase diel pCO2 variation by a factor of 4.6, depending on ecosystem feedbacks and seawater residence time. Importantly, these effects are different between day and night. With increasing seawater residence time and increasing feedback intensity, daytime seawater chemistry becomes more similar to present-day conditions while nighttime seawater chemistry becomes less similar to present-day conditions. Better constraining ecosystem feedbacks under global change will improve projections of coastal water chemistry, but this study shows the importance of considering changes in both average carbonate chemistry and diel chemistry variation for organisms and ecosystems. Further, we will discuss our recent work examining the effects of diel seawater chemistry variation on coral calcification rates.

Bias of Tedlar bags in the measurement of agricultural odorants.

PubMed

Trabue, Steven L; Anhalt, Jennifer C; Zahn, James A

2006-01-01

Odor regulations typically specify the use of dynamic dilution olfactometery (DDO) as a method to quantify odor emissions, and Tedlar bags are the preferred holding container for grab samples. This study was conducted to determine if Tedlar bags affect the integrity of sampled air from animal operations. Air samples were collected simultaneously in both Tedlar bags and Tenax thermal desorption tubes. Sample sources originated from either a hydrocarbon-free air tank, dynamic headspace chamber (DHC), or swine-production facility, and were analyzed by gas chromatography-mass spectrometry-olfactometry (GC-MS-O). Several background contaminants were identified from Tedlar bags, which included the odorous compounds N,N-dimethyl acetamide (DMAC), acetic acid, and phenol. Samples from the DHC demonstrated that recovery of malodor compounds was dependent on residence time in the Tedlar bag with longer residence time leading to lower recovery. After 24 h of storage, recovery of C3-C6 volatile fatty acids (VFA) averaged 64%, 4-methylphenol and 4-ethylphenol averaged 10%, and indole and 3-methylindole were below the detection limits of GC-MS-O. The odor activity value (OAV) of grab samples collected in Tedlar bags were 33 to 65% lower following 24 h of storage. These results indicate that significant odorant bias occurs when using Tedlar bags for the sampling of odors from animal production facilities.

Physical activity and physical fitness of nursing home residents with cognitive impairment: A pilot study.

PubMed

Marmeleira, José; Ferreira, Soraia; Raimundo, Armando

2017-12-15

Physical activity and physical fitness are important for health, functional mobility and performance of everyday activities. To date, little attention has been given to physical activity and physical fitness among nursing home residents with cognitive impairment. Therefore, the main aim of this study was to examine physical activity behavior and physical fitness of institutionalized older adults with cognitive impairment and to investigate their interrelations. Forty-eight older adults with cognitive impairment (83.9±7.7years; 72.9% women) and 22 without cognitive impairment (82.2±8.8years; 54.5% women) participated. Physical activity was objectively assessed with accelerometers and physical fitness components (muscular strength, flexibility, balance, body composition and reaction time) were evaluated with physical fitness field tests. Nursing home residents with cognitive impairment spent only ~1min per day in moderate physical activity and ~89min in light physical activity. In average they accumulated 863 (±599) steps per day and spent 87.2% of the accelerometer wear time in sedentary behavior. Participants' physical fitness components were markedly low and according to the cut-offs used for interpreting the results a great number of nursing home residents had an increased risk of associated health problems, functional impairment and of falling. The performance in some physical fitness tests was positively associated with physical activity. Participants without cognitive impairment had higher levels of physical activity and physical fitness than their counterparts with cognitive impairment. These results indicate that nursing home residents, especially those with cognitive impairment, have low levels of physical activity, spent a high proportion of daytime in sedentary behavior and have low physical fitness. Nursing homes should implement health promotion strategies targeting physical activity and physical fitness of their residents. Copyright © 2017 Elsevier Inc. All rights reserved.

The reproductive experience of women living in hotels for the homeless in New York City.

PubMed

Chavkin, W; Kristal, A; Seabron, C; Guigli, P E

1987-01-01

Incidence of low birth weight, infant mortality and attendance at prenatal care were estimated for 401 residents of welfare hotels in New York City and compared to data from housing project residents and the city-wide population. Hotel residents and the pertinent data were ascertained from children's birth certificates dating from January 1982 to June 1984. In 1984 there were 2889 families (3498 adults and 6789 children) housed in 48 privately managed hotels and 7 shelters in the city, set up as emergency housing for the homeless. Most of these families were single women; over 50% were under 25. The racial and ethnic composition of hotel residents was similar to that of housing project tenants. The hotel residents have high birth rates: from 7/month in 1982 to 23/month in 1984. They receive significantly less prenatal care than project or city dwellers; more than half have 0-3 visits. The hotel residents had 2.5 times the likelihood of getting no prenatal care than project tenants, and 4.12 times the likelihood than the citywide population. Mean birth weight for hotel infants was 2979 g; for project infants 3128 g; for city infants 3253 g. Both welfare groups were significantly lower than citywide average birth weights. The infant mortality was 24.9 per 1000 for the hotel group, 16.6 for the project group, and 12.0 for the city population. The stress and inconvenience of living far from social service offices, clinics, schools and shops was considered the likely cause of poor attendance at prenatal care. It was recommended that the city provide on-site health education and care, social and nutrition services in the hotels, and refrigerators for mothers with newborn children.

A systematic review of the effects of residency training on patient outcomes

PubMed Central

2012-01-01

Background Residents are vital to the clinical workforce of today and tomorrow. Although in training to become specialists, they also provide much of the daily patient care. Residency training aims to prepare residents to provide a high quality of care. It is essential to assess the patient outcome aspects of residency training, to evaluate the effect or impact of global investments made in training programs. Therefore, we conducted a systematic review to evaluate the effects of relevant aspects of residency training on patient outcomes. Methods The literature was searched from December 2004 to February 2011 using MEDLINE, Cochrane, Embase and the Education Resources Information Center databases with terms related to residency training and (post) graduate medical education and patient outcomes, including mortality, morbidity, complications, length of stay and patient satisfaction. Included studies evaluated the impact of residency training on patient outcomes. Results Ninety-seven articles were included from 182 full-text articles of the initial 2,001 hits. All studies were of average or good quality and the majority had an observational study design. Ninety-six studies provided insight into the effect of 'the level of experience of residents' on patient outcomes during residency training. Within these studies, the start of the academic year was not without risk (five out of 19 studies), but individual progression of residents (seven studies) as well as progression through residency training (nine out of 10 studies) had a positive effect on patient outcomes. Compared with faculty, residents' care resulted mostly in similar patient outcomes when dedicated supervision and additional operation time were arranged for (34 out of 43 studies). After new, modified or improved training programs, patient outcomes remained unchanged or improved (16 out of 17 studies). Only one study focused on physicians' prior training site when assessing the quality of patient care. In this study, training programs were ranked by complication rates of their graduates, thus linking patient outcomes back to where physicians were trained. Conclusions The majority of studies included in this systematic review drew attention to the fact that patient care appears safe and of equal quality when delivered by residents. A minority of results pointed to some negative patient outcomes from the involvement of residents. Adequate supervision, room for extra operation time, and evaluation of and attention to the individual competence of residents throughout residency training could positively serve patient outcomes. Limited evidence is available on the effect of residency training on later practice. Both qualitative and quantitative research designs are needed to clarify which aspects of residency training best prepare doctors to deliver high quality care. PMID:22742521

26 CFR 1.163-10T - Qualified residence interest (temporary).

Code of Federal Regulations, 2010 CFR

2010-04-01

... general. (ii)Example. (g)Selection of method. (h)Average balance. (1)Average balance defined. (2)Average balance reported by lender. (3)Average balance computed on a daily basis. (i)In general. (ii)Example. (4)Average balance computed using the interest rate. (i)In general. (ii)Points and prepaid interest. (iii...

Aggregate Interview Method of ranking orthopedic applicants predicts future performance.

PubMed

Geissler, Jacqueline; VanHeest, Ann; Tatman, Penny; Gioe, Terence

2013-07-01

This article evaluates and describes a process of ranking orthopedic applicants using what the authors term the Aggregate Interview Method. The authors hypothesized that higher-ranking applicants using this method at their institution would perform better than those ranked lower using multiple measures of resident performance. A retrospective review of 115 orthopedic residents was performed at the authors' institution. Residents were grouped into 3 categories by matching rank numbers: 1-5, 6-14, and 15 or higher. Each rank group was compared with resident performance as measured by faculty evaluations, the Orthopaedic In-Training Examination (OITE), and American Board of Orthopaedic Surgery (ABOS) test results. Residents ranked 1-5 scored significantly better on patient care, behavior, and overall competence by faculty evaluation (P<.05). Residents ranked 1-5 scored higher on the OITE compared with those ranked 6-14 during postgraduate years 2 and 3 (P⩽.5). Graduates who had been ranked 1-5 had a 100% pass rate on the ABOS part 1 examination on the first attempt. The most favorably ranked residents performed at or above the level of other residents in the program; they did not score inferiorly on any measure. These results support the authors' method of ranking residents. The rigorous Aggregate Interview Method for ranking applicants consistently identified orthopedic resident candidates who scored highly on the Accreditation Council for Graduate Medical Education resident core competencies as measured by faculty evaluations, performed above the national average on the OITE, and passed the ABOS part 1 examination at rates exceeding the national average. Copyright 2013, SLACK Incorporated.

Determination of the Residence Time of Food Particles During Aseptic Sterilization

NASA Technical Reports Server (NTRS)

Carl, J. R.; Arndt, G. D.; Nguyen, T. X.

1994-01-01

The paper describes a non-invasive method to measure the time an individual particle takes to move through a length of stainless steel pipe. The food product is in two phase flow (liquids and solids) and passes through a pipe with pressures of approximately 60 psig and temperatures of 270-285 F. The proposed problem solution is based on the detection of transitory amplitude and/or phase changes in a microwave transmission path caused by the passage of the particles of interest. The particles are enhanced in some way, as will be discussed later, such that they will provide transitory changes that are distinctive enough not to be mistaken for normal variations in the received signal (caused by the non-homogeneous nature of the medium). Two detectors (transmission paths across the pipe) will be required and place at a known separation. A minimum transit time calculation is made from which the maximum velocity can be determined. This provides the minimum residence time. Also average velocity and statistical variations can be computed so that the amount of 'over-cooking' can be determined.

Mechanisms behind the failure of residents' longitudinal primary care to promote disclosure and discussion of psychosocial issues.

PubMed

Wissow, Lawrence S; Roter, Debra; Larson, Susan M; Wang, Mei-Cheng; Hwang, Wei-Ting; Johnson, Rachel; Luo, Xianghua

2002-07-01

Longitudinality (care by a single physician over time) and continuity (receipt of most care from a single physician) are believed to enhance patient-physician relationships and facilitate disclosure of emotional distress, but some studies suggest this potential goes unrealized. To determine whether care in a pediatric residents' continuity clinic promotes, over time, increased discussion, disclosure, and detection of parents' social and emotional distress and to understand physicians' communication behaviors underlying changes with time. Longitudinal, observational study of parent-physician interaction over the course of 1 year. One hundred ninety parents (90% African American) and their infants' primary care physicians (31 [4 Asians and 27 whites] first- and second-year pediatric residents). Frequency with which parents and physicians raised topics related to parental mood and family or social functioning; proportion of distressed parents discussing mood or functioning; and physicians' detection of parent distress. Physician initiation of psychosocial topics fell in the course of longitudinal relationships (odds of initiation in visits > or =6 vs odds of initiation in visits 1-5 = 0.46 [95% confidence limits, 0.31%, 0.67%]); parent initiation did not change over time nor was it increased by greater levels of continuity. Length of relationship was not associated with increased physician detection of parental distress or with increased rates of disclosure by distressed parents. Physicians' positively framed leading questions, and their avoidant responses to prior parental disclosures were significantly associated with decreased odds of problem disclosure. In contrast, visits in which parents or physicians raised psychosocial topics were characterized, on average, by 40% higher levels of physicians' "patient-centeredness" (increases of about 100 utterances per visit [95% confidence limits, 65.7%, 133.9%]). Longitudinal relationships between residents and patients may not be sufficient to promote the discussion, disclosure, and detection of psychosocial issues. Training in communication skills may help residents achieve the potential and goals of longitudinal care.

Knowledge of HIV Testing Guidelines Among US Internal Medicine Residents: A Decade After the Centers for Disease Control and Prevention's Routine HIV Testing Recommendations.

PubMed

Dandachi, Dima; Dang, Bich N; Wilson Dib, Rita; Friedman, Harvey; Giordano, Thomas

2018-05-01

Ten years after the Centers for Disease Control and Prevention recommended universal HIV screening, rates remain low. Internal medicine residents are the front-line medical providers for large groups of patients. We evaluated the knowledge of internal medicine residents about HIV testing guidelines and examined adherence to universal HIV testing in an outpatient setting. A cross-sectional survey of internal medicine residents at four residency programs in Chicago was conducted from January to March 2016. Aggregate data on HIV screening were collected from 35 federally qualified community health centers in the Chicago area after inclusion of an HIV testing best practice alert in patients' electronic medical records. Of the 192 residents surveyed, 130 (68%) completed the survey. Only 58% were aware of universal HIV screening and 49% were aware that Illinois law allows for an opt-out HIV testing strategy. Most of the residents (64%) ordered no more than 10 HIV tests in 6 months. The most frequently reported barriers to HIV testing were deferral because of urgent care issues, lack of time, and the perception that patients were uncomfortable discussing HIV testing. From July 2015 to February 2016, the average HIV testing adherence rate in the 35 health centers was 18.2%. More effort is needed to change HIV testing practices among internal medicine residents so that they will adopt this approach in their future clinical practice. Improving knowledge about HIV testing and addressing other HIV testing barriers are essential for such a successful change.

Exploring the deep, ancient hydrogeosphere within Precambrian crystalline rocks using noble gases

NASA Astrophysics Data System (ADS)

Warr, O.; Sherwood Lollar, B.; Fellowes, J.; Sutcliffe, C. N.; McDermott, J. M.; Holland, G.; Mabry, J.; Ballentine, C. J.

2016-12-01

Serpentinization is a key long-term water-rock interaction occurring within isolated fractures in Precambrian crystalline rocks and is a significant source of global H2 production. Highly saline fracture fluids, containing in-situ produced dissolved gases (e.g. percent level He, abiogenic CH4 and mM H2), have revealed microbial ecosystems isolated from the surface photosphere for millions of years. Noble gases can provide crucial physical and temporal constraints on these serpentinizing and life-supporting environments via radiogenic-derived fluid residence times, while also providing evidence of isolation. New noble gas data is presented here from four locations on the Canadian Shield. Kidd Creek Mine in Ontario, where fluids with a mean residence time ≥ 1.1 Ga were identified in 2013, was revisited with resampling of the waters from 2.4 km bls (below land surface), and new samples collected from 2.9 km bls. The study was also expanded to include two mines from Sudbury, Ontario at 1.7 (Mine 1) and 1.4 (Mine 2) km bls. The radiogenic excesses within the fluids were greatest for the 2.9 km Kidd Creek samples and provided an average residence time of 1.6 Ga. Consistent with our hypothesis, the resampling of the 2.4 km fluids (80 months after the original study) reveal significantly reduced residence times (1.1 Ga to 390 Ma) due to stress-induced opening of younger, though nonetheless old, fractures. This is supported by recent sulphur isotope, and 2H & 18O data. Additional hydrogeological constraints are provided by the 129Xe & 136Xe data, which suggest distinct fracture networks feed the 2.4 km, and the 2.9 km systems. Fracture fluids in the Sudbury Basin were targeted to investigate the influence of a later 1.8 Ga bolide impact which formed major fractures in the underlying basement. As hypothesised the fluids in the Sudbury Archean basement are younger than those at Kidd Creek, with mean residence times of 313 and 544 Ma for Mine 1 and 2 respectively. Our results demonstrate that ancient fracture fluids in the Precambrian crust represent a previously under-investigated groundwater domain and H2 source. With mean residence times of 0.3-1.6 Ga, they provide an opportunity to explore an unprecedented ancient component of the Earth's hydrogeosphere.

The Society for Academic Emergency Medicine and Association of Academic Chairs in Emergency Medicine 2009-2010 emergency medicine faculty salary and benefits survey.

PubMed

Watts, Susan H; Promes, Susan B; Hockberger, Robert

2012-07-01

he objective was to report the results of a survey conducted jointly by the Society for Academic Emergency Medicine (SAEM) and the Association of Academic Chairs in Emergency Medicine (AACEM) of faculty salaries, benefits, work hours, and department demographics for institutions sponsoring residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) Residency Review Committee for Emergency Medicine (RRC-EM). Data represent information collected for the 2009-2010 academic year through an electronic survey developed by SAEM and AACEM and distributed by the Office for Survey Research at the University of Michigan to all emergency department (ED) chairs and chiefs at institutions sponsoring accredited residency programs. Information was collected regarding faculty salaries and benefits; clinical and nonclinical work hours; sources of department income and department expenses; and selected demographic information regarding faculty, EDs, and hospitals. Salary data were sorted by program geographic region and faculty characteristics such as training and board certification, academic rank, department title, and sex. Demographic data were analyzed with regard to numerous criteria, including ED staffing levels, patient volumes and length of stay, income sources, salary incentive components, research funding, and specific type and value of fringe benefits offered. Data were compared with previous SAEM studies and the most recent faculty salary survey conducted by the Association of American Medical Colleges (AAMC). Ninety-four of 155 programs (61%) responded, yielding salary data on 1,644 faculty, of whom 1,515 (92%) worked full-time. The mean salary for all faculty nationwide was $237,884, with the mean ranging from $232,819 to $246,853 depending on geographic region. The mean salary for first-year faculty nationwide was $204,833. Benefits had an estimated mean value of $48,915 for all faculty, with the mean ranging from $37,813 to $55,346 depending on geographic region. The following factors are associated with higher salaries: emergency medicine (EM) residency training and board certification, fellowship training in toxicology and hyperbaric medicine, higher academic rank, male sex, and living in the western and southern regions. Full-time EM faculty work an average of 20 to 23 clinical hours and 16 to 19 nonclinical hours per week. The salaries for full-time EM faculty reported in this survey were higher than those found in the AAMC survey for the same time period in the majority of categories for both academic rank and geographic region. On average, female faculty are paid 10% to 13% less than their male counterparts. Full-time EM faculty work an average of 20 to 23 clinical hours and 16 to 19 nonclinical hours per week, which is similar to the work hours reported in previous SAEM surveys. © 2012 by the Society for Academic Emergency Medicine.

7 CFR 1714.7 - Interest rate cap.

Code of Federal Regulations, 2011 CFR

2011-01-01

... the same year. (2) Consumer income test.The borrower meets this test if either the average per capita income of the residents receiving electric service from the borrower is less than the average per capita..., RUS will compare, on a weighted average basis, the average per capita and median household income of...

The changing selenium nutritional status of Chinese residents.

PubMed

Li, Sumei; Bañuelos, Gary S; Wu, Longhua; Shi, Weiming

2014-03-14

The selenium (Se) content in human hair is useful as an indicator of human Se intake and status. In this regard, when measuring the hair Se concentrations in Chinese inhabitants across northeast to southeast China, the results indicated that generally 84% of all residents have normal hair Se content. Between the sexes, the average hair Se content of males was higher than that of females, irrespective of districts. When comparing geographical regions, the average hair Se content of southern residents was greater than that of northern residents, regardless of gender. Historically, the overall hair Se content of today's inhabitants decreased between 24% and 46% when compared with the inhabitants living in the same geographic region 20 years ago. The decrease of hair Se content may be related to the overall decrease of grain consumption and the lower Se content in the staple food rice.

Anomaly Detection and Life Pattern Estimation for the Elderly Based on Categorization of Accumulated Data

NASA Astrophysics Data System (ADS)

Mori, Taketoshi; Ishino, Takahito; Noguchi, Hiroshi; Shimosaka, Masamichi; Sato, Tomomasa

2011-06-01

We propose a life pattern estimation method and an anomaly detection method for elderly people living alone. In our observation system for such people, we deploy some pyroelectric sensors into the house and measure the person's activities all the time in order to grasp the person's life pattern. The data are transferred successively to the operation center and displayed to the nurses in the center in a precise way. Then, the nurses decide whether the data is the anomaly or not. In the system, the people whose features in their life resemble each other are categorized as the same group. Anomalies occurred in the past are shared in the group and utilized in the anomaly detection algorithm. This algorithm is based on "anomaly score." The "anomaly score" is figured out by utilizing the activeness of the person. This activeness is approximately proportional to the frequency of the sensor response in a minute. The "anomaly score" is calculated from the difference between the activeness in the present and the past one averaged in the long term. Thus, the score is positive if the activeness in the present is higher than the average in the past, and the score is negative if the value in the present is lower than the average. If the score exceeds a certain threshold, it means that an anomaly event occurs. Moreover, we developed an activity estimation algorithm. This algorithm estimates the residents' basic activities such as uprising, outing, and so on. The estimation is shown to the nurses with the "anomaly score" of the residents. The nurses can understand the residents' health conditions by combining these two information.

Healthy food access for urban food desert residents: examination of the food environment, food purchasing practices, diet and BMI.

PubMed

Dubowitz, Tamara; Zenk, Shannon N; Ghosh-Dastidar, Bonnie; Cohen, Deborah A; Beckman, Robin; Hunter, Gerald; Steiner, Elizabeth D; Collins, Rebecca L

2015-08-01

To provide a richer understanding of food access and purchasing practices among US urban food desert residents and their association with diet and BMI. Data on food purchasing practices, dietary intake, height and weight from the primary food shopper in randomly selected households (n 1372) were collected. Audits of all neighbourhood food stores (n 24) and the most-frequented stores outside the neighbourhood (n 16) were conducted. Aspects of food access and purchasing practices and relationships among them were examined and tests of their associations with dietary quality and BMI were conducted. Two low-income, predominantly African-American neighbourhoods with limited access to healthy food in Pittsburgh, PA, USA. Household food shoppers. Only one neighbourhood outlet sold fresh produce; nearly all respondents did major food shopping outside the neighbourhood. Although the nearest full-service supermarket was an average of 2·6 km from their home, respondents shopped an average of 6·0 km from home. The average trip was by car, took approximately 2 h for the round trip, and occurred two to four times per month. Respondents spent approximately $US 37 per person per week on food. Those who made longer trips had access to cars, shopped less often and spent less money per person. Those who travelled further when they shopped had higher BMI, but most residents already shopped where healthy foods were available, and physical distance from full-service supermarkets was unrelated to weight or dietary quality. Improved access to healthy foods is the target of current policies meant to improve health. However, distance to the closest supermarket might not be as important as previously thought, and thus policy and interventions that focus merely on improving access may not be effective.

Spending patterns in region of residency training and subsequent expenditures for care provided by practicing physicians for Medicare beneficiaries.

PubMed

Chen, Candice; Petterson, Stephen; Phillips, Robert; Bazemore, Andrew; Mullan, Fitzhugh

2014-12-10

Graduate medical education training may imprint young physicians with skills and experiences, but few studies have evaluated imprinting on physician spending patterns. To examine the relationship between spending patterns in the region of a physician's graduate medical education training and subsequent mean Medicare spending per beneficiary. Secondary multilevel multivariable analysis of 2011 Medicare claims data (Part A hospital and Part B physician) for a random, nationally representative sample of family medicine and internal medicine physicians completing residency between 1992 and 2010 with Medicare patient panels of 40 or more patients (2851 physicians providing care to 491,948 Medicare beneficiaries). Locations of practice and residency training were matched with Dartmouth Atlas Hospital Referral Region (HRR) files. Training and practice HRRs were categorized into low-, average-, and high-spending groups, with approximately equal distribution of beneficiary numbers. There were 674 physicians in low-spending training and low-spending practice HRRs, 180 in average-spending training/low-spending practice, 178 in high-spending training/low-spending practice, 253 in low-spending training/average-spending practice, 417 in average-spending training/average-spending practice, 210 in high-spending training/average-spending practice, 97 in low-spending training/high-spending practice, 275 in average-spending training/high-spending practice, and 567 in high-spending training/high-spending practice. Mean physician spending per Medicare beneficiary. For physicians practicing in high-spending regions, those trained in high-spending regions had a mean spending per beneficiary per year $1926 higher (95% CI, $889-$2963) than those trained in low-spending regions. For practice in average-spending HRRs, mean spending was $897 higher (95% CI, $71-$1723) for physicians trained in high- vs low-spending regions. For practice in low-spending HRRs, the difference across training HRR levels was not significant ($533; 95% CI, -$46 to $1112). After controlling for patient, community, and physician characteristics, there was a 7% difference (95% CI, 2%-12%) in patient expenditures between low- and high-spending training HRRs. Across all practice HRRs, this corresponded to an estimated $522 difference (95% CI, $146-$919) between low- and high-spending training regions. For physicians 1 to 7 years in practice, there was a 29% difference ($2434; 95% CI, $1004-$4111) in spending between those trained in low- and high-spending regions; however, after 16 to 19 years, there was no significant difference. Among general internists and family physicians who completed residency training between 1992 and 2010, the spending patterns in the HRR in which their residency program was located were associated with expenditures for subsequent care they provided as practicing physicians for Medicare beneficiaries. Interventions during residency training may have the potential to help control future health care spending.

Axial-spin technique of endoscopic intracorporeal knot tying: comparison with the conventional technique and objective assessment of knot security, learning curves, and performance efficiency across training levels.

PubMed

Gopaldas, Raja R; Rohatgi, Chand

2009-04-01

A major limitation of conventional laparoscopic surgery is the placement of an intracorporeal (IC) knot, which requires a significant amount of training and practice. An easier technique of IC knot tying using 90-degree grasper is compared with the conventional technique (CLT). The new axial-spin technique (AST) uses the spin of the instrument shaft to tie IC knots. Fourteen participants stratified into 3 training levels were instructed to tie 50 reef IC knots using each technique on trainers in 3 sessions. The final 5 knots tied using each technique were deemed to be representative of maximal performance efficiency (PE) and randomly subject to tensile strength measurements using a tensiometer at 50 mm/s distraction. Mean knot execution time (mKET) measured in seconds (s), normalized KE time (nET=group mean/mKET), knot holding capacity, relative knot security (RKS), and PE (PE=RKS/nET) of the knots tied were computed and analyzed using paired t and analysis of variance. Variables included knot-tying session, technique and the training level. On completion of the study, junior residents (JR) averaged 51.72 seconds more, senior residents (SR) averaged 26.22 seconds more and attendings (ATT) averaged 19.17 seconds less to tie using CLT compared with the AST (F=40.52, P=0.0001). Across all levels, the CLT technique was taking 83.26 seconds on average to execute an IC knot compared with 59.08 seconds with AST method (t=2.784, P=0.015). Learning curves revealed that JR significantly improved mean KE times with the AST technique (first session vs. final session: 473.8 s vs. 55.9 s) compared with CLT (672.5 s vs. 107.6 s) across the sessions as compared with those in advanced levels of training. The RKS of knots executed by AST was significantly stronger (AST: 13.1 vs. 5.44 N, t=4.9, P=0.0001). The PE of knots executed using the CLT increased geometrically across training levels (JR: 1.35% SR: 5.58% ATT: 11.22%) whereas those of AST showed a linear trend (17.09%; 17.11%, and 13.95%). The AST follows a linear pattern of learning across training levels compared with the steep exponential learning of the CLT. Inexperienced JRs were surprisingly 1.5 times more efficient with AST and 8 times less efficient with CLT compared with ATT using the CLT to execute the same knot. The AST is significantly easier to learn for JRs and could serve as a platform before acquiring more advanced knot-tying skills. Overall, with the AST, execution times are significantly shorter whereas the RKS and PE are significantly higher. JRs achieve a level of proficiency comparable with the senior level residents and ATT after participating in a reasonable training session consisting of at least 25 knots.

Socioeconomic Inequalities Persist Despite Declining Stunting Prevalence in Low- and Middle-Income Countries.

PubMed

da Silva, Inácio Crochemore M; França, Giovanny V; Barros, Aluisio J D; Amouzou, Agbessi; Krasevec, Julia; Victora, Cesar G

2018-02-01

Global stunting prevalence has been nearly halved between 1990 and 2016, but it remains unclear whether this decline has benefited poor and rural populations within low- and middle-income countries (LMICs). We assessed time trends in stunting among children <5 y of age (under-5) according to household wealth and place of residence in 67 LMICs. Stunting prevalence was analyzed in 217 nationally representative Demographic and Health Surveys and Multiple Indicator Cluster Surveys from 67 countries with ≥2 surveys between 1993 and 2014. National estimates were stratified by wealth and area of residence, comparing the poorest 40% with the wealthiest 60%, and those residing in urban and rural areas. Time trends were calculated for LMICs by using multilevel regression models weighted by under-5 population, with stratification by wealth and by residence. Trends in absolute (slope index of inequality; SII) and relative (concentration index; CIX) inequalities were calculated. Mean prevalences in 1993 were 53.7% in low-income and 48.2% in middle-income countries, with annual average linear declines of 0.76 and 0.72 percentage points (pp), respectively. Although similar slopes of declines were observed for the poorest 40% and wealthiest 60% groups in all countries (0.78 and 0.74 pp, respectively), absolute and relative inequalities increased over time in low-income countries (SII increased from -19.3% in 1993 to -23.7% in 2014 and CIX increased from -6.2% to -10.8% in the same period). In middle-income countries, socioeconomic inequalities remained stable. Overall, stunting prevalence decreased more rapidly among rural than for urban children (0.78 and 0.55 pp, respectively). The prevalence of stunting is decreasing. Poor-rich gaps are stable in middle-income countries and slightly increasing in low-income countries. Rural-urban inequalities are decreasing over time.

Involuntary smoking in the restaurant workplace. A review of employee exposure and health effects.

PubMed

Siegel, M

1993-07-28

To determine the relative exposure to environmental tobacco smoke for bar and restaurant employees compared with office employees and with nonsmokers exposed in the home (part 1) and to determine whether this exposure is contributing to an elevated lung cancer risk in these employees (part 2). MEDLINE and bibliographies from identified publications. In part 1, published studies of indoor air quality were included if they reported a mean concentration of carbon monoxide, nicotine, or particulate matter from measurements taken in one or more bars, restaurants, offices, or residences with at least one smoker. In part 2, published epidemiologic studies that reported a risk estimate for lung cancer incidence or mortality in food-service workers were included if they controlled, directly or indirectly, for active smoking. In part 1, a weighted average of the mean concentration of carbon monoxide, nicotine, and respirable suspended particulates reported in studies was calculated for bars, restaurants, offices, and residences. In part 2, the relative lung cancer risk for food-service workers compared with that for the general population was examined in the six identified studies. Levels of environmental tobacco smoke in restaurants were approximately 1.6 to 2.0 times higher than in office workplaces of other businesses and 1.5 times higher than in residences with at least one smoker. Levels in bars were 3.9 to 6.1 times higher than in offices and 4.4 to 4.5 times higher than in residences. The epidemiologic evidence suggested that there may be a 50% increase in lung cancer risk among food-service workers that is in part attributable to tobacco smoke exposure in the workplace. Environmental tobacco smoke is a significant occupational health hazard for food-service workers. To protect these workers, smoking in bars and restaurants should be prohibited.

Where Do Patients With Cancer in Iowa Receive Radiation Therapy?

PubMed Central

Ward, Marcia M.; Ullrich, Fred; Matthews, Kevin; Rushton, Gerard; Tracy, Roger; Goldstein, Michael A.; Bajorin, Dean F.; Kosty, Michael P.; Bruinooge, Suanna S.; Hanley, Amy; Jacobson, Geraldine M.; Lynch, Charles F.

2014-01-01

Purpose: Multiple studies have shown survival benefits in patients with cancer treated with radiation therapy, but access to treatment facilities has been found to limit its use. This study was undertaken to examine access issues in Iowa and determine a methodology for conducting a similar national analysis. Patients and Methods: All Iowa residents who received radiation therapy regardless of where they were diagnosed or treated were identified through the Iowa Cancer Registry (ICR). Radiation oncologists were identified through the Iowa Physician Information System (IPIS). Radiation facilities were identified through IPIS and classified using the Commission on Cancer accreditation standard. Results: Between 2004 and 2010, 113,885 invasive cancers in 106,603 patients, 28.5% of whom received radiation treatment, were entered in ICR. Mean and median travel times were 25.8 and 20.1 minutes, respectively, to the nearest facility but 42.4 and 29.1 minutes, respectively, to the patient's chosen treatment facility. Multivariable analysis predicting travel time showed significant relationships for disease site, age, residence location, and facility category. Residents of small and isolated rural towns traveled nearly 3× longer than urban residents to receive radiation therapy, as did patients using certain categories of facilities. Conclusion: Half of Iowa patients could reach their nearest facility in 20 minutes, but instead, they traveled 30 minutes on average to receive treatment. The findings identified certain groups of patients with cancer who chose more distant facilities. However, other groups of patients with cancer, namely those residing in rural areas, had less choice, and some had to travel considerably farther to radiation facilities than urban patients. PMID:24443730

Practice management education during surgical residency.

PubMed

Jones, Kory; Lebron, Ricardo A; Mangram, Alicia; Dunn, Ernest

2008-12-01

Surgical education has undergone radical changes in the past decade. The introductions of laparoscopic surgery and endovascular techniques have required program directors to alter surgical training. The 6 competencies are now in place. One issue that still needs to be addressed is the business aspect of surgical practice. Often residents complete their training with minimal or no knowledge on coding of charges or basic aspects on how to set up a practice. We present our program, which has been in place over the past 2 years and is designed to teach the residents practice management. The program begins with a series of 10 lectures given monthly beginning in August. Topics include an introduction to types of practices available, negotiating a contract, managed care, and marketing the practice. Both medical and surgical residents attend these conferences. In addition, the surgical residents meet monthly with the business office to discuss billing and coding issues. These are didactic sessions combined with in-house chart reviews of surgical coding. The third phase of the practice management plan has the coding team along with the program director attend the outpatient clinic to review in real time the evaluation and management coding of clinic visits. Resident evaluations were completed for each of the practice management lectures. The responses were recorded on a Likert scale. The scores ranged from 4.1 to 4.8 (average, 4.3). Highest scores were given to lectures concerning negotiating employee agreements, recruiting contracts, malpractice insurance, and risk management. The medical education department has tracked resident coding compliance over the past 2 years. Surgical coding compliance increased from 36% to 88% over a 12-month period. The program director who participated in the educational process increased his accuracy from 50% to 90% over the same time period. When residents finish their surgical training they need to be ready to enter the world of business. These needs will be present whether pursuing a career in academic medicine or the private sector. A program that focuses on the business aspect of surgery enables the residents to better navigate the future while helping to fulfill the systems-based practice competency.

Evaluation of the impact of resident work hour restrictions on resident outpatient clinical experience.

PubMed

Patel, Shweta V; Driggers, Rita W; Zahn, Christopher M

2011-01-01

To estimate the effect of work hour restrictions on resident outpatient clinical experience. Schedule templates from academic years 1998-1999 (before work hour restrictions), 2002-2003 (when night float rotation was added in anticipation of work hour restrictions), and 2008-2009 (during work hour restrictions) were compared for outpatient clinic experience before and after work hour restrictions were implemented. Actual clinics on specific rotations and estimated patient encounters per scheduled clinic were considered. Between academic year (AY) 1998-1999 and AY 2008-2009 there was a generalized downward trend in average outpatient encounters for postgraduate year (PGY)-2, PGY-3 and PGY-4 residents (45%, 34% and 36%, respectively). For obstetrics, gynecology and ambulatory rotations, there was a downward trend in average outpatient encounters for each rotation type (61%, 14% and 63%, respectively). The average number of scheduled clinics per week was slightly decreased when comparing AY 1998-1999 to either AY 2002-2003 or AY 2008-2009. Rotation schedules before and after work hour restrictions demonstrated a downward trend in the number of scheduled outpatient encounters. These findings indicate a potential negative impact on preparation for clinical practice.

Biofiltration of asphalt emissions: Full-scale operation treating off-gases from polymer-modified asphalt production

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cook, L.L.; Gostomski, P.A.; Apel, W.A.

1999-09-30

In response to complaints from nearby residents, a biofilter was designed, installed, and tested for treating odors in one of three odorous emission streams from an asphalt plant producing polymer-modified asphalt. Hydrogen sulfide (H{sub 2}S) was determined to be the most prevalent gaseous reduced sulfur compound and was detected in the emission stream only when polymer material was being added to raw asphalt. Emission stream H{sub 2}S concentrations were quite variable, ranging from 16 to approximately 30,000 ppm (v/v) and considered the likely compound contributing most to the plant's odor complaints. The biofilter was effective in controlling odor from themore » production process and removed an overall average of 65% of the H{sub 2}S during polymer addition, and for H{sub 2}S concentrations less than 400 ppmv, removal averaged 98%. These removal efficiencies reflect data from the biofilter operating at 2.5-minute empty bed residence time in 1996 and a 6.1-minute empty bed residence time in 1997. The biofilter's bed became increasingly acidified during the plant's 1997 operating season producing a pH gradient through the bed ranging from a high of 6.6 to a low of 3.1. The bed medium moisture content remained constant at about 60% (wet weight basis), but changes were observed in the water potential: no correlation to performance was determined. Changes in the microbial community reflected the bed acidification trend, with acidophiles becoming generally more numerous in the bed's deeper portions and in the mid to late season when the bed was most acidified. Bed acidification did not impact the biofilter's H{sub 2}S removal efficiency.« less

Spring-migration ecology of Northern Pintails in south-central Nebraska

USGS Publications Warehouse

Pearse, A.T.; Krapu, G.L.; Cox, R.R.; Davis, B.E.

2011-01-01

Spring-migration ecology of staging Northern Pintails, Anas acuta, was investigated in south-central Nebraska, USA. Habitat associations, local movements, settling patterns, arrival dates, residency times and survival were estimated from 71 radiomarked pintails during spring 2001, 2003 and 2004, and diet determined from 130 females collected during spring 1998 and 1999. Seventy-two percent of pintail diurnal locations were in palustrine wetlands, 7% in riverine wetlands, 3% in lacustrine wetlands, 6% in municipal sewage lagoons and irrigation reuse pits and 10.5% in croplands. Emergent wetlands with hemi-marsh conditions were used diurnally more often than wetlands with either open or closed vegetation structures. Evening foraging flights averaged 4.3 km (SE = 0.6) and 72% were to cornfields. In accord with these findings, 87% of 93 pintails collected during spring 1998 and 1999 returning to evening roosts consumed corn, which represented 84% dry mass of all foods. Pintails collected on non-cropped wetlands ingested invertebrates and seeds from wetland plants more frequently than birds returning to roost. Radiomarked pintails arrived in Nebraska on 7 March 2003 and 18 February 2004; average arrival date was six days earlier during 2004 compared to 2003. Residency time for individuals varied greatly (1-40 days) yet yearly means were similar and averaged 9.5 days within the region. No mortality was detected for 71 birds monitored over 829 exposure days. Conservation planners linking population dynamics and habitat conditions at spring-staging areas need to focus on pintail body condition during spring and its connection with reproductive success and survival during the breeding season.

Spring-migration ecology of Northern Pintails in south-central Nebraska

USGS Publications Warehouse

Pearse, Aaron T.; Krapu, Gary L.; Cox, Robert R.; Davis, Bruce E.

2011-01-01

Spring-migration ecology of staging Northern Pintails, Anas acuta, was investigated in south-central Nebraska, USA. Habitat associations, local movements, settling patterns, arrival dates, residency times and survival were estimated from 71 radiomarked pintails during spring 2001, 2003 and 2004, and diet determined from 130 females collected during spring 1998 and 1999. Seventy-two percent of pintail diurnal locations were in palustrine wetlands, 7% in riverine wetlands, 3% in lacustrine wetlands, 6% in municipal sewage lagoons and irrigation reuse pits and 10.5% in croplands. Emergent wetlands with hemi-marsh conditions were used diurnally more often than wetlands with either open or closed vegetation structures. Evening foraging flights averaged 4.3 km (SE = 0.6) and 72% were to cornfields. In accord with these findings, 87% of 93 pintails collected during spring 1998 and 1999 returning to evening roosts consumed corn, which represented 84% dry mass of all foods. Pintails collected on non-cropped wetlands ingested invertebrates and seeds from wetland plants more frequently than birds returning to roost. Radiomarked pintails arrived in Nebraska on 7 March 2003 and 18 February 2004; average arrival date was six days earlier during 2004 compared to 2003. Residency time for individuals varied greatly (1–40 days) yet yearly means were similar and averaged 9.5 days within the region. No mortality was detected for 71 birds monitored over 829 exposure days. Conservation planners linking population dynamics and habitat conditions at spring-staging areas need to focus on pintail body condition during spring and its connection with reproductive success and survival during the breeding season.

Longitudinal variability in outdoor, indoor, and personal PM 2.5 exposure in healthy non-smoking adults

NASA Astrophysics Data System (ADS)

Adgate, J. L.; Ramachandran, G.; Pratt, G. C.; Waller, L. A.; Sexton, K.

Multiple 24-h average outdoor, indoor and personal PM 2.5 measurements were made in a population of healthy non-smoking adults from the Minneapolis-St. Paul metropolitan area between April and November 1999. Personal ( P) PM 2.5 concentrations were higher than indoor ( I) concentrations, which were higher than outdoor (O) concentrations. For 28 adults with a median of 9 (range 5-11) measurements per person, the distribution of longitudinal (i.e., within-person) correlation coefficients between P and I was moderate (median r=0.45). The distribution of longitudinal correlation coefficients between I and O concentrations showed that these variables were less strongly associated (median r=0.25; 28 residences; measurement median n=10 per residence, range 7-13), and the distribution of P and O correlation coefficients (median r=0.02; 29 subjects; measurement median n=11 per subject, range 7-15) showed little statistical relation between these two variables for a majority of participants. A sensitivity analysis indicated that correlations did not increase if days with exposure to environmental tobacco smoke or occupational exposures were excluded. On average these adults spent 91% of their time indoors, and the mean of the average PM 2.5 "personal cloud" was 15.3 μg/m 3. Participants who had the largest personal cloud values tended to work outside the home and spent more time outdoors than subjects who did not work outside the home. In this population of healthy non-smoking adults, personal exposure to PM 2.5 does not correlate strongly with outdoor central site PM 2.5 concentrations.

A novel program for clinical pathology training for residents emphasizing high-impact and attending-level learning opportunities.

PubMed

Ranheim, Erik A

2014-02-01

Clinical pathology (CP) rotations in our residency program consistently received lower evaluations and lower scores on the Resident In-Service Exam (RISE) in comparison to anatomic pathology rotations. In 2010 to 2011, we instituted a new model for CP training, wherein the separate rotations for chemistry, transfusion medicine, molecular diagnostics, microbiology, and coagulation/immunology were combined into a 3-month "Superblock" in an effort to maximize and repeat high-impact learning opportunities in a team-based model. Resident and faculty satisfaction with the new curriculum and RISE scores were assessed in the 3 years before and after implementation of the curriculum. Large majorities of residents and faculty expressed increased satisfaction with the curriculum. Average RISE scores increased 8.3% in CP in the 3 years following introduction of the curriculum compared to the 3 years prior to introduction, while anatomic pathology average scores decreased by 1.5%. The CP Superblock provides a model of CP education which may address some of the difficulties in teaching CP topics and recruiting residents to CP specialization. The pros and cons of its implementation are discussed. © 2014.

Variability of Arthroscopy Case Volume in Orthopaedic Surgery Residency.

PubMed

Gil, Joseph A; Waryasz, Gregory R; Owens, Brett D; Daniels, Alan H

2016-05-01

To examine orthopaedic surgery case logs for arthroscopy case volume during residency training and to evaluate trends in case volume and variability over time. Publicly available Accreditation Council for Graduate Medical Education surgical case logs from 2007 to 2013 for orthopaedic surgery residency were assessed for variability and case volume trends in shoulder, elbow, wrist, hip, knee, and ankle arthroscopy. The national average number of procedures performed in each arthroscopy category reported was directly compared from 2009 to 2013. The 10th and 90th percentile arthroscopy case volume was compared between 2007 and 2013 for shoulder and knee arthroscopy procedures. Subsequently, the difference between the 10th and 90th percentile arthroscopy case volume in each category in 2007 was compared with the difference between the 10th and 90th percentile arthroscopy case volume in each category in 2013. From 2007 to 2013, shoulder arthroscopy procedures performed per resident increased by 43.1% (P = .0001); elbow arthroscopy procedures increased by 28.0% (P = .00612); wrist arthroscopy procedures increased by 8.6% (P = .05); hip arthroscopy procedures, which were first reported in 2012, increased by 588.9%; knee arthroscopy procedures increased by 8.5% (P = .0435); ankle arthroscopy increased by 27.6% (P = .00149). The difference in knee and shoulder arthroscopy volume between residents in the 10th and 90th percentile in 2007 and residents in the 10th and 90th percentile in 2013 was not significant (P > .05). There was a 3.66-fold difference in knee arthroscopy volume between residents in the 10th and 90th percentile in 2007, whereas the difference was 3.36-fold in 2013 (P = .70). There was a 5.86-fold difference in shoulder arthroscopy case volume between residents in the 10th and 90th percentile in 2007, whereas the difference was 4.96-fold in 2013 (P = .29). The volume of arthroscopy cases performed by graduating orthopaedic surgery residents has significantly increased over time. There continues to be substantial variability in knee and shoulder arthroscopy case volume between residents in the 10th and 90th percentile. Variability in residency training is notable and may affect knowledge, skill, and practice patterns of surgeons. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

A Quality Improvement System to Manage Feeding Assistance Care in Assisted-Living.

PubMed

Simmons, Sandra F; Coelho, Chris S; Sandler, Andrew; Schnelle, John F

2018-03-01

To describe a feasible quality improvement system to manage feeding assistance care processes in an assisted living facility (ALF) that provides dementia care and the use of these data to maintain the quality of daily care provision and prevent unintentional weight loss. Supervisory ALF staff used a standardized observational protocol to assess feeding assistance care quality during and between meals for 12 consecutive months for 53 residents receiving dementia care. Direct care staff received feedback about the quality of assistance and consistency of between-meal snack delivery for residents with low meal intake and/or weight loss. On average, 78.4% of the ALF residents consumed more than one-half of each served meal and/or received staff assistance during meals to promote consumption over the 12 months. An average of 79.7% of the residents were offered snacks between meals twice per day. The prevalence of unintentional weight loss averaged 1.3% across 12 months. A quality improvement system resulted in sustained levels of mealtime feeding assistance and between-meal snack delivery and a low prevalence of weight loss among ALF residents receiving dementia care. Given that many ALF residents receiving dementia care are likely to be at risk for low oral intake and unintentional weight loss, ALFs should implement a quality improvement system similar to that described in this project, despite the absence of regulations to do so. Copyright © 2018 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Year-to-year variations in annual average indoor 222Rn concentrations.

PubMed

Martz, D E; Rood, A S; George, J L; Pearson, M D; Langner, G H

1991-09-01

Annual average indoor 222Rn concentrations in 40 residences in and around Grand Junction, CO, have been measured repeatedly since 1984 using commercial alpha-track monitors (ATM) deployed for successive 12-mo time periods. Data obtained provide a quantitative measure of the year-to-year variations in the annual average Rn concentrations in these structures over this 6-y period. A mean coefficient of variation of 25% was observed for the year-to-year variability of the measurements at 25 sampling stations for which complete data were available. Individual coefficients of variation at the various stations ranged from a low of 7.7% to a high of 51%. The observed mean coefficient of variation includes contributions due to the variability in detector response as well as the true year-to-year variation in the annual average Rn concentrations. Factoring out the contributions from the measured variability in the response of the detectors used, the actual year-to-year variability of the annual average Rn concentrations was approximately 22%.

Partnering on a Curriculum To Address the Dental Care Crisis in a Rural Island Community: The First Step of a Career Ladder Program in Dental Assisting.

ERIC Educational Resources Information Center

Pezzoli, J. A.; Johnson, Nancy

This document describes the curriculum and objectives of the Certificate of Completion in Dental Assisting at Maui Community College, Hawaii. Hawaii is below the national average in oral health care, with as many as 40% of Maui residents being underserved. Dental disease among the uninsured and underinsured in Hawaii is three times the national…

Atlanta's Successful Charles R. Drew Charter School: The Cornerstone of East Lake's Community Transformation. The Abell Report. Volume 27, No.1

ERIC Educational Resources Information Center

Eberhart, Linda; Barnes, Tara

2014-01-01

The community of East Lake, home to Charles R. Drew Charter School (Drew), is 6 miles from downtown Atlanta. In 1995, crime in East Lake was 19 times higher than the national average. Now, violent crime is down 95 percent. In 1995, 88 percent of residents were unemployed. Now, only 5 percent receive welfare. In 1995, just 5 percent of fifth…

Residence times in a hypersaline lagoon: Using salinity as a tracer

NASA Astrophysics Data System (ADS)

Mudge, Stephen M.; Icely, John D.; Newton, Alice

2008-04-01

Generally the waters of the Ria Formosa Lagoon, Portugal have a short residence time, in the order of 0.5 days (Tett, P., Gilpin, L., Svendsen, H., Erlandsson, C.P., Larsson, U., Kratzer, S., Fouilland, E., Janzen, C., Lee, J., Grenz, C., Newton, A., Ferreira, J.G., Fernandes, T., Scory, S., 2003. Eutrophication and some European waters of restricted exchange. Continental Shelf Research 23, 1635-1671). This estimation is based on the measurements of currents and the modelling of water exchange at the outlets to the ocean. However, observations of the temperature and salinity in the inner channels imply that residence time is greater in these regions of the lagoon. To resolve this apparent contradiction, spatial measurements of the temperature and salinity were made with a meter for conductivity, temperature and depth along the principal channels of the western portion of the lagoon, with a sampling frequency of two per second. Evaporation rates of 5.4 mm day -1 were measured in a salt extraction pond adjacent to the lagoon and used to determine the residence time through salinity differences with the incoming seawater. In June 2004, the water flooding in from the ocean had an average salinity of 36.07 which contrasted with a maximum of 37.82 at mid ebb on a spring tide, corresponding to a residence time of >7 days; the mean residence time was 2.4 days. As the tide flooded into the channels, the existing water was advected back into the lagoon. Although there was a small amount of mixing with water from another inlet, the water body from the inner lagoon essentially remained distinct with respect to temperature and salinity characteristics. The residence time of the water was further prolonged at the junction between the main channels, where distinct boundaries were observed between the different water masses. As the water ebbed out, the shallow Western Channel was essentially isolated from the rest of the outer lagoon, and the water from this channel was forced down the Ramalhete Channel, from where it was unable to exit the lagoon in one tidal cycle due to the extensive path length of ˜14 km to the sea. Although the overall exchange rate of water is short in the outer lagoon, this study emphasizes that management models should take into account additional complexities that might arise from the much longer exchange rates of the inner lagoon. For example, the principal sewage discharge for the urban area of Faro is into the section of the Ramalhete Channel where efficient flushing is impeded by the relatively high residence times of the water body in this channel. The implementation of the techniques used for this study are a quick and relatively cost effective approach to testing assumptions about water quality and exchange in shallow coastal systems.

A new analytical method for the classification of time-location data obtained from the global positioning system (GPS).

PubMed

Kim, Taehyun; Lee, Kiyoung; Yang, Wonho; Yu, Seung Do

2012-08-01

Although the global positioning system (GPS) has been suggested as an alternative way to determine time-location patterns, its use has been limited. The purpose of this study was to evaluate a new analytical method of classifying time-location data obtained by GPS. A field technician carried a GPS device while simulating various scripted activities and recorded all movements by the second in an activity diary. The GPS device recorded geological data once every 15 s. The daily monitoring was repeated 18 times. The time-location data obtained by the GPS were compared with the activity diary to determine selection criteria for the classification of the GPS data. The GPS data were classified into four microenvironments (residential indoors, other indoors, transit, and walking outdoors); the selection criteria used were used number of satellites (used-NSAT), speed, and distance from residence. The GPS data were classified as indoors when the used-NSAT was below 9. Data classified as indoors were further classified as residential indoors when the distance from the residence was less than 40 m; otherwise, they were classified as other indoors. Data classified as outdoors were further classified as being in transit when the speed exceeded 2.5 m s(-1); otherwise, they were classified as walking outdoors. The average simple percentage agreement between the time-location classifications and the activity diary was 84.3 ± 12.4%, and the kappa coefficient was 0.71. The average differences between the time diary and the GPS results were 1.6 ± 2.3 h for the time spent in residential indoors, 0.9 ± 1.7 h for the time spent in other indoors, 0.4 ± 0.4 h for the time spent in transit, and 0.8 ± 0.5 h for the time spent walking outdoors. This method can be used to determine time-activity patterns in exposure-science studies.

[Work stress, health and satisfaction of life in young doctors. Results of a longitudinal study in Switzerland].

PubMed

Buddeberg-Fischer, B; Stamm, M; Buddeberg, C; Bauer, G; Hämmig, O; Klaghofer, R

2008-11-01

Based on the Effort-Reward-Imbalance Model by Siegrist a study was undertaken to find out (a) in what way young doctors assess effort and reward during their specialist training; (b) whether there are certain job stress patterns over time; and (c) what the correlations are, if any, between perceived job stress, health and satisfaction with life. Within the framework of a prospective study (2001 - 2007) 370 doctors who had just qualified and were residents in the German-speaking part of Switzerland were assessed four times by means of anonymized questionnaires. Job stress, measured by the Effort-Reward-Imbalance scale, as well as health and satisfaction with life were assessed in these doctors' 2nd (T2), 4th (T3), and 6th (T4) year of specialist training ("residents"). Stress patterns of the participants were evaluated, based on the effort and reward scale values at T2, T3, and T4, by two-step cluster analysis. Gender differences between the clusters were calculated by the 2 test and differences in the continuous variables by analysis of variance with repeated measurements. During residency the percentage of doctors who experienced an Effort-Reward-Imbalance (ratio between effort and reward ERI > 1) increased from 18% at T2 to 20 % at T3 to 25 % at T4. The cluster analysis revealed two clusters: Type 1 (67%) with effort values below average and reward values above average (ER balance) across the three measurement points, and type 2 (33 %) with effort values above average and reward values below average (ER imbalance). Subjects in cluster 2 showed unfavorable values, when compared with those in cluster 1, in overcommitment, in workload and in the health variables (anxiety, depression, physical and psychological well-being), as well as in their assessed satisfaction with life at all three measurement points. One third of the doctors experienced stress at work, caused by an effort-reward imbalance. This had a negative impact on their health and satisfaction with life. Regular supervision and goal-oriented career counselling provided by senior physicians could contribute to young doctors not feeling so much stressed at work, feeling well and being more content with their work.

Otolith analysis of pre-restoration habitat use by Chinook salmon in the delta-flats and nearshore regions of the Nisqually River Estuary

USGS Publications Warehouse

Lind-Null, Angie; Larsen, Kim

2010-01-01

The Nisqually Fall Chinook population is one of 27 salmon stocks in the Puget Sound (Washington) evolutionarily significant unit listed as threatened under the federal Endangered Species Act (ESA). Extensive restoration of the Nisqually River delta ecosystem is currently taking place to assist in recovery of the stock as juvenile Fall Chinook salmon are dependent on the estuary. A pre-restoration baseline that includes the characterization of life history strategies, estuary residence times, growth rates, and habitat use is needed to evaluate the potential response of hatchery and natural origin Chinook salmon to restoration efforts and to determine restoration success. Otolith analysis was selected as a tool to examine Chinook salmon life history, growth, and residence in the Nisqually River estuary. Previously funded work on samples collected in 2004 (marked and unmarked) and 2005 (unmarked only) partially established a juvenile baseline on growth rates and length of residence associated with various habitats (freshwater, forested riverine tidal, emergent forested transition, estuarine emergent marsh, delta-flats and nearshore). However, residence times and growth rates for the delta-flats (DF) and nearshore (NS) habitats have been minimally documented due to small sample sizes. The purpose of the current study is to incorporate otolith microstructural analysis using otoliths from fish collected within the DF and NS habitats during sampling years 2004-08 to increase sample size and further evaluate between-year variation in otolith microstructure. Our results from this analysis indicated the delta-flats check (DFCK) on unmarked and marked Chinook samples in 2005-08 varied slightly in appearance from that seen on samples previously analyzed only from 2004. A fry migrant life history was observed on otoliths of unmarked Chinook collected in 2005, 2007, and 2008. Generally, freshwater mean increment width of unmarked fish, on average, was smaller compared to marked Chinook followed by tidal delta and DF/NS portions respectively. On average, the complete tidal delta growth rate was higher for marked Chinook compared to unmarked Chinook. The DF/NS growth rate was highest for unmarked and marked Chinook during 2008 compared to all other sampling years. The average DF/NS growth rate on unmarked Chinook was consistently lower than marked Chinook during all years; however, sample sizes were small during some years. Unmarked Chinook, on average, spent longer in the tidal delta compared to marked Chinook. Our results from this report suggest that otolith microstructural analysis can be a valuable tool in establishing baseline information on the utilization of Nisqually River estuary habitats by juvenile Chinook salmon prior to the newly funded restoration efforts.

Lifestyle medicine curriculum for a preventive medicine residency program: implementation and outcomes.

PubMed

Nawaz, Haq; Petraro, Paul V; Via, Christina; Ullah, Saif; Lim, Lionel; Wild, Dorothea; Kennedy, Mary; Phillips, Edward M

2016-01-01

The vast majority of the healthcare problems burdening our society today are caused by disease-promoting lifestyles (e.g., physical inactivity and unhealthy eating). Physicians report poor training and lack of confidence in counseling patients on lifestyle changes. To evaluate a new curriculum and rotation in lifestyle medicine for preventive medicine residents. Training included didactics (six sessions/year), distance learning, educational conferences, and newly developed lifestyle medicine rotations at the Institute of Lifestyle Medicine, the Yale-Griffin Prevention Research Center, and the Integrative Medicine Center. We used a number of tools to assess residents' progress including Objective Structured Clinical Examinations (OSCEs), self-assessments, and logs of personal health habits. A total of 20 residents participated in the lifestyle medicine training between 2010 and 2013. There was a 15% increase in residents' discussions of lifestyle issues with their patients based on their baseline and follow-up surveys. The performance of preventive medicine residents on OSCEs increased each year they were in the program (average OSCE score: PGY1 73%, PGY2 83%, PGY3 87%, and PGY4 91%, p=0.01). Our internal medicine and preliminary residents served as a control, since they did participate in didactics but not in lifestyle medicine rotations. Internal medicine and preliminary residents who completed the same OSCEs had a slightly lower average score (76%) compared with plural for resident, preventive medicine residents (80%). However, this difference did not reach statistical significance (p=0.11). Incorporating the lifestyle medicine curriculum is feasible for preventive medicine training allowing residents to improve their health behavior change discussions with patients as well as their own personal health habits.

Increasing Patient Safety Event Reporting in an Emergency Medicine Residency.

PubMed

Steen, Sven; Jaeger, Cassie; Price, Lindsay; Griffen, David

2017-01-01

Patient safety event reporting is an important component for fostering a culture of safety. Our tertiary care hospital utilizes a computerized patient safety event reporting system that has been historically underutilized by residents and faculty, despite encouragement of its use. The objective of this quality project was to increase patient safety event reporting within our Emergency Medicine residency program. Knowledge of event reporting was evaluated with a survey. Eighteen residents and five faculty participated in a formal educational session on event reporting followed by feedback every two months on events reported and actions taken. The educational session included description of which events to report and the logistics of accessing the reporting system. Participants received a survey after the educational intervention to assess resident familiarity and comfort with using the system. The total number of events reported was obtained before and after the educational session. After the educational session, residents reported being more confident in knowing what to report as a patient safety event, knowing how to report events, how to access the reporting tool, and how to enter a patient safety event. In the 14 months preceding the educational session, an average of 0.4 events were reported per month from the residency. In the nine months following the educational session, an average of 3.7 events were reported per month by the residency. In addition, the reported events resulted in meaningful actions taken by the hospital to improve patient safety, which were shared with the residents. Improvement efforts including an educational session, feedback to the residency of events reported, and communication of improvements resulting from reported events successfully increased the frequency of safety event reporting in an Emergency Medicine residency.

Residency times and patterns of movement of postbreeding dunlin on a subarctic staging area in Alaska

USGS Publications Warehouse

Warnock, Nils; Handel, Colleen M.; Gill, Robert E.; McCaffery, Brian J.

2013-01-01

Understanding how individuals use key resources is critical for effective conservation of a population. The Yukon-Kuskokwim Delta (YKD) in western Alaska is the most important postbreeding staging area for shorebirds in the subarctic North Pacific, yet little is known about movements of shorebirds there during the postbreeding period. To address this information gap, we studied residency times and patterns of movement of 17 adult and 17 juvenile radio-marked Dunlin (Calidris alpina) on the YKD between early August and early October 2005. Throughout this postbreeding period, during which Dunlin were molting, most birds were relocated within a 130 km radius of their capture site on the YKD, but three birds were relocated more than 600 km to the south at estuaries along the Alaska Peninsula. On average, juvenile Dunlin were relocated farther away from the banding site (median relocation distance = 36.3 km) than adult Dunlin (median relocation distance = 8.8 km). Post-capture, minimum lengths of stay by Dunlin on the YKD were not significantly different between juveniles (median = 19 days) and adults (median = 23 days), with some birds staging for more than 50 days. Body mass at time of capture was the best single variable explaining length of stay on the YKD, with average length of stay decreasing by 2.5 days per additional gram of body mass at time of capture. Conservation efforts for postbreeding shorebirds should consider patterns of resource use that may differ not only by age cohort but also by individual condition.

Computational Fluid Dynamics Modeling of the John Day Dam Tailrace

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rakowski, Cynthia L.; Perkins, William A.; Richmond, Marshall C.

US Army Corps of Engineers - Portland District required that a two-dimensional (2D) depth-averaged and a three-dimensional (3D) free-surface numerical models to be developed and validated for the John Day tailrace. These models were used to assess potential impact of a select group of structural and operational alternatives to tailrace flows aimed at improving fish survival at John Day Dam. The 2D model was used for the initial assessment of the alternatives in conjunction with a reduced-scale physical model of the John Day Project. A finer resolution 3D model was used to more accurately model the details of flow inmore » the stilling basin and near-project tailrace hydraulics. Three-dimensional model results were used as input to the Pacific Northwest National Laboratory particle tracking software, and particle paths and times to pass a downstream cross section were used to assess the relative differences in travel times resulting from project operations and structural scenarios for multiple total river flows. Streamlines and neutrally-buoyant particles were seeded in all turbine and spill bays with flows. For a Total River of 250 kcfs running with the Fish Passage Plan spill pattern and a spillwall, the mean residence times for all particles were little changed; however the tails of the distribution were truncated for both spillway and powerhouse release points, and, for the powerhouse releases, reduced the residence time for 75% of the particles to pass a downstream cross section from 45.5 minutes to 41.3 minutes. For a total river of 125 kcfs configured with the operations from the Fish Passage Plan for the temporary spillway weirs and for a proposed spillwall, the neutrally-buoyant particle tracking data showed that the river with a spillwall in place had the overall mean residence time increase; however, the residence time for 75% of the powerhouse-released particles to pass a downstream cross section was reduced from 102.4 min to 89 minutes.« less

Quality of life and the complex needs of recovery home residents.

PubMed

Mericle, Amy A; Miles, Jennifer

2017-01-01

Having a stable and safe place to live is integral to recovery from addiction. Recovery residences represent an important component in the substance use continuum of care, but research on them has been limited to certain types of recovery residences and has yet to examine quality of life among those who live in them. This study presents data on the characteristics of residents (N = 104) living in a stratified random sample of recovery homes in Philadelphia (N = 13) as well as data from a random subsample of residents (N = 27) who participated in 3-month follow-up interviews. Residents in these homes reported deficits in a variety of aspects of their lives critical to helping them initiate and sustain their recovery; many (20%) reported living in a shelter or on the streets prior to moving in, 37% had less than a high school education, and only 26% reported currently working for pay. Although the majority of residents rated their quality of life as good or very good (74%), average physical health, social relationship, and environment domain scores measured by the World Health Organization Quality of Life (WHOQOL)-Bref were generally lower than scores found among community samples. At follow-up, all residents were housed and rates of substance use (7%), criminal justice involvement (0%), and employment (44%) in the past 30 days were encouraging. Quality of life domain scores were unchanged, with the exception of psychological health, which decreased. These findings highlight the complex needs of residents living in Philadelphia recovery homes and the role that these homes play in maintaining residents in their early recovery. Studies with larger samples of residents followed up over longer periods of time are needed to assess the role that these homes may play in promoting long-term recovery and improving the well-being of the vulnerable population of individuals who live in them.

Accuracy of time-domain and frequency-domain methods used to characterize catchment transit time distributions

NASA Astrophysics Data System (ADS)

Godsey, S. E.; Kirchner, J. W.

2008-12-01

The mean residence time - the average time that it takes rainfall to reach the stream - is a basic parameter used to characterize catchment processes. Heterogeneities in these processes lead to a distribution of travel times around the mean residence time. By examining this travel time distribution, we can better predict catchment response to contamination events. A catchment system with shorter residence times or narrower distributions will respond quickly to contamination events, whereas systems with longer residence times or longer-tailed distributions will respond more slowly to those same contamination events. The travel time distribution of a catchment is typically inferred from time series of passive tracers (e.g., water isotopes or chloride) in precipitation and streamflow. Variations in the tracer concentration in streamflow are usually damped compared to those in precipitation, because precipitation inputs from different storms (with different tracer signatures) are mixed within the catchment. Mathematically, this mixing process is represented by the convolution of the travel time distribution and the precipitation tracer inputs to generate the stream tracer outputs. Because convolution in the time domain is equivalent to multiplication in the frequency domain, it is relatively straightforward to estimate the parameters of the travel time distribution in either domain. In the time domain, the parameters describing the travel time distribution are typically estimated by maximizing the goodness of fit between the modeled and measured tracer outputs. In the frequency domain, the travel time distribution parameters can be estimated by fitting a power-law curve to the ratio of precipitation spectral power to stream spectral power. Differences between the methods of parameter estimation in the time and frequency domain mean that these two methods may respond differently to variations in data quality, record length and sampling frequency. Here we evaluate how well these two methods of travel time parameter estimation respond to different sources of uncertainty and compare the methods to one another. We do this by generating synthetic tracer input time series of different lengths, and convolve these with specified travel-time distributions to generate synthetic output time series. We then sample both the input and output time series at various sampling intervals and corrupt the time series with realistic error structures. Using these 'corrupted' time series, we infer the apparent travel time distribution, and compare it to the known distribution that was used to generate the synthetic data in the first place. This analysis allows us to quantify how different record lengths, sampling intervals, and error structures in the tracer measurements affect the apparent mean residence time and the apparent shape of the travel time distribution.

Hydrogeologic Characteristics of the St. Croix River Basin, Minnesota and Wisconsin: Implications for the Susceptibility of Ground Water to Potential Contamination

USGS Publications Warehouse

Juckem, Paul F.

2007-01-01

Population growth in the St. Croix River Basin in Minnesota and Wisconsin has intensified concerns of county resource managers and the National Park Service, which is charged with protecting the St. Croix National Scenic Riverway, about the potential for ground-water contamination in the basin. This report describes a previously developed method that was adapted to illustrate potential ground-water-contamination susceptibility in the St. Croix River Basin. The report also gives an estimate of ground-water-residence time and surface-water/ground-water interaction as related to natural attenuation and movement of contaminants in five tributary basins. A ground-water-contamination-susceptibility map was adapted from a state-wide map of Wisconsin to the St. Croix River Basin by use of well-driller construction records and regional maps of aquifer properties in Minnesota and Wisconsin. Measures of various subsurface properties were combined to generate a spatial index of susceptibility. The subjective index method developed for the State of Wisconsin by Schmidt (1987) was not derived from analyses of water-quality data or physical processes. Nonetheless, it was adapted for this report to furnish a seamless map across state boundaries that would be familiar to many resource managers. Following this method, areas most susceptible to contamination appear to have coarse-grained sediments (sands or gravels) and shallow water tables or are underlain by carbonate-bedrock aquifers. The least susceptible areas appear to have fine-grained sediments and deep water tables. If an aquifer becomes contaminated, the ground-water-residence time can affect potential natural attenuation along the ground-water-flow path. Mean basin ground-water-residence times were computed for the Apple, Kettle, Kinnickinnic, Snake and Sunrise River Basins, which are tributary basins to the St. Croix Basin, by use of average aquifer properties of saturated thickness, porosity, and recharge rates. The Apple River Basin had the shortest mean ground-water-residence times (20-120 years), owing largely to the moderate saturated thickness and high recharge rate in the basin. The Kinnickinnic and Sunrise River Basins had the longest mean residence times (60-350 and 70-390 years, respectively) chiefly because of the relatively large saturated thickness of the basins. Owing to limitations of the residence-time calculations, actual ground-water-residence times will vary around the mean values within each basin and may range from days or weeks in karst carbonate aquifers to millennia in deep confined sandstone aquifers. Areas of relatively short residence time (less than the median residence time in each basin) were identified by use of ground-water-flow models for each of the five tributary basins. Results of simulations show that these areas, in which contaminants may have relatively less time for natural attenuation along the short flow paths, generally occur near streams and rivers where ground water discharges to the surface. Finally, the ground-water-flow models were used to simulate ground-water/surface-water interaction in the five tributary basins. Results of simulations show that some lakes and reservoirs leak surface water into the ground-water-flow system on their downgradient side, where the surface-water outflow has been restricted by a dam or a naturally constricted outlet. These locations are noteworthy because contaminated surface waters could potentially enter the ground-water-flow system at these locations.

Biofiltration of hydrogen sulfide by Sulfolobus metallicus at high temperatures.

PubMed

Morales, M; Silva, J; Morales, P; Gentina, J C; Aroca, G

2012-01-01

Biofiltration of reduced sulfur compounds such as hydrogen sulfide has been mainly applied to emissions at mild temperatures (25 to 35 °C). However, an important number of industrial gaseous emission containing sulfur compounds, from diverse industrial sectors (petroleum refinery, cellulose production, smelting, rendering plants and food industries) are emitted at temperatures over 50 °C. Most of the studies on thermophilic systems report that a higher elimination capacity can be obtained at elevated temperature, allowing the design of smaller equipment for the same loading rate than that required for removing the same load under mesophilic conditions. A biotrickling filter inoculated with Sulfolobus metallicus, which operates at three different residence times, 60, 80 and 120 s, and two different temperatures (45 and 55 °C) for treating H(2)S is reported. The input loads of H(2)S were progressively increased from 0 to 100 gS/m(3). The aim of this study was to determine the capacity and ability of S. metallicus to oxidize H(2)S at high temperatures. The better removal capacity of H(2)S obtained was 37.1 ± 1.7 gS/m(3) h at 55 °C for a residence time of 120 s. The difference of the removal capacity of H(2)S between the two temperatures was 4 g/m(3) h on average of sulfur removal for the different residence times.

Modeling of ground-water flow in subsurface Austin Chalk and Taylor marl in Ellis County, Texas, near the superconducting super collider site

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mace, R.E.

1993-02-01

Numerical models are useful tools for developing an understanding of ground-water flow in sparsely characterized low-permeability aquifers. Finite-difference, cross-sectional models of Cretaceous chalk and marl formations near the Superconducting Super Collider (SSC) were constructed using MODFLOW to evaluate ground-water circulation paths and travel times. Weathered and fractured zones with enhanced permeability were included to assess the effect these features had on flow paths and times. Pump tests, slug tests, packer tests, core tests, and estimates were used to define hydraulic properties for model input. The model was calibrated with water-level data from monitor wells and from wire-line piezometers near amore » test shaft excavated by the SSC project. A ratio of vertical-to-horizontal permeability of 0.0085 was estimated through model calibration. A chalk-to-marl permeability ratio of 18 was needed to reproduce artesian head in a well completed in chalk beneath marl. Hydraulic head distributions and ground-water flow paths reflected local, intermediate, and regional flow systems with recharge beneath upland surface-water divides and discharge in valleys. Most of the flow (99%) occurred in the weathered zone, with average residence times of 5 to 10 years. Residence time in unweathered chalk bedrock was substantially longer, at an average of 1.7 Ma. As expected, the model demonstrated that deep and rapid ground-water circulation might occur in fracture zones. Particle paths calculated using MODPATH showed that ground-water travel times from recharge areas to the SSC subsurface facilities might be 20 to 60 years where flow is through fracture zones.« less

Work-related health complaints in surgical residents and the influence of social support and job-related autonomy.

PubMed

Boerjan, Martine; Bluyssen, Simone J M; Bleichrodt, Robert P; van Weel-Baumgarten, Evelyn M; van Goor, Harry

2010-08-01

The aim of this cross-sectional study was to investigate the influence of job-related autonomy and social support provided by consultants and colleagues on the stress-related health complaints of surgical residents in the Netherlands. All (n = 400) Dutch residents in training in general surgery were sent validated self-report questionnaires. Odds ratios were calculated predicting health and exposure to long-term stress for gender, number of working hours, type of hospital, level of social support, job-related autonomy and training phase. The interactions between job-related autonomy and level of social support provided by consultants and colleagues, and all variables, were analysed. A total of 254 of 400 (64%) residents returned questionnaires that were eligible for analysis. Residents experienced more health complaints than the average member of the Dutch working population (4.0 versus 2.5; p = 0.000). Male and senior residents were significantly 'healthier' than female and junior residents, respectively. Social support by consultants was a strong predictor of health and social support by colleagues showed a significant interaction with gender. Women and residents in university hospitals experienced less social support by consultants than men and residents in general teaching hospitals. Residents working in university hospitals experienced lower levels of job-related autonomy and less support from colleagues in comparison with those working in general teaching hospitals. A working week of > 60 hours adversely affected health and job-related autonomy. Social support provided by consultants and colleagues, and job control, are important factors that interact with the work-associated, stress-related health of residents in training in general surgery. Residents report a greater number of health complaints than the average member of the working population, especially female and junior residents. General teaching hospitals seem to provide better support at work than university hospitals.

Voice recognition technology implementation in surgical pathology: advantages and limitations.

PubMed

Singh, Meenakshi; Pal, Timothy R

2011-11-01

Voice recognition technology (VRT) has been in use for medical transcription outside of laboratories for many years, and in recent years it has evolved to a level where it merits consideration by surgical pathologists. To determine the feasibility and impact of making a transition from a transcriptionist-based service to VRT in surgical pathology. We have evaluated VRT in a phased manner for sign out of general and subspecialty surgical pathology cases after conducting a pilot study. We evaluated the effect on turnaround time, workflow, staffing, typographical error rates, and the overall ability of VRT to be adapted for use in surgical pathology. The stepwise implementation of VRT has resulted in real-time sign out of cases and improvement in average turnaround time from 4 to 3 days. The percentage of cases signed out in 1 day improved from 22% to 37%. Amendment rates for typographical errors have decreased. Use of templates and synoptic reports has been facilitated. The transcription staff has been reassigned to other duties and is successfully assisting in other areas. Resident involvement and exposure to complete case sign out has been achieved resulting in a positive impact on resident education. Voice recognition technology allows for a seamless workflow in surgical pathology, with improvements in turnaround time and a positive impact on competency-based resident education. Individual practices may assess the value of VRT and decide to implement it, potentially with gains in many aspects of their practice.

Effect of Commuter Time on Emergency Medicine Residents.

PubMed

Sampson, Christopher; Borenstein, Marc

2018-01-12

Background The impact of resident work hours on resident well-being and patient safety has long been a controversial issue. Objectives What has not been considered in resident work hour limitations is whether resident commuting time has any impact on a resident's total work hours or well-being. Methods A self-administered electronic survey was distributed to emergency medicine residents in 2016. Results The survey response was 8% (569/6828). Commuter time was 30 minutes or less in 70%. Two residents reported a commuter time of 76 to 90 minutes and one resident had a commuter time of 91 to 105 minutes. None reported commuter times greater than 105 minutes. Of most concern was that 29.3% of the residents reported falling asleep while driving their car home from work. We found 12% of respondents reporting being involved in a car collision while commuting. For residents with commute times greater than one hour, 66% reported they had fallen asleep while driving. When asked their opinion on the effect of commute time, those with commute times greater than one hour (75% of residents) responded that it was detrimental. Conclusions While the majority of emergency medicine residents in this survey have commuter times of 30 minutes or less, there is a small population of residents with commuter times of 76 to 105 minutes. At times, residents whose commute is up to 105 minutes each way could be traveling a total of more than 3.5 hours for each round trip. Given that these residents often work 12-hour shifts, these extended commuter times may be having detrimental effects on their health and well-being.

Effect of Commuter Time on Emergency Medicine Residents

PubMed Central

Borenstein, Marc

2018-01-01

Background The impact of resident work hours on resident well-being and patient safety has long been a controversial issue. Objectives What has not been considered in resident work hour limitations is whether resident commuting time has any impact on a resident's total work hours or well-being. Methods A self-administered electronic survey was distributed to emergency medicine residents in 2016. Results The survey response was 8% (569/6828). Commuter time was 30 minutes or less in 70%. Two residents reported a commuter time of 76 to 90 minutes and one resident had a commuter time of 91 to 105 minutes. None reported commuter times greater than 105 minutes. Of most concern was that 29.3% of the residents reported falling asleep while driving their car home from work. We found 12% of respondents reporting being involved in a car collision while commuting. For residents with commute times greater than one hour, 66% reported they had fallen asleep while driving. When asked their opinion on the effect of commute time, those with commute times greater than one hour (75% of residents) responded that it was detrimental. Conclusions While the majority of emergency medicine residents in this survey have commuter times of 30 minutes or less, there is a small population of residents with commuter times of 76 to 105 minutes. At times, residents whose commute is up to 105 minutes each way could be traveling a total of more than 3.5 hours for each round trip. Given that these residents often work 12-hour shifts, these extended commuter times may be having detrimental effects on their health and well-being. PMID:29545979

The Impact of a new Surgery Residency Program on Case Volume and Case Complexity in a Sub Saharan African Hospital

PubMed Central

Kendig, Claire; Tyson, Anna; Young, Sven; Mabedi, Charles; Cairns, Bruce; Charles, Anthony

2014-01-01

Background Improved access to surgical care could prevent a significant burden of disease and disability-adjusted life years (DALYs), and workforce shortages are the biggest obstacle to surgical care. To address this shortage, a 5-year surgical residency program was established at Kamuzu Central Hospital (KCH) in July 2009. As the residency enters its fourth year, we hypothesized that the initiation of a general surgical residency program would result in an increase in the overall case volume and complexity at KCH. Methods We conducted a retrospective analysis of operated cases at KCH during the three years prior to and the third year after the implementation of the KCH- Surgical residency program, from July 2006 to July 2009, and the calendar year 2012, respectively. Results During the three years prior to the initiation of the surgical residency, an average of 2317 operations were performed per year, while in 2012, 2773 operations were performed, representing a 20% increase. Pre-residency, an average of 1191 major operations per year were performed, and in 2012, 1501 major operations were performed, representing a 26% increase. Conclusion Our study demonstrates that operative case volume and complexity increases following the initiation of a surgical residency program in a sub Saharan tertiary hospital. We believe that by building on established partnerships and emphasizing education, research, and clinical care, we can start to tackle the issues of surgical access and care. PMID:25456410

Resident Training in Bariatric Surgery-A National Survey in the Netherlands.

PubMed

van Ramshorst, Gabrielle H; Kaijser, Mirjam A; Pierie, Jean-Pierre E N; van Wagensveld, Bart A

2017-11-01

Surgical procedures for morbid obesity, including laparoscopic Roux-en-Y gastric bypass (LRYGB), are considered standardized laparoscopic procedures. Our goal was to determine how bariatric surgery is trained in the Netherlands. Questionnaires were sent to lead surgeons from all 19 bariatric centers in the Netherlands. At least two residents or fellows were surveyed for each center. Dutch residents are required to collect at least 20 electronic Objective Standard Assessment of Technical Skills (OSATS) observations per year, which include the level of supervision needed for specific procedures. Centers without resident accreditation were excluded. All 19 surgeons responded (100%). Answers from respondents who worked at teaching hospitals with residency accreditation (12/19, 63%) were analyzed. The average number of trained residents or fellows was 14 (range 3-33). Preferred procedures were LRYGB (n = 10), laparoscopic gastric sleeve (LGS) resection (n = 1), or no preference (n = 1). Three groups could be discerned for the order in which procedural steps were trained: unstructured, in order of increasing difficulty, or in order of chronology. Questionnaire response was 79% (19/24) for residents and 73% (8/11) for fellows. On average, residents started training in bariatric surgery in postgraduate year (PGY) 4 (range 0-5). The median number of bariatric procedures performed was 40 for residents (range 0-148) and 220 during fellowships (range 5-306). Training in bariatric surgery differs considerably among centers. A structured program incorporating background knowledge, step-wise technical skills training, and life-long learning should enhance efficient training in bariatric teaching centers without affecting quality or patient safety.

Utility of 3D Reconstruction of 2D Liver Computed Tomography/Magnetic Resonance Images as a Surgical Planning Tool for Residents in Liver Resection Surgery.

PubMed

Yeo, Caitlin T; MacDonald, Andrew; Ungi, Tamas; Lasso, Andras; Jalink, Diederick; Zevin, Boris; Fichtinger, Gabor; Nanji, Sulaiman

A fundamental aspect of surgical planning in liver resections is the identification of key vessel tributaries to preserve healthy liver tissue while fully resecting the tumor(s). Current surgical planning relies primarily on the surgeon's ability to mentally reconstruct 2D computed tomography/magnetic resonance (CT/MR) images into 3D and plan resection margins. This creates significant cognitive load, especially for trainees, as it relies on image interpretation, anatomical and surgical knowledge, experience, and spatial sense. The purpose of this study is to determine if 3D reconstruction of preoperative CT/MR images will assist resident-level trainees in making appropriate operative plans for liver resection surgery. Ten preoperative patient CT/MR images were selected. Images were case-matched, 5 to 2D planning and 5 to 3D planning. Images from the 3D group were segmented to create interactive digital models that the resident can manipulate to view the tumor(s) in relation to landmark hepatic structures. Residents were asked to evaluate the images and devise a surgical resection plan for each image. The resident alternated between 2D and 3D planning, in a randomly generated order. The primary outcome was the accuracy of resident's plan compared to expert opinion. Time to devise each surgical plan was the secondary outcome. Residents completed a prestudy and poststudy questionnaire regarding their experience with liver surgery and the 3D planning software. Senior level surgical residents from the Queen's University General Surgery residency program were recruited to participate. A total of 14 residents participated in the study. The median correct response rate was 2 of 5 (40%; range: 0-4) for the 2D group, and 3 of 5 (60%; range: 1-5) for the 3D group (p < 0.01). The average time to complete each plan was 156 ± 107 seconds for the 2D group, and 84 ± 73 seconds for the 3D group (p < 0.01). A total 13 of 14 residents found the 3D model easier to use than the 2D. Most residents noticed a difference between the 2 modalities and found that the 3D model improved their confidence with the surgical plan proposed. The results of this study show that 3D reconstruction for liver surgery planning increases accuracy of resident surgical planning and decreases amount of time required. 3D reconstruction would be a useful model for improving trainee understanding of liver anatomy and surgical resection, and would serve as an adjunct to current 2D planning methods. This has the potential to be developed into a module for teaching liver surgery in a competency-based medical curriculum. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Pressure Ulcer Prevention Program Study: a randomized, controlled prospective comparative value evaluation of 2 pressure ulcer prevention strategies in nursing and rehabilitation centers.

PubMed

Shannon, Ronald J; Brown, Lynne; Chakravarthy, Debashish

2012-10-01

This article assesses the comparative prevention-effectiveness and economic implications of a Pressure Ulcer Prevention Program (PUPP) against standard practice of prevention using Agency for Health Care Policy and Research (now the Agency for Healthcare Research and Quality [AHRQ]) guidelines and a mixture of commercial products. The study is a randomized, controlled, prospective cohort study with an accompanying economic evaluation. The economic evaluation is performed from the perspective of the nursing and rehabilitation centers. Two nursing and rehabilitation centers under the same quality and safety support organization. Both institutions are experiencing high nursing staff turnover and incidence of pressure ulcers (PrUs). 133 residents at risk of developing PrUs (EQUIP-for-Quality Risk Score Moderate to Very High [MVH]). All are Medicare-eligible residents with Minimum Data Set (MDS) 2.0 evaluations. The PUPP includes a strategic product bundle and decision algorithms driven by MDS 2.0 Resident Assessment Scores to assist in reducing or preventing PrUs and incontinence-associated skin conditions. The control group utilizes a different brand and assortment of commercial skin care products, briefs, pads, and mattresses, but without use of the decision algorithms driven by MDS 2.0 Resident Assessment Scores. Pressure ulcer prevention education was done for all nurses by a nurse certified in the PUPP program at the beginning and ad libitum by trained senior nursing staff at the end of the study. Comparative reduction in the incidence of nosocomial PrUs and average 6-month net cost savings per MVH-risk resident. Residents were assessed for PrU risk using EQUIP-for-Quality risk assessment algorithm based on data from their Minimum Data Set (MDS 2.0), then assigned to either the PUPP program or control group (standard practice following AHRQ guidelines). Residents were followed until discharge, death, development of PrU, or a maximum time period of 6 months. Direct medical costs of prevention and PrU treatment were recorded using a modified activity-based costing method. A decision model was used to estimate the net cost savings attributed to the PUPP program over a 6-month period. A 67% reduction in the incidence of nosocomial pressure ulcers is attributable to the PUPP strategy over a 6-month period for MVH residents. The average 6-month cost for a MVH Medicare resident is $1928 and $1130 for the control group and PUPP group respectively. Mean difference (net cost savings per resident at risk of pressure ulceration) is $798 per resident for PUPP. PUPP assisted in reducing the incidence of PrUs by 67% in a 6-month period in nursing home facilities. The estimated annual net cost savings attributed to PUPP for 300 MVH residents is estimated at approximately $240,000.

Concurrent Validity Between a Shared Curriculum, the Internal Medicine In-Training Examination, and the American Board of Internal Medicine Certifying Examination.

PubMed

Sisson, Stephen D; Bertram, Amanda; Yeh, Hsin-Chieh

2015-03-01

A core objective of residency education is to facilitate learning, and programs need more curricula and assessment tools with demonstrated validity evidence. We sought to demonstrate concurrent validity between performance on a widely shared, ambulatory curriculum (the Johns Hopkins Internal Medicine Curriculum), the Internal Medicine In-Training Examination (IM-ITE), and the American Board of Internal Medicine Certifying Examination (ABIM-CE). A cohort study of 443 postgraduate year (PGY)-3 residents at 22 academic and community hospital internal medicine residency programs using the curriculum through the Johns Hopkins Internet Learning Center (ILC). Total and percentile rank scores on ILC didactic modules were compared with total and percentile rank scores on the IM-ITE and total scores on the ABIM-CE. The average score on didactic modules was 80.1%; the percentile rank was 53.8. The average IM-ITE score was 64.1% with a percentile rank of 54.8. The average score on the ABIM-CE was 464. Scores on the didactic modules, IM-ITE, and ABIM-CE correlated with each other (P < .05). Residents completing greater numbers of didactic modules, regardless of scores, had higher IM-ITE total and percentile rank scores (P < .05). Resident performance on modules covering back pain, hypertension, preoperative evaluation, and upper respiratory tract infection was associated with IM-ITE percentile rank. Performance on a widely shared ambulatory curriculum is associated with performance on the IM-ITE and the ABIM-CE.

Factors associated with physiotherapy provision in a population of elderly nursing home residents; a cross sectional study.

PubMed

Leemrijse, Chantal J; de Boer, Marike E; van den Ende, Cornelia H M; Ribbe, Miel W; Dekker, Joost

2007-04-04

Although physiotherapy (PT) plays an important role in improving activities of daily living (ADL functioning) and discharge rates, it is unclear how many nursing home residents receive treatment. Furthermore, there is a lack of insight into the determinants that influence the decision for treatment. In this study, we investigated how many nursing home residents receive PT. In addition, we analysed the factors that contribute to the variation in the provision of PT both between nursing homes and between residents. A random sample of 600 elderly residents was taken from a random sample of 15 nursing homes. Residents had to be admitted for rehabilitation or for long-term care. Data were collected through interviews with the nursing home physician and the physiotherapist. Multilevel analysis was used to define the variation in the provision of PT and the factors that are associated with the question whether a resident receives PT or not. Furthermore the amount of PT provided was analysed and the factors that are associated with this. On average 69% of the residents received PT. The percentage of patients receiving treatment differed significantly across nursing homes, and especially the number of physiotherapists available, explained this difference between nursing homes. Residents admitted to a somatic ward for rehabilitation, and male residents in general, were most likely to receive PT. Residents who were treated by a physiotherapist received on average 55 minutes (sd 41) treatment a week. Residents admitted for rehabilitation received more PT a week, as were residents with a status after a total hip replacement. PT is most likely to be provided to residents on a somatic ward, recently admitted for rehabilitation to a nursing home, which has a relatively large number of physiotherapists. This suggests a potential under-use of PT for long-term residents with cognitive problems. It is recommended that physiotherapists reconsider which residents may benefit from treatment. This may require a shift in the focus of physiotherapists from 'recovery and discharge' to 'quality of life and well-being'.

Factors associated with physiotherapy provision in a population of elderly nursing home residents; a cross sectional study

PubMed Central

Leemrijse, Chantal J; de Boer, Marike E; van den Ende, Cornelia HM; Ribbe, Miel W; Dekker, Joost

2007-01-01

Background Although physiotherapy (PT) plays an important role in improving activities of daily living (ADL functioning) and discharge rates, it is unclear how many nursing home residents receive treatment. Furthermore, there is a lack of insight into the determinants that influence the decision for treatment. In this study, we investigated how many nursing home residents receive PT. In addition, we analysed the factors that contribute to the variation in the provision of PT both between nursing homes and between residents. Methods A random sample of 600 elderly residents was taken from a random sample of 15 nursing homes. Residents had to be admitted for rehabilitation or for long-term care. Data were collected through interviews with the nursing home physician and the physiotherapist. Multilevel analysis was used to define the variation in the provision of PT and the factors that are associated with the question whether a resident receives PT or not. Furthermore the amount of PT provided was analysed and the factors that are associated with this. Results On average 69% of the residents received PT. The percentage of patients receiving treatment differed significantly across nursing homes, and especially the number of physiotherapists available, explained this difference between nursing homes. Residents admitted to a somatic ward for rehabilitation, and male residents in general, were most likely to receive PT. Residents who were treated by a physiotherapist received on average 55 minutes (sd 41) treatment a week. Residents admitted for rehabilitation received more PT a week, as were residents with a status after a total hip replacement. Conclusion PT is most likely to be provided to residents on a somatic ward, recently admitted for rehabilitation to a nursing home, which has a relatively large number of physiotherapists. This suggests a potential under-use of PT for long-term residents with cognitive problems. It is recommended that physiotherapists reconsider which residents may benefit from treatment. This may require a shift in the focus of physiotherapists from 'recovery and discharge' to 'quality of life and well-being'. PMID:17407612

Monitoring feed amounts in goliath groupers (Epinephelus itajara) using behavioral conditioning in a large mixed species exhibit.

PubMed

Kittell, Michele M; Ratte, Magan E

2008-09-01

Goliath groupers (Epinephelus itajara) are large charismatic species, which are often residents in public aquaria. This study reports a novel approach to feeding techniques for three resident goliath groupers. Because of the size and depth of their exhibit, the groupers were conditioned to hand feed from aquarists. Daily food logs were recorded including the type and number of species, how often the groupers were fed, and how often they accepted the offered food. Mackerel, herring, and sardine represented the highest percentage of the diet, whereas capelin, squid, and shrimp were the lowest percentage. Over a one-year period, records showed that grouper 1 and grouper 3 ate fairly consistently throughout the year. Grouper 2 had a higher degree of variation in his monthly feeding average with a decrease from May to September and an increase through April. Grouper 1 and grouper 3 took food from the aquarists most consistently with a monthly average of 88.8+/-10.8 and 89.7+/-6.15% of the time, respectively. Grouper 2 was not as consistent, hand feeding at only 74.5+/-16.2% of the time offered. Diet management and behavioral conditioning with the goliath groupers have established consistent husbandry records and therefore better monitoring of the individual fish's long-term health status. Zoo Biol 27:414-419, 2008. (c) 2008 Wiley-Liss, Inc.

Comparison of two estimation methods for surface area concentration using number concentration and mass concentration of combustion-related ultrafine particles

NASA Astrophysics Data System (ADS)

Park, Ji Young; Raynor, Peter C.; Maynard, Andrew D.; Eberly, Lynn E.; Ramachandran, Gurumurthy

Recent research has suggested that the adverse health effects caused by nanoparticles are associated with their surface area (SA) concentrations. In this study, SA was estimated in two ways using number and mass concentrations and compared with SA (SA meas) measured using a diffusion charger (DC). Aerosol measurements were made twice: once starting in October 2002 and again starting in December 2002 in Mysore, India in residences that used kerosene or liquefied petroleum gas (LPG) for cooking. Mass, number, and SA concentrations and size distributions by number were measured in each residence. The first estimation method (SA PSD) used the size distribution by number to estimate SA. The second method (SA INV) used a simple inversion scheme that incorporated number and mass concentrations while assuming a lognormal size distribution with a known geometrical standard deviation. SA PSD was, on average, 2.4 times greater (range = 1.6-3.4) than SA meas while SA INV was, on average, 6.0 times greater (range = 4.6-7.7) than SA meas. The logarithms of SA PSD and SA INV were found to be statistically significant predictors of the logarithm of SA meas. The study showed that particle number and mass concentration measurements can be used to estimate SA with a correction factor that ranges between 2 and 6.

Training Nonnursing Staff to Assist with Nutritional Care Delivery in Nursing Homes: A Cost-Effectiveness Analysis.

PubMed

Simmons, Sandra F; Hollingsworth, Emily K; Long, Emily A; Liu, Xulei; Shotwell, Matthew S; Keeler, Emmett; An, Ruopeng; Silver, Heidi J

2017-02-01

To determine the effect and cost-effectiveness of training nonnursing staff to provide feeding assistance for nutritionally at-risk nursing home (NH) residents. Randomized, controlled trial. Five community NHs. Long-stay NH residents with an order for caloric supplementation (N = 122). Research staff provided an 8-hour training curriculum to nonnursing staff. Trained staff were assigned to between-meal supplement or snack delivery for the intervention group; the control group received usual care. Research staff used standardized observations and weighed-intake methods to measure frequency of between-meal delivery, staff assistance time, and resident caloric intake. Fifty staff (mean 10 per site) completed training. The intervention had a significant effect on between-meal caloric intake (F = 56.29, P < .001), with the intervention group consuming, on average, 163.33 (95% CI = 120.19-206.47) calories per person per day more than the usual care control group. The intervention costs were $1.27 per person per day higher than usual care (P < .001). The incremental cost-effectiveness ratio for the intervention was 134 kcal per dollar. The increase in cost was due to the higher frequency and number of snack items given per person per day and the associated staff time to provide assistance. It is cost effective to train nonnursing staff to provide caloric supplementation, and this practice has a positive effect on residents' between-meal intake. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Large urban-rural disparity in the severity of two-week illness: updated results based on the first health service survey of Hunan Province, China.

PubMed

Tian, Danping; Sun, Li; Zhang, Lingling; Zhang, Lin; Zhang, Wei; Li, Li; Deng, Xin; Ning, Peishan; Cheng, Xunjie; Deng, Jing; Hu, Guoqing

2016-02-29

To examine urban-rural differences in the severity of non-fatal disease and injury using the latest household interview survey data of Hunan Province, China. Two-week illness data were from the first provincial health household interview survey of Hunan in 2013. The proportion of patients being bedridden, the average days of being bedridden and the average off-work days were calculated to measure the severity of two-week illness. Rao-Scott-adjusted chi-square test was performed to examine the significance of two-week illness severity differences from demographic variables. Multiple logistic regression and linear regression were used to control for sex, age and household income. The two-week illness prevalence was 22.8 % in Hunan province. Despite similar two-week ill prevalence rates between urban areas and rural areas (23.0 % vs. 22.8 %), rural residents had higher proportions of being bedridden and of being off work than urban residents after controlling for sex, age and household income, with adjusted odds ratios of 3.4 and 6.9, respectively. Similarly, the average days of being bedridden and of being off work in rural residents were 0.45 days and 1.61 days longer than in urban residents after controlling for demographic variables, respectively. The recent data shows that two-week illness in rural residents is more serious than urban residents in Hunan Province, China in spite of very similar two-week prevalence rates. The neglected urban-rural disparities in the severity of two-week illness deserve the attention of health policy-makers and researchers.

Assessment of resident operative performance using a real-time mobile Web system: preparing for the milestone age.

PubMed

Wagner, Justin P; Chen, David C; Donahue, Timothy R; Quach, Chi; Hines, O Joe; Hiatt, Jonathan R; Tillou, Areti

2014-01-01

To satisfy trainees' operative competency requirements while improving feedback validity and timeliness using a mobile Web-based platform. The Southern Illinois University Operative Performance Rating Scale (OPRS) was embedded into a website formatted for mobile devices. From March 2013 to February 2014, faculty members were instructed to complete the OPRS form while providing verbal feedback to the operating resident at the conclusion of each procedure. Submitted data were compiled automatically within a secure Web-based spreadsheet. Conventional end-of-rotation performance (CERP) evaluations filed 2006 to 2013 and OPRS performance scores were compared by year of training using serial and independent-samples t tests. The mean CERP scores and OPRS overall resident operative performance scores were directly compared using a linear regression model. OPRS mobile site analytics were reviewed using a Web-based reporting program. Large university-based general surgery residency program. General Surgery faculty used the mobile Web OPRS system to rate resident performance. Residents and the program director reviewed evaluations semiannually. Over the study period, 18 faculty members and 37 residents logged 176 operations using the mobile OPRS system. There were 334 total OPRS website visits. Median time to complete an evaluation was 45 minutes from the end of the operation, and faculty spent an average of 134 seconds on the site to enter 1 assessment. In the 38,506 CERP evaluations reviewed, mean performance scores showed a positive linear trend of 2% change per year of training (p = 0.001). OPRS overall resident operative performance scores showed a significant linear (p = 0.001), quadratic (p = 0.001), and cubic (p = 0.003) trend of change per year of clinical training, reflecting the resident operative experience in our training program. Differences between postgraduate year-1 and postgraduate year-5 overall performance scores were greater with the OPRS (mean = 0.96, CI: 0.55-1.38) than with CERP measures (mean = 0.37, CI: 0.34-0.41). Additionally, there were consistent increases in each of the OPRS subcategories. In contrast to CERPs, the OPRS fully satisfies the Accreditation Council for Graduate Medical Education and American Board of Surgery operative assessment requirements. The mobile Web platform provides a convenient interface, broad accessibility, automatic data compilation, and compatibility with common database and statistical software. Our mobile OPRS system encourages candid feedback dialog and generates a comprehensive review of individual and group-wide operative proficiency in real time. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Associations of Acculturation With Self-Report and Objective Physical Activity and Sedentary Behaviors Among Latinas.

PubMed

Perez, Lilian G; Chavez, Adrian; Marquez, David X; Soto, Sandra C; Haughton, Jessica; Arredondo, Elva M

2017-06-01

Less than 50% of Latinas meet physical activity (PA) recommendations. Acculturation is a complex cultural phenomenon that may influence health behaviors, but associations between acculturation and Latinas' activity and sedentary levels are unclear. To examine associations of acculturation with Latinas' domain-specific and total PA as well as sedentary time. We analyzed baseline data collected between 2011 and 2013 among 410 Latinas (18-65 years) from a PA promotion intervention in San Diego, CA ( Fe en Acción/ Faith in Action). Participants wore an accelerometer to assess moderate-to-vigorous PA (MVPA) and sedentary time and completed a survey assessing domain-specific PA, sociodemographics, and acculturation as measured by length of residence in the United States and the Bidimensional Acculturation Scale (BAS) for Hispanics. Higher acculturation was defined as longer residence in the United States or being either assimilated or bicultural as per scores on the Hispanic and Anglo domains of the BAS. Based on weekly averages from the accelerometer, Latinas spent 103 minutes in MVPA and 76% of total activity in sedentary time. Only 32% met MVPA recommendations via self-reported leisure-time and transportation PA. Longer residence in the United States was inversely associated with reporting any transportation or occupational PA and meeting MVPA recommendations. Assimilated/bicultural Latinas had significantly less accelerometer-based total MVPA and higher sedentary time than their lower acculturated counterparts. Overall, higher acculturation, based on either measure, was related to less activity. Our findings suggest interventions tailored to the acculturation levels of Latinas are needed to help reduce disparities in Latinas' PA and sedentary behaviors.

The adequacy of antenatal care services among slum residents in Addis Ababa, Ethiopia.

PubMed

Bayou, Yibeltal T; Mashalla, Yohana S; Thupayagale-Tshweneagae, Gloria

2016-06-15

There are recent efforts made to eliminate inequalities in the utilisation of basic health care services. More emphasis is given for improvement of health in developing countries including maternal and child health. However, disparities for the fast-growing population of urban poor are masked by the urban averages. The aim of this paper is to report on the findings of antenatal care adequacy among slum residents in Addis Ababa, Ethiopia. This was a quantitative and cross-sectional community based study design which employed a stratified two-stage cluster sampling technique to determine the sample. Data was collected using structured questionnaire administered to 870 women aged 15-49 years. Weighted 'backward selection' logistic regression models were employed to identify predictors of adequacy of antenatal care. Majority of slum residents did not have adequate antenatal care services with only 50.3, 20.2 and 11.0 % of the slum resident women initiated antenatal care early, received adequate antenatal care service contents and had overall adequate antenatal care services respectively. Educational status and place of ANC visits were important determinant factors for adequacy of ANC in the study area. Women with secondary and above educational status were 2.7 times more likely to receive overall adequate care compared to those with no formal education. Similarly, clients of private healthcare facilities were 2.2 times respectively more likely to receive overall adequate antenatal care compared to those clients of public healthcare facilities. In order to improve ANC adequacy in the study area, the policy-making, planning, and implementation processes should address the poor adequacy of ANC among the disadvantaged groups in particular and the slum residents in general.

RESIDENTIAL EXPOSURE TO EXTREMELY LOW FREQUENCY ELECTRIC AND MAGNETIC FIELDS IN THE CITY OF RAMALLAH-PALESTINE.

PubMed

Abuasbi, Falastine; Lahham, Adnan; Abdel-Raziq, Issam Rashid

2018-04-01

This study was focused on the measurement of residential exposure to power frequency (50-Hz) electric and magnetic fields in the city of Ramallah-Palestine. A group of 32 semi-randomly selected residences distributed amongst the city were under investigations of fields variations. Measurements were performed with the Spectrum Analyzer NF-5035 and were carried out at one meter above ground level in the residence's bedroom or living room under both zero and normal-power conditions. Fields' variations were recorded over 6-min and some times over few hours. Electric fields under normal-power use were relatively low; ~59% of residences experienced mean electric fields <10 V/m. The highest mean electric field of 66.9 V/m was found at residence R27. However, electric field values were log-normally distributed with geometric mean and geometric standard deviation of 9.6 and 3.5 V/m, respectively. Background electric fields measured under zero-power use, were very low; ~80% of residences experienced background electric fields <1 V/m. Under normal-power use, the highest mean magnetic field (0.45 μT) was found at residence R26 where an indoor power substation exists. However, ~81% of residences experienced mean magnetic fields <0.1 μT. Magnetic fields measured inside the 32 residences showed also a log-normal distribution with geometric mean and geometric standard deviation of 0.04 and 3.14 μT, respectively. Under zero-power conditions, ~7% of residences experienced average background magnetic field >0.1 μT. Fields from appliances showed a maximum mean electric field of 67.4 V/m from hair dryer, and maximum mean magnetic field of 13.7 μT from microwave oven. However, no single result surpassed the ICNIRP limits for general public exposures to ELF fields, but still, the interval 0.3-0.4 μT for possible non-thermal health impacts of exposure to ELF magnetic fields, was experienced in 13% of the residences.

A novel use of the discrete templated notes within an electronic health record software to monitor resident supervision.

PubMed

Ban, Vin Shen; Madden, Christopher J; Browning, Travis; O'Connell, Ellen; Marple, Bradley F; Moran, Brett

2017-04-01

Monitoring the supervision of residents can be a challenging task. We describe our experience with the implementation of a templated note system for documenting procedures with the aim of enabling automated, discrete, and standardized capture of documentation of supervision of residents performing floor-based procedures, with minimal extra effort from the residents. Procedural note templates were designed using the standard existing template within a commercial electronic health record software. Templates for common procedures were created such that residents could document every procedure performed outside of the formal procedural areas. Automated reports were generated and letters were sent to noncompliers. A total of 27 045 inpatient non-formal procedural area procedures were recorded from August 2012 to June 2014. Compliance with NoteWriter template usage averaged 86% in the first year and increased to 94.6% in the second year ( P  = .0055). Initially, only 12.5% of residents documented supervision of any form. By the end of the first year, this was above 80%, with the gains maintained into the second year and beyond. Direct supervision was documented to have occurred where required in 62.8% in the first year and increased to 99.8% in the second year ( P  = .0001) after the addition of hard stops. Notification of attendings prior to procedures was documented 100% of the time by September 2013. Letters sent to errant residents decreased from 3.6 to 0.83 per 100 residents per week. The templated procedure note system with hard stops and integrated reporting can successfully be used to improve monitoring of resident supervision. This has potential impact on resident education and patient safety. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Geometrical effects on the electron residence time in semiconductor nano-particles

DOE Office of Scientific and Technical Information (OSTI.GOV)

Koochi, Hakimeh; Ebrahimi, Fatemeh, E-mail: f-ebrahimi@birjand.ac.ir; Solar Energy Research Group, University of Birjand, Birjand

2014-09-07

We have used random walk (RW) numerical simulations to investigate the influence of the geometry on the statistics of the electron residence time τ{sub r} in a trap-limited diffusion process through semiconductor nano-particles. This is an important parameter in coarse-grained modeling of charge carrier transport in nano-structured semiconductor films. The traps have been distributed randomly on the surface (r{sup 2} model) or through the whole particle (r{sup 3} model) with a specified density. The trap energies have been taken from an exponential distribution and the traps release time is assumed to be a stochastic variable. We have carried out (RW)more » simulations to study the effect of coordination number, the spatial arrangement of the neighbors and the size of nano-particles on the statistics of τ{sub r}. It has been observed that by increasing the coordination number n, the average value of electron residence time, τ{sup ¯}{sub r} rapidly decreases to an asymptotic value. For a fixed coordination number n, the electron's mean residence time does not depend on the neighbors' spatial arrangement. In other words, τ{sup ¯}{sub r} is a porosity-dependence, local parameter which generally varies remarkably from site to site, unless we are dealing with highly ordered structures. We have also examined the effect of nano-particle size d on the statistical behavior of τ{sup ¯}{sub r}. Our simulations indicate that for volume distribution of traps, τ{sup ¯}{sub r} scales as d{sup 2}. For a surface distribution of traps τ{sup ¯}{sub r} increases almost linearly with d. This leads to the prediction of a linear dependence of the diffusion coefficient D on the particle size d in ordered structures or random structures above the critical concentration which is in accordance with experimental observations.« less

Toward a Resident Personal Finance Curriculum: Quantifying Resident Financial Circumstances, Needs, and Interests.

PubMed

McKillip, Ryan; Ernst, Michael; Ahn, James; Tekian, Ara; Shappell, Eric

2018-04-26

Introduction Resident financial health has been linked to wellness and resiliency, yet financial literacy among residents is highly variable. While some medical school curricula include budgeting and student loan education, content on managing finances as a resident is usually lacking. We sought to quantitatively assess residents' financial circumstances, needs, and interests to inform the design of a resident personal finance curriculum. Methods Surveys were sent to residents in eight specialties at an academic medical center. Likert-type responses allowed respondents to rate their level of comfort (1 = Very Uncomfortable, 7 = Very Comfortable) and interest (1 = Very Uninterested, 7 = Very Interested) in various personal finance topics including budgeting, loan repayment, disability insurance, life insurance, home buying, and retirement planning. Details regarding financial circumstances, including assets, liabilities, and insurance, were also collected. Results of questions that utilized a Likert-type scale are reported as median (interquartile range). Results Of 346 residents surveyed, 144 (41.6%) responded. Residents were from Internal Medicine (56, 38.9%), Pediatrics (34, 23.6%), Emergency Medicine (18, 12.5%), and other specialties (36, 25.0%). Ninety-one (63.2%) reported educational loans, with an average balance of $191,730. Credit card balances exceeding $3,000 were reported by 11 (7.6%) respondents. One-hundred-two (70.1%) reported emergency savings, but only 65 (45.1%) reported having a retirement account (average balance $27,608). Respondents rated highest comfort levels with budgeting (5[4-6]), and lowest level of comfort with disability insurance (2[2-4]) and home buying (2[2-5]). Interest in learning each topic was high (6[5-7]), with retirement planning (6[5-7]), investing (6[5-7]), and home buying (6[5-7]) the topics of highest interest. Conclusion These results highlight the deficits in personal finance literacy among residents. Future work should focus on development of a nationally scalable personal finance curriculum for residents.

Biofiltration of Asphalt Emissions: Full-scale Operation Treating Off-gases from Polymer-modified Asphalt Production

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cook, Lawrence Leslie; Apel, William Arnold; Gostomski, P. A.

2004-04-01

In response to complaints from nearby residents, a biofilter was designed, installed, and tested for treating odors in one of three odorous emission streams from an asphalt plant producing polymer-modified asphalt. Hydrogen sulfide (H2S) was determined to be the most prevalent gaseous reduced sulfur compound and was detected in the emission stream only when polymer material was being added to raw asphalt. Emission stream H2S concentrations we requite variable, ranging from 16 to approximately 30,000 ppm (v/v) and considered the likely compound contributing most to the plant's odor complaints. The biofilter was effective in controlling odor from the production processmore » and removed an overall average of 65% of the H2S during polymer addition, and for H2S concentrations less than 400 ppmv, re m oval averaged 98%. These removal efficiencies reflect data from the biofilter operating at 2.5-minute empty bed residence time in 1996 and a 6.1-minute empty bed residence time in 1997. The biofilter's bed became increasingly acidified during the plant's 1997 operating season producing a pH gradient through the bed ranging from a high of 6.6 to a low of 3.1. The bed medium moisture content remained constant at about 60% (wet weight basis), but changes were observed in the water potential: no correlation to performance was determined. Changes in the microbial community reflected the bed acidification trend, with acidophiles becoming gene rally more numerous in the bed's deeper portions and in the mid to late season when the bed was most acidified. Bed acidification did not impact the biofilter's H2S removal efficiency. Nearby residents we resurveyed and roughly half of the respondents indicated that the odor conditions had improved, one-third felt odor conditions were unchanged and the remaining 15% felt odor conditions were worse despite the fact that only one of three of the plant's odorous emission streams were treated by the biofilter. Plans are to implement biofiltration for odor control at all of the facility's emission points.« less

Graduating med-peds residents' interest in part-time employment.

PubMed

Fix, Amy L; Kaelber, David C; Melgar, Thomas A; Chamberlain, John; Cull, William; Robbins, Brett W

2011-01-01

As part-time work is becoming more popular among the primary care specialties, we examined the demographic descriptors of med-peds residents seeking and finding part-time employment upon completion of residency training. As part of the 2006 annual American Academy of Pediatrics (AAP) Graduating Med-Peds Residents Survey, we surveyed the graduating residents of all med-peds programs about their interest in and plans for part-time employment. A total of 199 (60%) of the residents responded. Of the resident respondents applying for nonfellowship jobs, 19% sought part-time positions and 10% actually accepted a part-time position. Female residents were significantly more likely than male residents to apply for part-time jobs (26% vs. 7%, P = .034). Sixty percent of female residents immediately seeking work and 58% of those going on to fellowship reported an interest in arranging a part-time or reduced-hours position at some point in the next 5 years. Part-time employment among med-peds residents applying for nonfellowship positions after graduation is similar to the current incidence of part-time employment in other fields of primary care. A much higher percentage of med-peds residents are interested in arranging part-time work within 5 years after graduation. This strong interest in part-time work has many implications for the primary care workforce. Copyright © 2011 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Differentiating levels of surgical experience on a virtual reality temporal bone simulator.

PubMed

Zhao, Yi C; Kennedy, Gregor; Hall, Richard; O'Leary, Stephen

2010-11-01

Virtual reality simulation is increasingly being incorporated into surgical training and may have a role in temporal bone surgical education. Here we test whether metrics generated by a virtual reality surgical simulation can differentiate between three levels of experience, namely novices, otolaryngology residents, and experienced qualified surgeons. Cohort study. Royal Victorian Eye and Ear Hospital. Twenty-seven participants were recruited. There were 12 experts, six residents, and nine novices. After orientation, participants were asked to perform a modified radical mastoidectomy on the simulator. Comparisons of time taken, injury to structures, and forces exerted were made between the groups to determine which specific metrics would discriminate experience levels. Experts completed the simulated task in significantly shorter time than the other two groups (experts 22 minutes, residents 36 minutes, and novices 46 minutes; P = 0.001). Novices exerted significantly higher average forces when dissecting close to vital structures compared with experts (0.24 Newton [N] vs 0.13 N, P = 0.002). Novices were also more likely to injure structures such as dura compared to experts (23 injuries vs 3 injuries, P = 0.001). Compared with residents, the experts modulated their force between initial cortex dissection and dissection close to vital structures. Using the combination of these metrics, we were able to correctly classify the participants' level of experience 90 percent of the time. This preliminary study shows that measurements of performance obtained from within a virtual reality simulator can differentiate between levels of users' experience. These results suggest that simulator training may have a role in temporal bone training beyond foundational training. Copyright © 2010 American Academy of Otolaryngology–Head and Neck Surgery Foundation. Published by Mosby, Inc. All rights reserved.

Effectiveness of a blended learning course and flipped classroom in first year anaesthesia training.

PubMed

Marchalot, Antoine; Dureuil, Bertrand; Veber, Benoit; Fellahi, Jean-Luc; Hanouz, Jean-Luc; Dupont, Hervé; Lorne, Emmanuel; Gerard, Jean-Louis; Compère, Vincent

2017-11-22

Blended learning, which combines internet-based platform and lecturing, is used in anaesthesiology and critical care teaching. However, the benefits of this method remain unclear. We conducted a prospective, multicentre, non-randomised work between 2007 and 2014 to study the effect of blended learning on the results of first year anaesthesia and critical care residents in comparison with traditional teaching. Blended learning was implemented in Rouen University Hospital in 2011 and residents affiliated to this university corresponded as the blended learning group. The primary outcome was the resident's results as measured with multiple-choice questions between blended learning and control groups after beginning blended learning (post-interventional stage). The secondary outcomes included residents' results between pre and post-interventional stages and homework's time. Moreover, comparison between control and blended learning group before beginning blended learning (pre-interventional stage) was performed. From 2007 to 2014, 308 residents were included. For the pre-interventional period, the mean score in the blended learning group (n=53) was 176 (CI 95% 163 to 188) whereas the mean score in the control group (n=106) was 167 (CI 95% 160 to 174) (no difference). For the post-interventional period, the mean score in blended learning group (n=54) was 232 on 300 (CI95% 227-237) whereas the mean score in the control group (n=95) is 215 (CI95% 209-220) (P<0.001). In the two groups, comparison between pre and post-interventional stages showed the increase of mean score, stronger for blended learning group (32% and 28% in blended learning and control group, P<0.05). The average time of homework in the blended learning group was 27h (CI 95% 18.2-35.8) and 10h in the control group (CI 95% 2-18) (P<0.05). This work suggests the positive effect of blended learning (associating internet-based learning and flipped classroom) on the anaesthesia and critical care residents' knowledge by increasing their homework's time. Copyright © 2017. Published by Elsevier Masson SAS.

Associations among cataract prevalence, sunlight hours, and altitude in the Himalayas.

PubMed

Brilliant, L B; Grasset, N C; Pokhrel, R P; Kolstad, A; Lepkowski, J M; Brilliant, G E; Hawks, W N; Pararajasegaram, R

1983-08-01

The relationship between cataract prevalence, altitude, and sunlight hours was investigated in a large national probability sample survey of 105 sites in the Himalayan kingdom of Nepal, December 1980 through April 1981. Cataract of senile or unknown etiology was diagnosed by ophthalmologists in 873 of 30,565 full-time life-long residents of survey sites. Simultaneously, the altitude of sites was measured using a standard mountain altimeter. Seasonally adjusted average daily duration of sunlight exposure for each site was calculated by a method which took into account latitude and obstructions along the skyline. Age- and sex-standardized cataract prevalence was 2.7 times higher in sites at an altitude of 185 meters or less than in sites over 1000 meters. Cataract prevalence was negatively correlated with altitude (r = -0.533, p less than 0.0001). However, a positive correlation between cataract prevalence and sunlight was observed (r = 0.563, p less than 0.0001). Sites with an average of 12 hours of sunlight exposure had 3.8 times as much cataract as sites with an average of only seven hours of exposure. Sunlight was blocked from reaching certain high altitude sites by tall neighboring mountains.

Optimization of Injection Molding Parameters for HDPE/TiO₂ Nanocomposites Fabrication with Multiple Performance Characteristics Using the Taguchi Method and Grey Relational Analysis.

PubMed

Pervez, Hifsa; Mozumder, Mohammad S; Mourad, Abdel-Hamid I

2016-08-22

The current study presents an investigation on the optimization of injection molding parameters of HDPE/TiO₂ nanocomposites using grey relational analysis with the Taguchi method. Four control factors, including filler concentration (i.e., TiO₂), barrel temperature, residence time and holding time, were chosen at three different levels of each. Mechanical properties, such as yield strength, Young's modulus and elongation, were selected as the performance targets. Nine experimental runs were carried out based on the Taguchi L₉ orthogonal array, and the data were processed according to the grey relational steps. The optimal process parameters were found based on the average responses of the grey relational grades, and the ideal operating conditions were found to be a filler concentration of 5 wt % TiO₂, a barrel temperature of 225 °C, a residence time of 30 min and a holding time of 20 s. Moreover, analysis of variance (ANOVA) has also been applied to identify the most significant factor, and the percentage of TiO₂ nanoparticles was found to have the most significant effect on the properties of the HDPE/TiO₂ nanocomposites fabricated through the injection molding process.

[Part-time residency training in Israel].

PubMed

Fishbain, Dana; Levi, Baruch; Borow, Malke; Ashkenazi, Shai; Lindner, Arie

2012-08-01

Full-time work has long been perceived as a cornerstone of medical residency, the consensus being that a resident must apply the bulk of his time and attention to his professional training. Demographic and cultural changes that have taken place over the last several years, specifically the rise in the number of female doctors and the importance of leisure time to the younger generation, have intensified the need to find new and innovative ways to deal with the plight of the resident population. One idea, already in effect in many Western countries, is the institution of part-time residency programs. The possibility of fulfilling residency requirements on a part-time basis is intended to assist medical residents in integrating their professional development with their personal and family life, without compromising the quality of their training. A number of research studies conducted over the last several years in countries that allow part-time residency, among them the United States, England and Switzerland, aimed to examine the quality of part-time training. The various studies evinced a high level of satisfaction from the program both by the residents themselves and their supervisors, and in many aspects those doing residency part-time received higher appraisals than their full-time colleagues. Some of the residents polled noted that they would have totally foregone the practice of medicine had there not been an option to complete residency part-time. In light of the experience throughout the world and the changing landscape in Israel, the Scientific Council of the Israeli Medical Association decided to examine the issue and its various aspects, and weighed all the considerations in favor and against part-time residency. Recently, the Scientific Council approved the launch of a pilot program to allow part-time residency in several fields that were carefully selected according to specific criteria. Once the Ministry of Health completes the LegisLation process, part-time residency will officially begin in Israel.

Day-night pattern in accidental exposures to blood-borne pathogens among medical students and residents.

PubMed

Parks, D K; Yetman, R J; McNeese, M C; Burau, K; Smolensky, M H

2000-01-01

The purpose of this study was to determine whether the occurrence of accidental blood-borne pathogen exposure incidents in medical students and residents in training varies during the 24 h. A retrospective review of reported exposures was conducted in a large urban teaching institution--the University of Texas Health Science Center in Houston--between November 1993 and July 1998. Professional level (year of student or level of resident), time of exposure, means/route of exposure (needle stick, laceration, or splash), and type of medical service were recorded. Analysis of the clock time of the 745 reported blood-borne pathogen exposures showed they occurred more frequently during the day than night. Over the nearly 5-year span, 531 incidents took place between 06:00 and 17:59 in comparison to only 214 between 18:00 and 05:59. To account for the day-night difference in medical student and resident hospital staffing, the data were reexpressed as exposure rates, that is, in terms of the number of events per hour per 1000 medical students and residents. Based on the total number of reported exposures over the almost 5-year span of data collection, the average rate was 40 accidents per hour per 1000 doctors in training during the 12 h daytime span (6:00-17:59). It was 50% greater at night (18:00-05:59), with 60 incidents per hour per 1000 doctors in training. The day-night difference in rate of exposures was statistically significant (p < .04). The relative risk ratio for residents and students when working during the day shift compared to working the night shift was 0.67. This means that doctors in training are at a 1.50 higher risk of sustaining a blood-borne pathogen exposure when working nights than when working days.

Take the HEAT: A pilot study on improving communication with angry families.

PubMed

Delacruz, Nicolas; Reed, Suzanne; Splinter, Ansley; Brown, Amy; Flowers, Stacy; Verbeck, Nicole; Turpening, Debbie; Mahan, John D

2017-06-01

Our objective was to evaluate the utility of an educational program consisting of a workshop based on the Take the HEAT communication strategy, designed specifically for addressing patients who are angry, using a novel tool to evaluate residents' skills in employing this method. 33 first-year pediatric and internal medicine-pediatrics residents participated in the study. The workshop presented the Take the HEAT (Hear, Empathize, Apologize, Take action) strategy of communication. Communication skills were assessed through standardized patient encounters at baseline and post-workshop. Encounters were scored using a novel assessment tool. After the workshop, residents' Take the HEAT communication improved from baseline total average score 23.15 to total average score 25.36 (Z=-3.428, p<0.001). At baseline, empathy skills were the lowest. Intraclass Correlation Coefficient demonstrated substantial agreement (0.60 and 0.61) among raters using the tool. First-year pediatric trainees' communication with angry families improved with education focused on the Take the HEAT strategy. Poor performance by residents in demonstrating empathy should be explored further. This study demonstrates the utility of a brief communications curriculum aimed at improving pediatric residents' ability to communicate with angry families. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

[Teacher's perfomance assessment in Family Medicine specialization].

PubMed

Martínez-González, Adrián; Gómez-Clavelina, Francisco J; Hernández-Torres, Isaías; Flores-Hernández, Fernando; Sánchez-Mendiola, Melchor

2016-01-01

In Mexico there is no systematic evaluation of teachers in medical specialties. It is difficult to identify appropriate teaching practices. The lack of evaluation has limited the recognition and improvement of teaching. The objective of this study was to analyze feedback from students about teaching activities of teachers-tutors responsible for the specialization course in family medicine, and evaluate the evidence of reliability and validity of the instrument applied online. It was an observational and cross-sectional study. Seventy eight teachers of Family Medicine of medical residency were evaluated by 734 resident´s opinion. The anonymous questionnaire to assess teaching performance by resident's opinion and it is composed of 5 dimensions using a Likert scale. Descriptive and inferential statistics (t test, one-way ANOVA and factor analysis) were used. Residents stated that teaching performance is acceptable, with an average of 4.25 ± 0.93. The best valued dimension was "Methodology" with an average of 4.34 ± .92 in contrast to the "assessment" dimension with 4.16 ± 1.04. Teachers of specialization in family medicine have acceptable performance by resident's opinion. The online assessment tool meets the criteria of validity and reliability.

[Multilevel model analysis on the relevant factors influencing the total amount of drinking water consumed daily by Beijing residents].

PubMed

Zhao, Jinhui; Wei, Jianrong; Chen, Huajie; Liu, Yumin; Li, Tiantian; Sun, Qinghua; Liu, Qiaolan

2012-09-01

To investigate the influencing factors for daily water intake of Beijing residents. A multi-stage sampling method was constructed to interview 270 Beijing residents in the winter of 2009 and in the summer of 2010 by using a questionnaire to collect data on daily drinking water consumption. Multilevel models were used to analyze the variation and influencing factors for the amount of water intake. Multilevel model results showed that the average daily water intake of residents living in different villages or neighborhood committees was statistically significant (sigma2 mu0 = = 0.030 (0.009), P < 0.05). The individual variation in the same village or neighborhood committee was also significant (sigma2 e0 = 0.157 (0.010), P < 0.05). Season, gender, and body weight affected the daily water intake (P < 0.05). There were interaction between season and source of water supply. The average daily water intake of residents was affected by several factors. In the health risk assessment of drinking water, it needs considering not only the individual characteristics but also the differences of villages/neighborhood committees and the seasonal variation.

Inconsistency of residents' communication performance in challenging consultations.

PubMed

Wouda, Jan C; van de Wiel, Harry B M

2013-12-01

Communication performance inconsistency between consultations is usually regarded as a measurement error that jeopardizes the reliability of assessments. However, inconsistency is an important phenomenon, since it indicates that physicians' communication may be below standard in some consultations. Fifty residents performed two challenging consultations. Residents' communication competency was assessed with the CELI instrument. Residents' background in communication skills training (CST) was also established. We used multilevel analysis to explore communication performance inconsistency between the two consultations. We also established the relationships between inconsistency and average performance quality, the type of consultation, and CST background. Inconsistency accounted for 45.5% of variance in residents' communication performance. Inconsistency was dependent on the type of consultation. The effect of CST background training on performance quality was case specific. Inconsistency and average performance quality were related for those consultation combinations dissimilar in goals, structure, and required skills. CST background had no effect on inconsistency. Physician communication performance should be of high quality, but also consistent regardless of the type and complexity of the consultation. In order to improve performance quality and reduce performance inconsistency, communication education should offer ample opportunities to practice a wide variety of challenging consultations. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Protected Time for Research During Orthopaedic Residency Correlates with an Increased Number of Resident Publications.

PubMed

Williams, Benjamin R; Agel, Julie A; Van Heest, Ann E

2017-07-05

The Accreditation Council for Graduate Medical Education (ACGME) requires orthopaedic residency programs to promote scholarship and research, which manifest differently among programs. We assess the impact of protected research time during orthopaedic residency on the number of resident publications. Rotation schedules and resident names were collected from 125 ACGME-accredited U.S. orthopaedic residency programs. Protected research time was classified as 1 of 3 types: (1) block time, (2) longitudinal time, or (3) no dedicated time. In April 2016, we searched residents in postgraduate year (PGY)-3 to PGY-5 on pubmed.gov to generate all orthopaedic publications with a PubMed identifier published during residency. Each publication's 2015 Thomson Reuters Journal Citation Reports 5-Year Journal Impact Factor and resident first authorship were noted. The number of PubMed identifiers for each program was summed and was divided by the number of residents in PGY-3 to PGY-5, giving a mean number of publications per resident. The relationship between output and program research time was compared using t tests and analysis of variance (ANOVA). A total of 1,690 residents were included, with an overall mean number (and standard deviation) of 1.2 ± 2.4 publications per resident. Eighty-seven programs reported block time, 14 programs reported longitudinal time, and 24 programs reported no time. There was a significant difference (p = 0.02) in the mean number of publications per resident when compared between programs with protected time (1.1 ± 1.2 publications) and programs with no protected time (0.6 ± 0.5 publication). One-way ANOVA demonstrated a significant mean difference across the 3 groups (p < 0.001), with longitudinal time correlating with significantly greater output at 1.9 ± 1.8 publications than block time at 1.0 ± 1.0 publication or no time at 0.6 ± 0.5 publication, a difference that persisted when adjusted to include only impact factors of >0 and exclude case reports (p = 0.0015). Both the presence of and the type of dedicated research time correlate with residents' research productivity; further consideration of protected research time during residency is warranted. This article provides objective data with regard to research strategies in training orthopaedic surgeons.

Effects of electronic health record use on the exam room communication skills of resident physicians: a randomized within-subjects study.

PubMed

Taft, Teresa; Lenert, Leslie; Sakaguchi, Farrant; Stoddard, Gregory; Milne, Caroline

2015-01-01

The effects of electronic health records (EHRs) on doctor-patient communication are unclear. To evaluate the effects of EHR use compared with paper chart use, on novice physicians' communication skills. Within-subjects randomized controlled trial using observed structured clinical examination methods to assess the impact of use of an EHR on communication. A large academic internal medicine training program. First-year internal medicine residents. Residents interviewed, diagnosed, and initiated treatment of simulated patients using a paper chart or an EHR on a laptop computer. Video recordings of interviews were rated by three trained observers using the Four Habits scale. Thirty-two residents completed the study and had data available for review (61.5% of those enrolled in the residency program). In most skill areas in the Four Habits model, residents performed at least as well using the EHR and were statistically better in six of 23 skills areas (p<0.05). The overall average communication score was better when using an EHR: mean difference 0.254 (95% CI 0.05 to 0.45), p = 0.012, Cohen's d of 0.47 (a moderate effect). Residents scoring poorly (>3 average score) with paper methods (n = 8) had clinically important improvement when using the EHR. This study was conducted in first-year residents in a training environment using simulated patients at a single institution. Use of an EHR on a laptop computer appears to improve the ability of first-year residents to communicate with patients relative to using a paper chart. © The Author 2014. Published by Oxford University Press on behalf of the American Medical Informatics Association.

Effects of electronic health record use on the exam room communication skills of resident physicians: a randomized within-subjects study

PubMed Central

Taft, Teresa; Lenert, Leslie; Sakaguchi, Farrant; Stoddard, Gregory; Milne, Caroline

2015-01-01

Background The effects of electronic health records (EHRs) on doctor–patient communication are unclear. Objective To evaluate the effects of EHR use compared with paper chart use, on novice physicians’ communication skills. Design Within-subjects randomized controlled trial using observed structured clinical examination methods to assess the impact of use of an EHR on communication. Setting A large academic internal medicine training program. Population First-year internal medicine residents. Intervention Residents interviewed, diagnosed, and initiated treatment of simulated patients using a paper chart or an EHR on a laptop computer. Video recordings of interviews were rated by three trained observers using the Four Habits scale. Results Thirty-two residents completed the study and had data available for review (61.5% of those enrolled in the residency program). In most skill areas in the Four Habits model, residents performed at least as well using the EHR and were statistically better in six of 23 skills areas (p<0.05). The overall average communication score was better when using an EHR: mean difference 0.254 (95% CI 0.05 to 0.45), p = 0.012, Cohen's d of 0.47 (a moderate effect). Residents scoring poorly (>3 average score) with paper methods (n = 8) had clinically important improvement when using the EHR. Limitations This study was conducted in first-year residents in a training environment using simulated patients at a single institution. Conclusions Use of an EHR on a laptop computer appears to improve the ability of first-year residents to communicate with patients relative to using a paper chart. PMID:25336596

Case-mix and quality indicators in Chinese elder care homes: are there differences between government-owned and private-sector facilities?

PubMed

Liu, Chang; Feng, Zhanlian; Mor, Vincent

2014-02-01

To assess the association between ownership of Chinese elder care facilities and their performance quality and to compare the case-mix profile of residents and facility characteristics in government-owned and private-sector homes. Cross-sectional study. Census of elder care homes surveyed in Nanjing (2009) and Tianjin (2010). Elder care facilities located in urban Nanjing (n = 140, 95% of all) and urban Tianjin (n = 157, 97% of all). A summary case-mix index based on activity of daily living (ADL) limitations and cognitive impairment was created to measure levels of care needs of residents in each facility. Structure, process, and outcome measures were selected to assess facility-level quality of care. A structural quality measure, understaffing relative to resident levels of care needs, which indicates potentially inadequate staffing given resident case-mix, was also developed. Government-owned homes had significantly higher occupancy rates, presumably reflecting popular demand for publicly subsidized beds, but served residents who, on average, have fewer ADL and cognitive functioning limitations than those in private-sector facilities. Across a range of structure, process, and outcome measures of quality, there is no clear evidence suggesting advantages or disadvantages of either ownership type, although when staffing-to-resident ratio is gauged relative to resident case-mix, private-sector facilities were more likely to be understaffed than government-owned facilities. In Nanjing and Tianjin, private-sector homes were more likely to be understaffed, although their residents were sicker and frailer on average than those in government facilities. It is likely that the case-mix differences are the result of selective admission policies that favor healthier residents in government facilities than in private-sector homes. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

Gender Differences in Academic Productivity and Academic Career Choice Among Urology Residents

PubMed Central

Yang, Glen; Villalta, Jacqueline D.; Weiss, Dana A.; Carroll, Peter R.; Breyer, Benjamin N.

2012-01-01

Purpose Gender disparities have long existed in medicine but they have not been well examined in urology. We analyzed a large cohort of graduating urology residents to investigate gender disparities in academic productivity, as measured by peer reviewed publications and academic career choice. Materials and Methods We assembled a list of urology residents who graduated from 2002 through 2008 who were affiliated with the top 50 urology hospitals, as ranked by 2009 U.S. News & World Report. PubMed® was queried to determine the publication output of each resident during the last 3 years of residency. We used an Internet search to determine the fellowship training, career choice and academic rank of each subject. Gender effects on each factor were evaluated. Results A total of 459 male (84.5%) and 84 female (15.5%) residents were included in analysis. During residency women produced fewer total publications (average 3.0 vs 4.8, p = 0.01) and fewer as first author (average 1.8 vs 2.5, p = 0.03) than men. A higher proportion of women than men underwent fellowship training (54.8% vs 48.5%, p =0.29) and ultimately chose an academic career (40.5% vs 33.3%, p = 0.20), although these differences were not statistically significant. Of residents who chose an academic career a higher proportion of men than women (24.7% vs 2.9%, p = 0.01) obtained associate vs assistant professor rank. Conclusions Women produced fewer peer reviewed publications than men during residency but they were equally likely to undergo fellowship training and choose an academic career. During the study period a higher proportion of men achieved associate professor rank. PMID:22902027

Gender differences in academic productivity and academic career choice among urology residents.

PubMed

Yang, Glen; Villalta, Jacqueline D; Weiss, Dana A; Carroll, Peter R; Breyer, Benjamin N

2012-10-01

Gender disparities have long existed in medicine but they have not been well examined in urology. We analyzed a large cohort of graduating urology residents to investigate gender disparities in academic productivity, as measured by peer reviewed publications and academic career choice. We assembled a list of urology residents who graduated from 2002 through 2008 who were affiliated with the top 50 urology hospitals, as ranked by 2009 U.S. News & World Report. PubMed® was queried to determine the publication output of each resident during the last 3 years of residency. We used an Internet search to determine the fellowship training, career choice and academic rank of each subject. Gender effects on each factor were evaluated. A total of 459 male (84.5%) and 84 female (15.5%) residents were included in analysis. During residency women produced fewer total publications (average 3.0 vs 4.8, p = 0.01) and fewer as first author (average 1.8 vs 2.5, p = 0.03) than men. A higher proportion of women than men underwent fellowship training (54.8% vs 48.5%, p = 0.29) and ultimately chose an academic career (40.5% vs 33.3%, p = 0.20), although these differences were not statistically significant. Of residents who chose an academic career a higher proportion of men than women (24.7% vs 2.9%, p = 0.01) obtained associate vs assistant professor rank. Women produced fewer peer reviewed publications than men during residency but they were equally likely to undergo fellowship training and choose an academic career. During the study period a higher proportion of men achieved associate professor rank. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Lifestyle medicine curriculum for a preventive medicine residency program: implementation and outcomes

PubMed Central

Nawaz, Haq; Petraro, Paul V.; Via, Christina; Ullah, Saif; Lim, Lionel; Wild, Dorothea; Kennedy, Mary; Phillips, Edward M.

2016-01-01

Background The vast majority of the healthcare problems burdening our society today are caused by disease-promoting lifestyles (e.g., physical inactivity and unhealthy eating). Physicians report poor training and lack of confidence in counseling patients on lifestyle changes. Objective To evaluate a new curriculum and rotation in lifestyle medicine for preventive medicine residents. Methods Training included didactics (six sessions/year), distance learning, educational conferences, and newly developed lifestyle medicine rotations at the Institute of Lifestyle Medicine, the Yale-Griffin Prevention Research Center, and the Integrative Medicine Center. We used a number of tools to assess residents’ progress including Objective Structured Clinical Examinations (OSCEs), self-assessments, and logs of personal health habits. Results A total of 20 residents participated in the lifestyle medicine training between 2010 and 2013. There was a 15% increase in residents’ discussions of lifestyle issues with their patients based on their baseline and follow-up surveys. The performance of preventive medicine residents on OSCEs increased each year they were in the program (average OSCE score: PGY1 73%, PGY2 83%, PGY3 87%, and PGY4 91%, p=0.01). Our internal medicine and preliminary residents served as a control, since they did participate in didactics but not in lifestyle medicine rotations. Internal medicine and preliminary residents who completed the same OSCEs had a slightly lower average score (76%) compared with plural for resident, preventive medicine residents (80%). However, this difference did not reach statistical significance (p=0.11). Conclusion Incorporating the lifestyle medicine curriculum is feasible for preventive medicine training allowing residents to improve their health behavior change discussions with patients as well as their own personal health habits. PMID:27507540

Hands-on Physics Education of Residents in Diagnostic Radiology.

PubMed

Zhang, Jie; Hardy, Peter A; DiSantis, David J; Oates, M Elizabeth

2017-06-01

The American Board of Radiology Core Examination integrates assessment of physics knowledge into its overall testing of clinical radiology, with an emphasis on understanding image quality and artifacts, radiation dose, and patient safety for each modality or subspecialty organ system. Accordingly, achieving a holistic approach to physics education of radiology residents is a huge challenge. The traditional teaching of radiological physics-simply through didactic lectures-was not designed for such a holistic approach. Admittedly, time constraints and clinical demands can make incorporation of physics teaching into clinical practice problematic. We created and implemented a week-long, intensive physics rotation for fledgling radiology residents and evaluated its effectiveness. The dedicated physics rotation is held for 1 week during the first month of radiology residency. It comprises three components: introductory lectures, hands-on practical clinical physics operations, and observation of clinical image production. A brief introduction of the physics pertinent to each modality is given at the beginning of each session. Hands-on experimental demonstrations are emphasized, receiving the greatest allotment of time. The residents perform experiments such as measuring radiation dose, studying the relationship between patient dose and clinical practice (eg, fluoroscopy technique), investigating the influence of acquisition parameters (kV, mAs) on radiographs, and evaluating image quality using computed tomography, magnetic resonance imaging, ultrasound, and gamma camera/single-photon emission computed tomography/positron emission tomography phantoms. Quantitative assessment of the effectiveness of the rotation is based on an examination that tests the residents' grasp of basic medical physics concepts along with written course evaluations provided by each resident. The pre- and post-rotation tests show that after the physics rotation, the average correct score of 25 questions improved from 13.6 ± 2.4 to 19 ± 1.2. The survey shows that the physics rotation during the first week of residency is favored by all residents and that 1 week's duration is appropriate. All residents are of the opinion that the intensive workshop would benefit them in upcoming clinical rotations. Residents acknowledge becoming more comfortable regarding the use of radiation and providing counsel regarding radiation during pregnancy. An immersive, short-duration, clinically oriented physics rotation is well received by new or less experienced radiology trainees, correlates basic physics concepts with their relevance to clinical imaging, and more closely parallels expectations of the American Board of Radiology Core Examination. Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Pregnancy and parental leave among obstetrics and gynecology residents: results of a nationwide survey of program directors.

PubMed

Hariton, Eduardo; Matthews, Benjamin; Burns, Abigail; Akileswaran, Chitra; Berkowitz, Lori R

2018-04-16

The health and economic benefits of paid parental leave have been well-documented. In 2016, the American College of Obstetricians and Gynecologists released a policy statement about recommended parental leave for trainees; however, data on adoption of said guidelines are nonexistent, and published data on parental leave policies in obstetrics-gynecology are outdated. The objective of our study was to understand existing parental leave policies in obstetrics-gynecology training programs and to evaluate program director opinions on these policies and on parenting in residency. A Web-based survey regarding parental leave policies and coverage practices was sent to all program directors of accredited US obstetrics-gynecology residency programs. Cross-sectional Web-based survey. Sixty-five percent (163/250) of program directors completed the survey. Most program directors (71%) were either not aware of or not familiar with the recommendations of the American College of Obstetricians and Gynecologists 2016 policy statement on parental leave. Nearly all responding programs (98%) had arranged parental leave for ≥1 residents in the past 5 years. Formal leave policies for childbearing and nonchildbearing parents exist at 83% and 55% of programs, respectively. Program directors reported that, on average, programs offer shorter parental leaves than program directors think trainees should receive. Coverage for residents on leave is most often provided by co-residents (98.7%), usually without compensation or schedule rearrangement to reduce work hours at another time (45.4%). Most program directors (82.8%) believed that becoming a parent negatively affected resident performance, and approximately one-half of the program directors believed that having a child in residency decreased well-being (50.9%), although 19.0% believed that it increased resident well-being. Qualitative responses were mixed and highlighted the complex challenges and competing priorities related to parental leave. Most residency programs are not aligned with the American College of Obstetricians and Gynecologists recommendations on paid parental leave in residency. Complex issues regarding conflicting policies, burden to covering co-residents, and impaired training were raised. Copyright © 2018 Elsevier Inc. All rights reserved.

Clinical Reasoning Tasks and Resident Physicians: What Do They Reason About?

PubMed

McBee, Elexis; Ratcliffe, Temple; Goldszmidt, Mark; Schuwirth, Lambert; Picho, Katherine; Artino, Anthony R; Masel, Jennifer; Durning, Steven J

2016-07-01

A framework of clinical reasoning tasks thought to occur in a clinical encounter was recently developed. It proposes that diagnostic and therapeutic reasoning comprise 24 tasks. The authors of this current study used this framework to investigate what internal medicine residents reason about when they approach straightforward clinical cases. Participants viewed three video-recorded clinical encounters portraying common diagnoses. After each video, participants completed a post encounter form and think-aloud protocol. Two authors analyzed transcripts from the think-aloud protocols using a constant comparative approach. They conducted iterative coding of the utterances, classifying each according to the framework of clinical reasoning tasks. They evaluated the type, number, and sequence of tasks the residents used. Ten residents participated in the study in 2013-2014. Across all three cases, the residents employed 14 clinical reasoning tasks. Nearly all coded tasks were associated with framing the encounter or diagnosis. The order in which residents used specific tasks varied. The average number of tasks used per case was as follows: Case 1, 4.4 (range 1-10); Case 2, 4.6 (range 1-6); and Case 3, 4.7 (range 1-7). The residents used some tasks repeatedly; the average number of task utterances was 11.6, 13.2, and 14.7 for, respectively, Case 1, 2, and 3. Results suggest that the use of clinical reasoning tasks occurs in a varied, not sequential, process. The authors provide suggestions for strengthening the framework to more fully encompass the spectrum of reasoning tasks that occur in residents' clinical encounters.

Mind-Body Skills Training for Resident Wellness: A Pilot Study of a Brief Mindfulness Intervention.

PubMed

Romcevich, Laura E; Reed, Suzanne; Flowers, Stacy R; Kemper, Kathi J; Mahan, John D

2018-01-01

Interventions to address burnout include mind-body skills training (MBST), but few studies have evaluated the feasibility of MBST for busy pediatric residents. In this pilot study, we tested the feasibility of a brief MBST intervention, using in-person peer-led training supported by online modules, to decrease stress and burnout in pediatric resident physicians. Of 99 (10%) residents, 10 residents at Nationwide Children's Hospital in Ohio participated in up to four 90-minute MBST sessions more than 1 month, led by a co-resident with 5 years of informal training in mind-body skills. Participants were offered 8 assigned online modules through OSU Center for Integrative Health and Wellness. Measures including Maslach Burnout Inventory (MBI), Cohen's Perceived Stress, Smith's Brief Resilience, Cognitive and Affective Mindfulness Scale-Revised, and Neff's Self-Compassion Scale (NSS) were administered before (T1) and after (T2) the course. Participants were offered optional monthly "maintenance" sessions for 6 months and completed a third set of measures at this follow-up (T3). The residents completed an average of 4.3/8 online modules and attended an average of 2.8/4 in-person sessions. There was significant improvement in positive attitude, perceived stress, and resilience post intervention (T2). Follow-up evaluation (T3) also demonstrated significant improvement in burnout (depersonalization) and mindfulness. More than 75% of participants found the course worthwhile. A short mixed-method mindfulness-based skills course may be a practical way to offer resilience and stress management training to busy resident physicians.

Assessment of medical residents' satisfaction.

PubMed

González-Martínez, José Francisco; García-García, José Antonio; Del Rosario Arnaud-Viñas, María; Arámbula-Morales, Enna Gabriela; Uriega-González Plata, Silvia; Mendoza-Guerrero, José Antonio

2011-01-01

Modern medical education is focused on students, and it is necessary to assess its level of satisfaction. A questionnaire was validated and we then conducted a study about the educational satisfaction level of medical residents of the Hospital General of Mexico. An observational, descriptive, cross-sectional and prospective study was conducted. A questionnaire of 21 items was validated and then applied to a representative sample of medical residents. Each item was evaluated with a scale from 0 to 10 and then gathered in groups: 0-5 = poor, 6-7 = average, 8 = good, 9 = very good, and 10 = excellent. Descriptive and inferential statistics were carried out using SPSS v.17.0. The questionnaire had internal validity with Cronbach's alpha >0.91 by item. Included in the study were 355 medical residents representing 37 different specialties. The performance perception of the ìheadî professors showed a wide heterogeneity: excellent (23.7%), very good (20.6%), good (16.9%), average (23.1%), poor (15.8%). Fourth-year residents and upward valued the educational performance higher (p = 0.001) as well as medical/surgical residents (p = 0.02). Intermediate-level residents valued the professor higher (p = 0.001), similar to students who were married or living with a partner (p <0.001). Upon contrasting the evaluation of the teacher's performance with the overall course performance, a linear, direct and significant correlation was obtained with Spearman's correlation coefficient = 0.78 and regression coefficient (p <0.001). We found a wide range of heterogeneity of results. Performance of the professors was the basic component to judge the quality of the residents' courses.

Protected Resident Research Time Does Not Increase the Quantity or Quality of Residency Program Research Publications: A Comparison of 3 Orthopedic Residencies.

PubMed

Krueger, Chad A; Hoffman, Jeffery D; Balazs, George C; Johnson, Anthony E; Potter, Benjamin K; Belmont, Philip J

The effect of dedicated resident research time in terms of residency program research productivity remains largely unknown. We hypothesize that the quantity and quality of a residency program's peer-reviewed publications (PRPs) increase proportionately with the amount of dedicated research time given to residents. Three residency programs (P1, P2, and P3) were examined. P1 has a mandatory research year for all residents between postgraduate years 3 and 4. P2 has an elective research year for 1 resident between postgraduate years 2 and 3. P3 has no dedicated research time for residents. All publications produced by residents and staff at each program from January 2007 through December were recorded from PUBMED. SCImago Journal Rankings were used as a proxy to measure research quality. There was no significant difference in the number of publications produced between the institutions on a per-staff (p = 0.27) and per-resident (p = 0.80) basis. There were no residents at P3 who graduated without at least 1 PRP, whereas there were 7 residents from P1 and 8 residents from P2 who graduated without a PRP. There were no significant differences between programs in terms of the SCImago Journal Ranking for the journals containing their publications (p = 0.135). Residency programs with dedicated research time did not produce significantly (p > 0.05) more, or higher quality, PRPs than residencies without dedicated research time. It may be that the quantity and quality of PRPs is related more to faculty engagement, research interest, and mentorship at individual programs rather than the number of residents given dedicated time to complete research. Level 3. Published by Elsevier Inc.

Curriculum Design and Implementation of the Emergency Medicine Chief Resident Incubator.

PubMed

Gisondi, Michael A; Chou, Adaira; Joshi, Nikita; Sheehy, Margaret K; Zaver, Fareen; Chan, Teresa M; Riddell, Jeffrey; Sifford, Derek P; Lin, Michelle

2018-02-24

Background Chief residents receive minimal formal training in preparation for their administrative responsibilities. There is a lack of professional development programs specifically designed for chief residents. Objective In 2015, Academic Life in Emergency Medicine designed and implemented an annual, year-long, training program and virtual community of practice for chief residents in emergency medicine (EM). This study describes the curriculum design process and reports measures of learner engagement during the first two cycles of the curriculum. Methods Kern's Six-Step Approach for curriculum development informed key decisions in the design and implementation of the Chief Resident Incubator. The resultant curriculum was created using constructivist social learning theory, with specific objectives that emphasized the needs for a virtual community of practice, longitudinal content delivery, mentorship for participants, and the facilitation of multicenter digital scholarship. The 12-month curriculum included 11 key administrative or professional development domains, delivered using a combination of digital communications platforms. Primary outcomes measures included markers of learner engagement with the online curriculum, recognized as modified Kirkpatrick Level One outcomes for digital learning. Results An average of 206 chief residents annually enrolled in the first two years of the curriculum, with an overall participation by 33% (75/227) of the allopathic EM residency programs in the United States (U.S.). There was a high level of learner engagement, with an average 13,414 messages posted per year. There were also 42 small group teaching sessions held online, which included 39 faculty and 149 chief residents. The monthly e-newsletter had a 50.7% open rate. Digital scholarship totaled 23 online publications in two years, with 67 chief resident co-authors and 21 faculty co-authors. Conclusions The Chief Resident Incubator is a virtual community of practice that provides longitudinal training and mentorship for EM chief residents. This incubator conceptual framework may be used to design similar professional development curricula across various health professions using an online digital platform.

Curriculum Design and Implementation of the Emergency Medicine Chief Resident Incubator

PubMed Central

Chou, Adaira; Joshi, Nikita; Sheehy, Margaret K; Zaver, Fareen; Chan, Teresa M; Riddell, Jeffrey; Sifford, Derek P; Lin, Michelle

2018-01-01

Background Chief residents receive minimal formal training in preparation for their administrative responsibilities. There is a lack of professional development programs specifically designed for chief residents. Objective In 2015, Academic Life in Emergency Medicine designed and implemented an annual, year-long, training program and virtual community of practice for chief residents in emergency medicine (EM). This study describes the curriculum design process and reports measures of learner engagement during the first two cycles of the curriculum. Methods Kern’s Six-Step Approach for curriculum development informed key decisions in the design and implementation of the Chief Resident Incubator. The resultant curriculum was created using constructivist social learning theory, with specific objectives that emphasized the needs for a virtual community of practice, longitudinal content delivery, mentorship for participants, and the facilitation of multicenter digital scholarship. The 12-month curriculum included 11 key administrative or professional development domains, delivered using a combination of digital communications platforms. Primary outcomes measures included markers of learner engagement with the online curriculum, recognized as modified Kirkpatrick Level One outcomes for digital learning. Results An average of 206 chief residents annually enrolled in the first two years of the curriculum, with an overall participation by 33% (75/227) of the allopathic EM residency programs in the United States (U.S.). There was a high level of learner engagement, with an average 13,414 messages posted per year. There were also 42 small group teaching sessions held online, which included 39 faculty and 149 chief residents. The monthly e-newsletter had a 50.7% open rate. Digital scholarship totaled 23 online publications in two years, with 67 chief resident co-authors and 21 faculty co-authors. Conclusions The Chief Resident Incubator is a virtual community of practice that provides longitudinal training and mentorship for EM chief residents. This incubator conceptual framework may be used to design similar professional development curricula across various health professions using an online digital platform. PMID:29696101

Noticeable Variations in the Educational Exposure During Residency in Danish Orthopedic Departments.

PubMed

Brand, Eske; Fridberg, Marie; Knudsen, Ulrik Kragegaard; Barfod, Kristoffer Weisskirchner

The objective of the study was to examine the educational exposure during residency in Danish orthopedic departments. Questionnaire-based cross-sectional study. Data were gathered from January 1, 2014 to April 30, 2014 through a nationwide web-based questionnaire containing 15 questions within the areas of workload, surgical procedures, outpatient clinic, and research activities. The residents targeted worked at small-to-large hospitals and in tertiary care centers. Every resident in Denmark (n = 163) with at least 3 active months at a department was included. Questionnaires with less than 80% completion were excluded. In total, 152 entries were registered. Among those, 27 did not meet the inclusion criteria and 29 were excluded, leaving 96 participants, representing 22 of 26 departments, for further analysis. The average number of operative procedures as primary surgeon was 16 (range: 8-35) per month. In all, 18 of 22 (81%) departments offered the possibility to participate in research facilitated by the department and 38 of 96 (40%) worked for free (an average of 10h a month [range: 3-60]) to increase the amount of surgical procedures. A large variation in the educational exposure was found among the Danish orthopedic departments. Numbers indicate that Danish residents, compared with their US counterparts, operate considerably less during residency. Most residents work overtime and many of them work for free to participate in more surgical procedures. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Taking into account nighttime annoyance in the calculation of the psophic index

NASA Technical Reports Server (NTRS)

Francois, J.

1981-01-01

The annoyance factor caused by air traffic noise on the residents of areas near airports is discussed. The psophic index is used to predict the level of overall annoyance suffered on the average by residents around airports. The calculation method differentiates between daytime and nighttime annoyance.

26 CFR 1.884-5 - Qualified resident.

Code of Federal Regulations, 2010 CFR

2010-04-01

... local currency of the shares traded using an exchange rate equal to the average of the spot rates on the... paragraph (d) of this section (relating to publicly-traded corporations); (3) Meets the requirements of... foreign corporation is a resident and whose stock is primarily and regularly traded on an established...

Concurrent Validity Between a Shared Curriculum, the Internal Medicine In-Training Examination, and the American Board of Internal Medicine Certifying Examination

PubMed Central

Sisson, Stephen D.; Bertram, Amanda; Yeh, Hsin-Chieh

2015-01-01

Background A core objective of residency education is to facilitate learning, and programs need more curricula and assessment tools with demonstrated validity evidence. Objective We sought to demonstrate concurrent validity between performance on a widely shared, ambulatory curriculum (the Johns Hopkins Internal Medicine Curriculum), the Internal Medicine In-Training Examination (IM-ITE), and the American Board of Internal Medicine Certifying Examination (ABIM-CE). Methods A cohort study of 443 postgraduate year (PGY)-3 residents at 22 academic and community hospital internal medicine residency programs using the curriculum through the Johns Hopkins Internet Learning Center (ILC). Total and percentile rank scores on ILC didactic modules were compared with total and percentile rank scores on the IM-ITE and total scores on the ABIM-CE. Results The average score on didactic modules was 80.1%; the percentile rank was 53.8. The average IM-ITE score was 64.1% with a percentile rank of 54.8. The average score on the ABIM-CE was 464. Scores on the didactic modules, IM-ITE, and ABIM-CE correlated with each other (P < .05). Residents completing greater numbers of didactic modules, regardless of scores, had higher IM-ITE total and percentile rank scores (P < .05). Resident performance on modules covering back pain, hypertension, preoperative evaluation, and upper respiratory tract infection was associated with IM-ITE percentile rank. Conclusions Performance on a widely shared ambulatory curriculum is associated with performance on the IM-ITE and the ABIM-CE. PMID:26217421

Improving patient flow at a family health clinic.

PubMed

Bard, Jonathan F; Shu, Zhichao; Morrice, Douglas J; Wang, Dongyang Ester; Poursani, Ramin; Leykum, Luci

2016-06-01

This paper presents an analysis of a residency primary care clinic whose majority of patients are underserved. The clinic is operated by the health system for Bexar County and staffed primarily with physicians in a three-year Family Medicine residency program at The University of Texas School of Medicine in San Antonio. The objective of the study was to obtain a better understanding of patient flow through the clinic and to investigate changes to current scheduling rules and operating procedures. Discrete event simulation was used to establish a baseline and to evaluate a variety of scenarios associated with appointment scheduling and managing early and late arrivals. The first steps in developing the model were to map the administrative and diagnostic processes and to collect time-stamped data and fit probability distributions to each. In conjunction with the initialization and validation steps, various regressions were performed to determine if any relationships existed between individual providers and patient types, length of stay, and the difference between discharge time and appointment time. The latter two statistics along with resource utilization and closing time were the primary metrics used to evaluate system performance.The results showed that up to an 8.5 % reduction in patient length of stay is achievable without noticeably affecting the other metrics by carefully adjusting appointment times. Reducing the no-show rate from its current value of 21.8 % or overbooking, however, is likely to overwhelm the system's resources and lead to excessive congestion and overtime. Another major finding was that the providers are the limiting factor in improving patient flow. With an average utilization rate above 90 % there is little prospect in shortening the total patient time in the clinic without reducing the providers' average assessment time. Finally, several suggestions are offered to ensure fairness when dealing with out-of-order arrivals.

Identification of Best Practices for Resident Aesthetic Clinics in Plastic Surgery Training: The ACAPS National Survey

PubMed Central

Wu, Cindy; Bentz, Michael L.; Redett, Richard J.; Shack, R. Bruce; David, Lisa R.; Taub, Peter J.; Janis, Jeffrey E.

2015-01-01

Introduction: Resident aesthetic clinics (RACs) have demonstrated good outcomes and acceptable patient satisfaction, but few studies have evaluated their educational, financial, or medicolegal components. We sought to determine RAC best practices. Methods: We surveyed American Council of Academic Plastic Surgeon members (n = 399), focusing on operational details, resident supervision, patient safety, medicolegal history, financial viability, and research opportunities. Of the 96 respondents, 63 reported having a RAC, and 56% of plastic surgery residency program directors responded. Results: RACs averaged 243 patient encounters and 53.9 procedures annually, having been in existence for 19.6 years (mean). Full-time faculty (73%) supervised chief residents (84%) in all aspects of care (65%). Of the 63 RACs, 45 were accredited, 40 had licensed procedural suites, 28 had inclusion/exclusion criteria, and 31 used anesthesiologists. Seventeen had overnight capability, and 17 had a Life Safety Plan. No cases of malignant hyperthermia occurred, but 1 facility death was reported. Sixteen RACs had been involved in a lawsuit, and 33 respondents reported financial viability of the RACs. Net revenue was transferred to both the residents’ educational fund (41%) and divisional/departmental overhead (37%). Quality measures included case logs (78%), morbidity/mortality conference (62%), resident surveys (52%), and patient satisfaction scores (46%). Of 63 respondents, 14 have presented or published RAC-specific research; 80 of 96 of those who were surveyed believed RACs enhanced education. Conclusions: RACs are an important component of plastic surgery education. Most clinics are financially viable but carry high malpractice risk and consume significant resources. Best practices, to maximize patient safety and optimize resident education, include use of accredited procedural rooms and direct faculty supervision of all components of care. PMID:26146599

Cardiothoracic surgery resident education: update on resident recruitment and job placement.

PubMed

Salazar, Jorge D; Ermis, Peter; Laudito, Antonio; Lee, Richard; Wheatley, Grayson H; Paul, Sean; Calhoon, John

2006-09-01

Applications to cardiothoracic surgery training programs have steadily declined. The application cycle for 2004 marked the first time the number of applicants was lower than the positions offered. This survey reflects on this trend in applications and the perspectives of current and graduating residents. In June 2004, the Thoracic Surgery Residents Association, in conjunction with CTSNet, surveyed residents completing accredited cardiothoracic training or additional subspecialization. Participation was anonymous and voluntary. Of the 140 graduates, 88 responded. Most were male (92%) and married (72%). Their average age was 35.7 years, and 56% had children. The mean educational debt was less than $50,000. Of the 88 respondents, 69 (78%) had plans to seek jobs whereas 15 (17%) sought additional training. Among job-seeking residents, 12% received no offers. Also, 59% of graduates initially sought a position in academics and 41% in private practice. Nearly one quarter (23%) reported that they would not choose a career in cardiothoracic surgery again, and more than half (52%) would not strongly recommend cardiothoracic surgery to potential trainees. Almost all (90%) of the graduates believed that the number of cardiothoracic training spots should be decreased, and 92% believed that a reduction in training positions should be achieved by closing marginal training programs. Additionally, 91% believed reimbursement for cardiothoracic surgery was inadequate, and 88% thought low reimbursement resulted in restricted patient access and decreased quality of care. Cardiothoracic training programs are having difficulty in both applicant recruitment and in suitable job placement. This frustration in the job search coupled with reimbursement and lifestyle issues most likely contributes to the general dissatisfaction conveyed by the graduates. If these trends continue, the field will be faced with a crisis of unfilled residency programs and unemployed graduates.

The DE-PHARM Project: A Pharmacist-Driven Deprescribing Initiative in a Nursing Facility.

PubMed

Pruskowski, Jennifer; Handler, Steven M

2017-08-01

Many residents with life-limiting illnesses are being prescribed and taking potentially inappropriate medications (PIMs) and questionably beneficial medications either near or at the end of life. These medications can contribute to adverse drug reactions, increase morbidity, and increase unnecessary burden and cost. It is crucial that the process of deprescribing be incorporated into the care of these residents. After developing a clinical pharmacist-driven deprescribing initiative in the nursing facility, the objective of this project was to reduce the number of PIMs via accepted recommendations from the clinical pharmacist to the primary team. The Discussion to Ensure the Patient-centered, Health-focused, prognosis-Appropriate, and Rational Medication regimen (DE-PHARM) quality improvement-approved project was conducted in an urban, academic nursing facility in Pittsburgh, Pennsylvania. The pilot phase occurred between October 2015 and April 2016. To be included in this study, participants had to be a custodial resident of the nursing facility with a previously documented comfort-focused treatment plan. All medications used for the management of chronic comorbid diseases were eligible for review. Forty-seven residents managed by eight different primary teams met inclusion criteria. Thirty-nine recommendations for 23 residents were made by the clinical pharmacist, with an average of 0.82 and range of 0-5 recommendations per resident, respectively. Of those, only 10 (26%) were accepted, 1 (3%) was modified, 3 (7%) were rejected, and 25 (64%) had no response within the 120-day response period. Additionally, two residents died during the project, and one resident was readmitted to the hospital for a prolonged period of time. The pilot phase of the DE-PHARM project, a clinical pharmacist-driven deprescribing initiative, was designed and assessed. This project demonstrated the feasibility of such an initiative. Because of the complexity of such a process, special attention must be paid to eligible residents and medications, the need for interprofessional collaboration, and the operational process. This project is ongoing in other nursing facilities in Western Pennsylvania.

Teaching and learning in an 80-hour work week: a novel day-float rotation for medical residents.

PubMed

Wong, Jeffrey G; Holmboe, Eric S; Huot, Stephen J

2004-05-01

The 80-hour workweek limit for residents provides an opportunity for residency directors to creatively innovate their programs. Our novel day-float rotation augmented both the educational structure within the inpatient team setting and the ability for house staff to complete their work within the mandated limits. Descriptive evaluation of the rotation was performed through an end-of-rotation questionnaire. The average length of the ward residents' work week was quantified before and after the rotation's implementation. Educational portfolios and mentored peer-teaching opportunities enriched the rotation. As measured by our evaluation, this new rotation enhanced learning and patient care while reducing work hours for inpatient ward residents.

Anesthesia residents' global (departmental) evaluation of faculty anesthesiologists' supervision can be less than their average evaluations of individual anesthesiologists.

PubMed

Hindman, Bradley J; Dexter, Franklin; Smith, Thomas C

2015-01-01

Faculty anesthesiologists' supervision of anesthesiology residents is required for both postgraduate medical education and billing compliance. Previously, using the de Oliveira Filho et al. supervision question set, De Oliveira et al. found that residents who reported mean department-wide supervision scores <3.0 ("frequent") reported a significantly more frequent occurrence of mistakes with negative consequences to patients, as well as medication errors. In our department, residents provide daily evaluations of the supervision received by individual faculty. Using a survey study, we compared relationships between residents' daily supervision scores for individual faculty anesthesiologists and residents' supervision scores for the entire department (comprised these faculty). We studied all anesthesiology residents in clinical years 1, 2, and 3 (i.e., neither in the "base year" nor in fellowship). There were daily evaluations of individual faculty supervision of operative anesthesia for 36 weeks. Residents clicked a hyperlink on the invitation e-mail taking them to a secure Web page to provide their global (departmental) assessment of faculty supervision. We calculated the ratio of each resident's global (departmental) faculty supervision score (i.e., mean among 9 questions × 1 evaluation) to the same resident's daily evaluations of individual faculty (i.e., mean among 9 questions × many evaluations). All 39 of 39 residents chose to participate. The mean departmental supervision score was significantly less (P < 0.0001) than the mean of individual faculty scores. The median ratio of scores was 86% (95% confidence interval, 83%-89%). Kendall's rank correlation between global and (mean) individual faculty scores was τb = 0.34 ± 0.11 (P = 0.0032). The ratios were uniformly distributed (P = 0.64) between the observed minimums and maximums; were not correlated with the mean value of individual faculty scores previously provided by each resident (P = 0.64); were not correlated with the number of individual faculty evaluations previously provided by each resident (P = 0.49); and did not differ among the first, second, or third year residents (P = 0.37). Residents' perceptions of overall (departmental) faculty supervision were less than overall averages of their perceptions of individual faculty supervision. This should be considered when interpreting national survey results (e.g., of patient safety), residency program evaluations, and individual faculty anesthesiologist performance.

Distribution of marine boundary layer ammonia over the Atlantic and Indian Oceans during the Aerosols99 cruise

NASA Astrophysics Data System (ADS)

Norman, Michael; Leck, Caroline

2005-08-01

Over the Atlantic Ocean and southern Indian Ocean an overall large variation in gas phase ammonia was encountered with peak values occurring in regions heavily influenced by the smoke plume from biomass combustion and continental sources on the African continent. Concentrations were typically in the range 7 to 22 nmol m-3. Over the remote clean South Atlantic and Indian Oceans, median gas phase ammonia concentrations ranged between 1.1 and 3.2 nmol m-3, but were occasionally as high as 8.1 nmol m-3 or as low as 0.3 nmol m-3. It was reasonable to assume that the ocean was a net emitter of ammonia to the atmosphere and thus responsible for the ammonia levels measured. An average residence time of the order of a few hours was estimated. One implication of such a rapid removal of ammonia is that it prevented attainment of equilibrium between the gas phase and particulate phase ammonium. In areas under the influence of African biomass burning or dust, however, the particulate phase ammonium was concluded to be in equilibrium with the gas phase ammonia. The removal of atmospheric ammonia during the time of travel from the African continent to the position of the ship was estimated using a simplified Lagrangian approach. A response or residence time of 20 to 130 hours resulted. Thus, in order to explain the observed atmospheric ammonia levels at the ship, it seemed necessary to allow for an ammonia residence time of the order of several days within the plume which differs widely from previous reported estimates.

Simulated Crisis in Obstetric Anesthesia: Design and Evaluation of a Distance Education Presentation

PubMed Central

Murray, W. Bosseau; Schneider, Art; Underberg, Karin; Henry, Jody; Foster, Pat; Vaduva, Sorin; Venable, J. Clark; Shindel, Michelle

2001-01-01

Patient simulators are useful tools for training residents and all levels of medical personnel. Simulator usefulness, in small group sessions, is limited by the costs of training large numbers of people. We present an interrupted methodology designed to involve a large group at a location remote from the simulator. The goal was to enable the remote participants to take part in decision making while under time pressure. Two volunteers were chosen as hands-on participants while eighteen remaining anesthesiology residents observed from a lecture room via a closed circuit audio/video feed. A series of five crises in obstetric anesthesia was presented. After each crisis the simulation was paused and the observers were given three minutes to formulate a differential diagnosis and plan to be carried out. At the end of the session facilitators led a debriefing session with all participants. Surveys completed after the simulation indicated that most residents felt personally involved in the simulation, despite being physically removed from it. Surveys also showed that residents believed they learned more from this format than they would have from a lecture. Residents recalled an average of 3.4 crises two days after the session. This paper presents a model for distance education using a simulator and shows that residents believed remote, interrupted, interactive simulator training is valuable. The interrupted nature and involvement of remotely located peers differentiate this methodology from a passive viewing of a remote session. Further study is warranted to quantify the effectiveness of group and/or distance training with a simulator. PMID:27175412

Occupational Stress and Physical Symptoms among Family Medicine Residents

PubMed Central

Choi, So-Myung; Park, Yong Soon; Kim, Go-Young

2013-01-01

Background The purpose of this study was to examine the levels of occupational stress and physical symptoms among family medicine residents and investigate the effect of subscales of occupational stress on physical symptoms. Methods A self-administered questionnaire survey of 1,152 family medicine residents was carried out via e-mail from April 2010 to July 2010. The response rate was 13.1% and the R (ver. 2.9.1) was used for the analysis of completed data obtained from 150 subjects. The questionnaire included demographic factors, resident training related factors, 24-items of the Korean Occupational Stress Scales and Korean Versions of the Wahler Physical Symptom Inventory. Results The total score of occupational stress of family medicine residents was relatively low compared to that of average workers. The scores of 'high job demand', 'inadequate social support', 'organizational injustice', and 'discomfort in occupational climate' were within the top 50%. Parameters associated with higher occupational stress included level of training, on-duty time, daily patient load, critical patient assigned, total working days, night duty day, sleep duration, and sleep quality. The six subscales of occupational stress, except for 'Job insecurity', had a significant positive correlation with physical symptom scores after adjustment had been made for potential confounders (total score, r = 0.325 and P < 0.001; high job demand, r = 0.439 and P < 0.001). Conclusion After the adjustment had been made for potential confounders, the total score of occupational stress and six subscales in family medicine residents showed a significant positive correlation with physical symptom scores. PMID:23372906

Prevalence and determinants of common mental illness among adult residents of Harari Regional State, Eastern Ethiopia

PubMed Central

Hunduma, Gari; Girma, Mulugeta; Digaffe, Tesfaye; Weldegebreal, Fitsum; Tola, Assefa

2017-01-01

Introduction Common mental disorders include depression, anxiety and somatoform disorders are a public health problem in developed as well as developing countries. It represents a psychiatric morbidity with significant prevalence, affecting all stages of life and cause suffering to the individuals, their family and communities. Despite this fact, little information about the prevalence of common mental illness is available from low and middle-income countries including Ethiopia. The aim of this study was to determine the magnitude of common mental disorders and its associated factors among adult residents of Harari Region. Methods Comparative cross-sectional, quantitative community-based survey was conducted From February 1, 2016 to March 30, 2016 in Harari Regional State using multi-stage sampling technique. A total of 968 residents was selected using two stage sampling technique. Of this 901 were participated in the study. Validated and Pretested Self reported questionnaire (SQR_20) was used to determine the maginitude of common mental disorders. Data was entered and analyzed using Epi-info version 3.5.1 and SPSS-17 for windows statistical packages. Univirate, Bi-variate and multivariate logistic regression analysis with 95% CI was employed in order to infer associations. Results The prevalence of common mental illnesses among adults in our study area was 14.9%. The most common neurotic symptoms in this study were often head ache (23.2%), sleep badly (16%) and poor appetite (13.8%). Substance use like Khat chewing (48.2%), tobacco use (38.2%) and alcohol use (10.5%) was highly prevalent health problem among study participant. In multivariate logistic regression analysis, respondents age between 25-34 years, 35-44 years, 45-54 years and above 55years were 6.4 times (AOR 6.377; 95% CI: 2.280-17.835), 5.9 times (AOR 5.900; 95% CI: 2.243-14.859), 5.6 times (AOR 5.648; 95% CI: 2.200-14.50) and 4.1 times (AOR 4.110; 95% CI: 1.363-12.393) more likely having common mental illnesses than those age between 15-24 years, respectively. The occurrence of common mental illness was twice (AOR: 2.162; 95% CI 1.254-3.728) higher among respondents earn less than the average monthly income than those earn more than average monthly income. The odds of developing common mental illnesses were 6.6 times (AOR 6.653; 95% CI: 1.640-6.992) higher among adults with medically confirmed physical disability than those without physical disability. Similarly, adults who chewed Khat were 2.3 times (AOR 2.305; 95% CI: 1.484-3.579) more likely having common mental illnesses than those who did not chew Khat. Adults with emotional stress were twice (AOR 2.063; 95% CI: 1.176-3.619) higher chance to have common mental illnesses than adults without emotional stress. Conclusion This study had reveals that common mental disorders are major public health problems. Advancing age, low average family monthly income, Khat chewing and emotional stress were independent predictors of common mental illnesses. Whereas sex, place of residence, educational status, marital status, occupation, family size, financial stress, taking alcohol, tobacco use and family history of mental illnesses were not statistically associated with common mental illnesses.

Metabolic theory predicts whole-ecosystem properties.

PubMed

Schramski, John R; Dell, Anthony I; Grady, John M; Sibly, Richard M; Brown, James H

2015-02-24

Understanding the effects of individual organisms on material cycles and energy fluxes within ecosystems is central to predicting the impacts of human-caused changes on climate, land use, and biodiversity. Here we present a theory that integrates metabolic (organism-based bottom-up) and systems (ecosystem-based top-down) approaches to characterize how the metabolism of individuals affects the flows and stores of materials and energy in ecosystems. The theory predicts how the average residence time of carbon molecules, total system throughflow (TST), and amount of recycling vary with the body size and temperature of the organisms and with trophic organization. We evaluate the theory by comparing theoretical predictions with outputs of numerical models designed to simulate diverse ecosystem types and with empirical data for real ecosystems. Although residence times within different ecosystems vary by orders of magnitude-from weeks in warm pelagic oceans with minute phytoplankton producers to centuries in cold forests with large tree producers-as predicted, all ecosystems fall along a single line: residence time increases linearly with slope = 1.0 with the ratio of whole-ecosystem biomass to primary productivity (B/P). TST was affected predominantly by primary productivity and recycling by the transfer of energy from microbial decomposers to animal consumers. The theory provides a robust basis for estimating the flux and storage of energy, carbon, and other materials in terrestrial, marine, and freshwater ecosystems and for quantifying the roles of different kinds of organisms and environments at scales from local ecosystems to the biosphere.

The relative influence of local and regional environmental drivers of algal biomass (chlorophyll-a) varies by estuarine location

NASA Astrophysics Data System (ADS)

Wainger, Lisa; Yu, Hao; Gazenski, Kim; Boynton, Walter

2016-09-01

A major question in restoring estuarine water quality is whether local actions to manage excess nutrients can be effective, given that estuaries are also responding to tidal inputs from adjacent water bodies. Several types of statistical analysis were used to examine spatially-detailed and long-term water quality monitoring data in eight sub-estuaries of Chesapeake Bay. These sub-estuaries are likely to be similar to other shallow systems with moderate to long water residence times. Statistical cluster analysis of spatial water quality data suggested that estuaries had spatially distinct water quality zones and that the peak algal biomass (as measured by chlorophyll-a) was most often controlled by local watershed inputs in all but one estuary, although mainstem inputs affected most estuaries at some times and places. An elasticity indicator that compared inter-annual changes in sub-estuaries to parallel changes in the mainstem Chesapeake Bay supported the idea that water quality in sub-estuaries was not strongly coupled to the mainstem. A cross-channel zonation of water quality observed near the mouth of estuaries suggested that Bay influences were stronger on the right side of the lower channel (looking up estuary) at times in all estuaries, and was most common in small estuaries closest to the mouth of the primary water source to the estuary. Where Bay influences were strong, estuarine water quality would be expected to be less responsive to nutrient reductions made in the local watershed. Regression analysis was used to evaluate hypothesized relationships between environmental driver variables and average chlorophyll-a (chl-a) concentrations. Chl-a values were calculated from unusually detailed levels of spatial sampling, potentially providing a more comprehensive view of system conditions than that provided by traditional sparse sampling networks. The univariate models with the best data support to explain variability in averaged chl-a concentration were those that reflected water residence time. Of the land cover variables tested, septic density in the riparian zone explained the most variance in chl-a. The multivariate models that most improved upon the residence time effect added TN or TP flows (normalized by volume) and suggested that chl-a will be less responsive to nutrient reductions in estuaries that are poorly flushed.

Elective time during dermatology residency: A survey of residents and program directors.

PubMed

Uppal, Pushpinder; Shantharam, Rohini; Kaufmann, Tara Lynn

2017-12-15

Elective time during residency training provides residents with exposure to different subspecialties. This opportunity gives residents the chance tonurture growth in particular areas of interest and broaden their knowledge base in certain topics in dermatology by having the chance to work withexperts in the field. The purpose of this study was to assess the views of residency program directors and dermatology residents on the value of elective time through a cross sectional survey. An eight-questionIRB exempt survey was sent out to 113 residency program directors via email through the American Professors of Dermatology (APD) program director listserv. Program directors were asked to forward a separate set of 9 questions to their residents. The majority of programs that responded allowed for some elective time within their schedule, often duringthe PGY 4 (3rd year of dermatology training), but the amount of time allowed widely varied among many residency programs. Overall, residents and program directors agree that elective is important in residencytraining, but no standardization is established across programs.

Preimplementation predictors of website use: preliminary findings from the SCORE portal pilot study.

PubMed

Schmitz, Connie C; Risucci, Donald; Plass, Jan; Jones, Andrew; Darosa, Debra A

2011-01-01

in 2008, the Surgical Council on Resident Education selected 33 residency programs to pilot its General Surgery Resident Curriculum Website Portal. The portal aims to reduce program variability in curricula, align teaching and learning with essential content, and improve resident study and performance. two online surveys were sent to all program directors and their residents before releasing the portal. Data from 32 programs and 899 residents (84%) were analyzed to determine the extent to which preimplementation characteristics supported the portal's rationale and illuminated barriers to its use and impact on learning. the need for curriculum content and access to online texts varied markedly across programs. Residents had easy onsite access to the Internet and used it heavily for immediate purposes. Fewer residents used the Web for planned activities and proactive study. On average, residents reported studying an hour or less a day. the portal appears to serve curricular resource needs and may better direct resident study. Programs are advised to consciously integrate the SCORE curriculum and portal into residency training and faculty development. 2011 Elsevier Inc. All rights reserved.

Epidemiologic patterns of influenza outbreaks in institutional settings.

PubMed

Šubelj, M

2018-02-01

Congregate environments facilitate spread of influenza viruses and could result in serious outcomes among residents. We reviewed the epidemiology and identified factors that affect outbreak outcomes, using descriptive statistics and generalized estimating equations (GEE) regression. Outbreak duration, attack rate, hospitalization rate, case fatality rate, and the proportion of laboratory tests performed among infected residents were calculated by viral etiology, time to notification, and facility type and size. Between January 2011 and May 2015, the median attack rate for the 41 influenza outbreaks was highest among children in kindergarten (34%) and lowest among patients, who acquired influenza during hospitalization (17%). The median number of cases in each outbreak was 37 (range: 6-158) and a median of 199 individuals (range: 25-574) was exposed to influenza. The outbreaks lasted 2-49 days (median: 13 days). The average case fatality rate among residents for outbreaks attributed to influenza A or B was 3.1/1000 and for outbreaks attributed to influenza B 6.7/1000. Median time to notification was 10 days after the index case. In multivariate analysis, influenza outbreaks reported sooner after onset in the primary case ended sooner (P = 0.027) and had lower case fatality rates (P < 0.001). Residing in larger facilities was associated with lower proportion of laboratory tests performed (P = 0.024). Understanding whether earlier notification is a measure of a better functioning and therefore safer facility is a potentially important measure of the quality of care. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Atmospheric deposition effects on the chemistry of a stream in Northeastern Georgia

USGS Publications Warehouse

Buell, G.R.; Peters, N.E.

1988-01-01

The quantity and quality of precipitation and streamwater were measured from August 1985 through September 1986 in the Brier Creek watershed, a 440-ha drainage in the Southern Blue Ridge Province of northeastern Georgia, to determine stream sensitivity to acidic deposition. Precipitation samples collected at 2 sites had a volume-weighted average pH of 4.40 whereas stream samples collected near the mouth of Brier Creek had a discharge-weighted average pH of 6.70. Computed solute fluxes through the watershed and observed changes in streamwater chemistry during stormflow suggest that cation exchange, mineral weathering, SO42- adsorption by the soil, and groundwater discharge to the stream are probable factors affecting neutralization of precipitation acidity. Net solute fluxes for the watershed indicate that, of the precipitation input, > 99% of the H+, 93% of the NH4+ and NO3-, and 77% of the SO42- were retained. Sources within the watershed yielded base cations, Cl-, and HCO3- and accounted for 84, 47, and 100% of the net transport, respectively. Although streamwater SO42- and NO3- concentrations increased during stormflow, peak concentrations of these anions were much less than average concentrations in the precipitation. This suggests retention of these solutes occurs even when water residence time is short.The quantity and quality of precipitation and streamwater were measured from August 1985 through September 1986 in the Brier Creek watershed, a 440-ha drainage in the Southern Blue Ridge Province of northeastern Georgia, to determine stream sensitivity to acidic deposition. Precipitation samples collected at 2 sites had a volume-weighted average pH of 4.40 whereas stream samples collected near the mouth of Brier Creek had a discharge-weighted average pYH of 6.70. Computed solute fluxes through the watershed and observed changes in streamwater chemistry drying stormflow suggest that cation exchange, mineral weathering, SO42- adsorption by the soil, and groundwater discharge to the stream are probable factors affecting neutralization of precipitation acidity. Although streamwater SO42- and NO3- concentrations increased during stormflow, peak concentrations of these anions were much less than average concentrations in the precipitation. This suggests retention of these solutes occurs even when water residence time is short.

Impact of time-activity patterns on personal exposure to black carbon

NASA Astrophysics Data System (ADS)

Dons, Evi; Int Panis, Luc; Van Poppel, Martine; Theunis, Jan; Willems, Hanny; Torfs, Rudi; Wets, Geert

2011-07-01

Time-activity patterns are an important determinant of personal exposure to air pollution. This is demonstrated by measuring personal exposure of 16 participants for 7 consecutive days: 8 couples of which one person was a full-time worker and the other was a homemaker; both had a very different time-activity pattern. We used portable aethalometers to measure black carbon levels with a high temporal resolution and a PDA with GPS-logger and electronic diary. The exposure to black carbon differs between partners by up to 30%, although they live at the same location. The activity contributing most to this difference is transport: Average exposure in transport is 6445 ng m -3, followed by exposure during shopping (2584 ng m -3). Average exposure is lowest while sleeping (1153 ng m -3) and when doing home-based activities (1223 ng m -3). Full-time workers spend almost twice as much time in transport as the homemakers. As a result of the study design we measured in several different homes, shops, cars, etc. enabling a better insight in true overall exposure in those microenvironments. Other factors influencing personal exposure are: background concentrations and location of residence in an urban, suburban or rural environment.

A Prospective, Multicenter Study to Compare a Disposable, High-fluid Capacity Underpad to Nonpermeable, Disposable, Reusable Containment Products on Incontinence-associated Dermatitis Rates Among Skilled Nursing Facility Residents.

PubMed

Motta, Glenda; Milne, Catherine T

2017-12-01

Due to the high prevalence of incontinence among skilled nursing facility (SNF) residents, incontinence-associated derma- titis (IAD) is a common occurrence. In addition, facility staff may mistakenly identify IAD as a pressure injury. A prospective, descriptive, multicenter study was conducted in 3 Connecticut facilities to evaluate the effect of substituting a disposable, high- uid capacity underpad for nonpermeable disposable and reusable containment products on the rate of IADs. Residents with and without IAD but with high IAD risk scores who were bed- or chairbound or ambulatory and used disposable nonpermeable briefs and underpads or reusable, laundered containment products when in bed longer than 2 hours were randomly enrolled and observed for a 4-week period. Facility staff were trained on the importance of differentiating between IAD and pressure injury; they substituted the study product (a disposable, high- uid capacity underpad) for all previously used containment products. Patient risk for IAD and skin condition were assessed using the Perineal Assessment Tool (PAT) and the Skin Condition Assessment Tool (SAT), respectively, at 5 time points: baseline, week 1, week 2, week 3, and week 4. The PAT is a 4-item instrument based conceptually on the 4 determinants in perineal skin breakdown; subscales are rated from 1 (least risk) to 3 (most risk), with a total score range of 4 to 12. The SAT is used to evaluate IAD speci cally, generating a cumulative severity score ranging from 0 to 3 on area of skin affected, degree of redness, and depth of ero- sion. Final data analysis was conducted on 40 residents: 25 had IAD present at enrollment and 15 were deemed high risk for developing IAD. Mean SAT scores in the 25 participants with IAD decreased with signi cance at week 1 (P = .0016), week 2 (P = .0023), week 3 (P = .0005), and week 4 (P <.0001). Baseline IAD severity scores averaged 3.3 ± 1.7. Overall IAD average severity scores in this group decreased from baseline mean of 3.3 ± 1.7 to 0.7 ± 1.4 at week 4 (P <.001). The 15 participants with intact, nondamaged skin at enrollment did not develop IAD from baseline to week 4, and PAT score risk levels decreased from high (7 or greater) to low (6 or less) as a result of a speci c reduction in the duration of irritant exposure category for 11 (73%) of this group of participants by week 4. PAT risk level scores for both IAD and non-IAD participants at baseline averaged 8.1 ± 1.4; after 4 weeks, they averaged 7.0 ± 1.5). Although change was not significant, results suggest the use of a disposable, high- uid capacity underpad improved SAT scores over time. IAD rates increased in each facility, but pressure injury incidence rates decreased for the study duration. Replacing a nonpermeable, reusable containment product with a disposable, high- uid capacity underpad when SNF residents are in bed longer than 2 hours may impact the severity of IAD and reduce its incidence. The inverse impact reported on IAD and pressure injury incidence rates 1 month after training suggest study educational efforts had a short-lasting effect. Future research is indicated to determine the most effective method to improve nurses' ability to identify and distinguish IAD from pressure injury in the SNF setting.

Performance of High School Students in a Laparoscopic Training Program.

PubMed

Furer, Scott; Alam, Sarah; Rosser, James

2017-01-01

We hypothesized that high school students can be subjected to the same laparoscopic surgical training curriculum used by surgeons and successfully complete it. The goal of this study was to evaluate the appropriateness of early training in minimally invasive surgical techniques. Thirteen high school students, ages 15-18, participated in the validated Top Gun Surgeon Laparoscopic Skills and Suturing program. The students performed 3 preparatory drills 10 times each. The students' scores were then compared to a database of 393 surgeons. Performance graphs were prepared to allow comparison of skills acquisition between the 2 training groups. All 13 students successfully completed the tasks. The Students' performance (expressed as time/percentile range/average percentile) for each task were as follows: rope pass 101.8 seconds/3.8-47.1/11.8; bean drop 149.5 seconds/18.7-96.0/59.4; triangle transfer 303.2 seconds/1.3-16.0/5.8. The students started each drill with slower times, but their average improvement (decreased time to complete tasks) was more rapid than that of the surgeons between the first and second trials for each drill (-83 seconds vs -25 seconds, -120 seconds vs -53 seconds, -100 seconds vs -60 seconds). Average student times compared to average surgeon times during the last trials measured were not significantly different in the triangle transfer and rope pass drills ( P = .40 and .18, respectively). Students' times were significantly faster than surgeons' in the last measured trial of the bean drop ( P = .039). Despite the small sample size, this investigation suggests that high school students can successfully complete skill-building programs in minimally invasive surgery. Further study is needed to evaluate the appropriateness of starting surgical training of future residents at an earlier stage of their careers.

Healthy food access for urban food desert residents: examination of the food environment, food purchasing practices, diet, and body mass index

PubMed Central

Dubowitz, Tamara; Zenk, Shannon N.; Ghosh-Dastidar, Bonnie; Cohen, Deborah; Beckman, Robin; Hunter, Gerald; Steiner, Elizabeth D.; Collins, Rebecca L.

2015-01-01

Objective Provide a richer understanding of food access and purchasing practices among U.S. urban food desert residents and their association with diet and body mass. Design Data on food purchasing practices, dietary intake, height, and weight from the primary food shopper in randomly selected households (n=1372) was collected. Audits of all neighborhood food stores (n=24) and the most-frequented stores outside the neighborhood (n=16) were conducted. Aspects of food access and purchasing practices and relationships among them were examined and tests of their associations with dietary quality and body mass index (BMI) were conducted. Setting Two low-income predominantly African-American neighborhoods with limited access to healthy food in Pittsburgh, Pennsylvania. Subjects Household food shoppers. Results Only one neighborhood outlet sold fresh produce; nearly all respondents did major food shopping outside the neighborhood. Although the nearest full-service supermarket was an average of 2.6 km from their home, respondents shopped an average of 6.0 km from home. The average trip was by car, took approximately two hours roundtrip, and occurred two to four times per month. Respondents spent approximately $37 per person per week on food. Those who made longer trips had access to cars, shopped less often, and spent less money per person. Those who traveled further when they shopped had higher BMIs, but most residents already shopped where healthy foods were available, and physical distance from full service groceries was unrelated to weight or dietary quality. Conclusions Improved access to healthy foods is the target of current policies meant to improve health. However, distance to the closest supermarket might not be as important as previously thought and thus policy and interventions that focus merely on improving access may not be effective. PMID:25475559

Associations of Acculturation With Self-Report and Objective Physical Activity and Sedentary Behaviors Among Latinas

PubMed Central

Perez, Lilian G.; Chavez, Adrian; Marquez, David X.; Soto, Sandra C.; Haughton, Jessica; Arredondo, Elva M.

2017-01-01

Background Less than 50% of Latinas meet physical activity (PA) recommendations. Acculturation is a complex cultural phenomenon that may influence health behaviors, but associations between acculturation and Latinas’ activity and sedentary levels are unclear. Aim To examine associations of acculturation with Latinas’ domain-specific and total PA as well as sedentary time. Method We analyzed baseline data collected between 2011 and 2013 among 410 Latinas (18–65 years) from a PA promotion intervention in San Diego, CA (Fe en Acción/Faith in Action). Participants wore an accelerometer to assess moderate-to-vigorous PA (MVPA) and sedentary time and completed a survey assessing domain-specific PA, sociodemographics, and acculturation as measured by length of residence in the United States and the Bidimensional Acculturation Scale (BAS) for Hispanics. Higher acculturation was defined as longer residence in the United States or being either assimilated or bicultural as per scores on the Hispanic and Anglo domains of the BAS. Results Based on weekly averages from the accelerometer, Latinas spent 103 minutes in MVPA and 76% of total activity in sedentary time. Only 32% met MVPA recommendations via self-reported leisure-time and transportation PA. Longer residence in the United States was inversely associated with reporting any transportation or occupational PA and meeting MVPA recommendations. Assimilated/bicultural Latinas had significantly less accelerometer-based total MVPA and higher sedentary time than their lower acculturated counterparts. Conclusions Overall, higher acculturation, based on either measure, was related to less activity. Our findings suggest interventions tailored to the acculturation levels of Latinas are needed to help reduce disparities in Latinas’ PA and sedentary behaviors. PMID:27679665

Gaming used as an informal instructional technique: effects on learner knowledge and satisfaction.

PubMed

Webb, Travis P; Simpson, Deborah; Denson, Steven; Duthie, Edmund

2012-01-01

Jeopardy!, Concentration, quiz bowls, and other gaming formats have been incorporated into health sciences classroom and online education. However, there is limited information about the impact of these strategies on learner engagement and outcomes. To address this gap, we hypothesized that gaming would lead to a significant increase in retained short- and long-term medical knowledge with high learner session satisfaction. Using the Jeopardy! game show model as a primary instructional technique to teach geriatrics, 8 PGY2 General Surgery residents were divided into 2 teams and competed to provide the "question" to each stated "answer" during 5 protected block curriculum units (1-h/U). A surgical faculty facilitator acted as the game host and provided feedback and brief elaboration of quiz answers/questions as necessary. Each quiz session contained two 25-question rounds. Paper-based pretests and posttests contained questions related to all core curriculum unit topics with 5 geriatric gaming questions per test. Residents completed the pretests 3 days before the session and a delayed posttest of geriatric topics on average 9.2 weeks (range, 5-12 weeks) after the instructional session. The cumulative average percent correct was compared between pretests and posttests using the Student t test. The residents completed session evaluation forms using Likert scale ratings after each gaming session and each protected curriculum block to assess educational value. A total of 25 identical geriatric preunit and delayed postunit questions were administered across the instructional sessions. The combined pretest average score across all 8 residents was 51.5% for geriatric topics compared with 59.5% (p = 0.12) for all other unit topics. Delayed posttest geriatric scores demonstrated a statistically significant increase in retained medical knowledge with an average of 82.6% (p = 0.02). The difference between delayed posttest geriatric scores and posttest scores of all other unit topics was not significant. Residents reported a high level of satisfaction with the gaming sessions: The average session content rating was 4.9 compared with the overall block content rating of 4.6 (scale, 1-5, 5 = Outstanding). The quiz type and competitive gaming sessions can be used as a primary instructional technique leading to significant improvements in delayed posttests of medical knowledge and high resident satisfaction of educational value. Knowledge gains seem to be sustained based on the intervals between the interventions and recorded gains. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

From pipelines to pathways: the Memorial experience in educating doctors for rural generalist practice.

PubMed

Rourke, James; Asghari, Shabnam; Hurley, Oliver; Ravalia, Mohamed; Jong, Michael; Parsons, Wanda; Duggan, Norah; Stringer, Katherine; O'Keefe, Danielle; Moffatt, Scott; Graham, Wendy; Sturge Sparkes, Carolyn; Hippe, Janelle; Harris Walsh, Kristin; McKay, Donald; Samarasena, Asoka

2018-03-01

This report describes the community context, concept and mission of The Faculty of Medicine at Memorial University of Newfoundland (Memorial), Canada, and its 'pathways to rural practice' approach, which includes influences at the pre-medical school, medical school experience, postgraduate residency training, and physician practice levels. Memorial's pathways to practice helped Memorial to fulfill its social accountability mandate to populate the province with highly skilled rural generalist practitioners. Programs/interventions/initiatives: The 'pathways to rural practice' include initiatives in four stages: (1) before admission to medical school; (2) during undergraduate medical training (medical degree (MD) program); (3) during postgraduate vocational residency training; and (4) after postgraduate vocational residency training. Memorial's Learners & Locations (L&L) database tracks students through these stages. The Aboriginal initiative - the MedQuest program and the admissions process that considers geographic or minority representation in terms of those selecting candidates and the candidates themselves - occurs before the student is admitted. Once a student starts Memorial's MD program, the student has ample opportunities to have rural-based experiences through pre-clerkship and clerkship, of which some take place exclusively outside of St. John's tertiary hospitals. Memorial's postgraduate (PG) Family Medicine (FM) residency (vocational) training program allows for deeper community integration and longer periods of training within the same community, which increases the likelihood of a physician choosing rural family medicine. After postgraduate training, rural physicians were given many opportunities for professional development as well as faculty development opportunities. Each of the programs and initiatives were assessed through geospatial rurality analysis of administrative data collected upon entry into and during the MD program and PG training (L&L). Among Memorial MD-graduating classes of 2011-2020, 56% spent the majority of their lives before their 18th birthday in a rural location and 44% in an urban location. As of September 2016, 23 Memorial MD students self-identified as Aboriginal, of which 2 (9%) were from an urban location and 20 (91%) were from rural locations. For Year 3 Family Medicine, graduating classes 2011 to 2019, 89% of placement weeks took place in rural communities and 8% took place in rural towns. For Memorial MD graduating classes 2011-2013 who completed Memorial Family Medicine vocational training residencies, (N=49), 100% completed some rural training. For these 49 residents (vocational trainees), the average amount of time spent in rural areas was 52 weeks out of a total average FM training time of 95 weeks. For Family Medicine residencies from July 2011 to October 2016, 29% of all placement weeks took place in rural communities and 21% of all placement weeks took place in rural towns. For 2016-2017 first-year residents, 53% of the first year training is completed in rural locations, reflecting an even greater rural experiential learning focus. Memorial's pathways approach has allowed for the comprehensive training of rural generalists for Newfoundland and Labrador and the rest of Canada and may be applicable to other settings. More challenges remain, requiring ongoing collaboration with governments, medical associations, health authorities, communities, and their physicians to help achieve reliable and feasible healthcare delivery for those living in rural and remote areas.

Peak Dose Assessment for Proposed DOE-PPPO Authorized Limits

DOE Office of Scientific and Technical Information (OSTI.GOV)

Maldonado, Delis

2012-06-01

The Oak Ridge Institute for Science and Education (ORISE), a U.S. Department of Energy (DOE) prime contractor, was contracted by the DOE Portsmouth/Paducah Project Office (DOE-PPPO) to conduct a peak dose assessment in support of the Authorized Limits Request for Solid Waste Disposal at Landfill C-746-U at the Paducah Gaseous Diffusion Plant (DOE-PPPO 2011a). The peak doses were calculated based on the DOE-PPPO Proposed Single Radionuclides Soil Guidelines and the DOE-PPPO Proposed Authorized Limits (AL) Volumetric Concentrations available in DOE-PPPO 2011a. This work is provided as an appendix to the Dose Modeling Evaluations and Technical Support Document for the Authorizedmore » Limits Request for the C-746-U Landfill at the Paducah Gaseous Diffusion Plant, Paducah, Kentucky (ORISE 2012). The receptors evaluated in ORISE 2012 were selected by the DOE-PPPO for the additional peak dose evaluations. These receptors included a Landfill Worker, Trespasser, Resident Farmer (onsite), Resident Gardener, Recreational User, Outdoor Worker and an Offsite Resident Farmer. The RESRAD (Version 6.5) and RESRAD-OFFSITE (Version 2.5) computer codes were used for the peak dose assessments. Deterministic peak dose assessments were performed for all the receptors and a probabilistic dose assessment was performed only for the Offsite Resident Farmer at the request of the DOE-PPPO. In a deterministic analysis, a single input value results in a single output value. In other words, a deterministic analysis uses single parameter values for every variable in the code. By contrast, a probabilistic approach assigns parameter ranges to certain variables, and the code randomly selects the values for each variable from the parameter range each time it calculates the dose (NRC 2006). The receptor scenarios, computer codes and parameter input files were previously used in ORISE 2012. A few modifications were made to the parameter input files as appropriate for this effort. Some of these changes included increasing the time horizon beyond 1,050 years (yr), and using the radionuclide concentrations provided by the DOE-PPPO as inputs into the codes. The deterministic peak doses were evaluated within time horizons of 70 yr (for the Landfill Worker and Trespasser), 1,050 yr, 10,000 yr and 100,000 yr (for the Resident Farmer [onsite], Resident Gardener, Recreational User, Outdoor Worker and Offsite Resident Farmer) at the request of the DOE-PPPO. The time horizons of 10,000 yr and 100,000 yr were used at the request of the DOE-PPPO for informational purposes only. The probabilistic peak of the mean dose assessment was performed for the Offsite Resident Farmer using Technetium-99 (Tc-99) and a time horizon of 1,050 yr. The results of the deterministic analyses indicate that among all receptors and time horizons evaluated, the highest projected dose, 2,700 mrem/yr, occurred for the Resident Farmer (onsite) at 12,773 yr. The exposure pathways contributing to the peak dose are ingestion of plants, external gamma, and ingestion of milk, meat and soil. However, this receptor is considered an implausible receptor. The only receptors considered plausible are the Landfill Worker, Recreational User, Outdoor Worker and the Offsite Resident Farmer. The maximum projected dose among the plausible receptors is 220 mrem/yr for the Outdoor Worker and it occurs at 19,045 yr. The exposure pathways contributing to the dose for this receptor are external gamma and soil ingestion. The results of the probabilistic peak of the mean dose analysis for the Offsite Resident Farmer indicate that the average (arithmetic mean) of the peak of the mean doses for this receptor is 0.98 mrem/yr and it occurs at 1,050 yr. This dose corresponds to Tc-99 within the time horizon of 1,050 yr.« less

Gamified Twitter Microblogging to Support Resident Preparation for the American Board of Surgery In-Service Training Examination.

PubMed

Lamb, Laura C; DiFiori, Monica M; Jayaraman, Vijay; Shames, Brian D; Feeney, James M

We sought to determine if a daily gamified microblogging project improves American Board of Surgery In-Service Training Examination (ABSITE) scores for participants. In July 2016, we instituted a gamified microblogging project using Twitter as the platform and modified questions from one of several available question banks. A question of the day was posted at 7-o׳clock each morning, Monday through Friday. Respondents were awarded points for speed, accuracy, and contribution to discussion topics. The moderator challenged respondents by asking additional questions and prompted them to find evidence for their claims to fuel further discussion. Since 4 months into the microblogging program, a survey was administered to all residents. Responses were collected and analyzed. After 6 months of tweeting, residents took the ABSITE examination. We compared participating residents׳ ABSITE percentile rank to those of their nonparticipating peers. We also compared residents׳ percentile rank from 2016 to those in 2017 after their participation in the microblogging project. The University of Connecticut general surgery residency is an integrated program that is decentralized across 5 hospitals in the central Connecticut region, including Saint Francis Hospital and Medical Center, located in Hartford. We advertised our account to the University of Connecticut general surgery residents. Out of 45 residents, 11 participated in Twitter microblogging (24.4%) and 17 responded to the questionnaire (37.8%). In all, 100% of the residents who were participating in Twitter reported that daily microblogging prompted them to engage in academic reading. Twitter participants significantly increased their ABSITE percentile rank from 2016 to 2017 by an average of 13.7% (±14.1%) while nonparticipants on average decreased their ABSITE percentile rank by 10.0% (±16.6) (p = 0.003). Microblogging via Twitter with gamification is a feasible strategy to facilitate improving performance on the ABSITE, especially in a geographically distributed residency. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

[Residential facilities for the elderly in five Italian regions. The Progres-Anziani Project].

PubMed

de Girolamo, Giovanni; Tempestini, Antonella; Cavrini, Giulia; Argentino, Paola; Federici, Stefano; Putzu, Paolo; Scocco, Paolo; Zappia, Mario; Morosini, Pierluigi; Cascavilla, Isabella; Sgadari, Antonio; Azzarito, Caterina; Brancati, Giacomo; Spalletta, Gianfranco; Pasini, Augusto

2005-01-01

To survey all Residential Facilities (RFs) for the elderly in five Italian Regions (Calabria, Sardinia, Sicily. Umbria and Veneto), and to evaluate their logistic and organizational characteristics, staff and residents' features. Structured interviews were conducted with RF managers. All RFs operating in the five Italian Regions. In the five Regions there are 853 RFs with an average of 198.0 beds per 10000 elderly inhabitants; this rate shows a marked variability between different Regions. The mean number of beds in the RFs is 59.8 (median: 34). The large majority (96%) have a 24-hour staff cover. In terms of management, the RFs are handled by local municipalities (29%), religious non-profit associations (24%), and other non-profit organizations (21%). In the 754 RFs surveyed (91.1% of the sample) there were 24.456 workers employed, even the number of staff in each facility shows a great variability. The mean number of workers directly involved in residents' care is 27.8, and the ratio residents/staff is 2.1, which becomes lower (1.8) if we consider the ratio non-independent residents/staff. In the 754 RFs there were 42,687 residents, with an average of 53.5 elderly residents for each facility and 3.2 residents below the age of 65; the mean age of the resident sample was 79.3 years, and there is an high proportion of residents with neurological (including dementia), psychiatric or medical disorders. There is marked variability in the provision of residential places between different Regions; many other characteristics of RFs for the elderly, including staff/residents ratios, show a similar variability Most RFs host elderly with a variety of neurological, psychiatric and medical disorders. The future waves of the project will shed light on many features of these institutions, which care for 2.1% of the elderly population in Italy and may serve larger proportions of the elderly in the future.

Seasonal change of residence time in spring water and groundwater at a mountainous headwater catchment

NASA Astrophysics Data System (ADS)

Nagano, Kosuke; Tsujimura, Maki; Onda, Yuichi; Iwagami, Sho; Sakakibara, Koichi; Sato, Yutaro

2017-04-01

Determination of water age in headwater is important to consider water pathway, source and storage in the catchment. Previous studies showed that groundwater residence time changes seasonally. These studies reported that mean residence time of water in dry season tends to be longer than that in rainy season, and it becomes shorter as precipitation and discharge amount increases. However, there are few studies to clarify factors causing seasonal change in mean residence time in spring water and groundwater based on observed data. Therefore, this study aims to reveal the relationship between mean residence time and groundwater flow system using SFconcentration in spring and 10 minutes interval hydrological data such as discharge volume, groundwater level and precipitation amount in a headwater catchment in Fukushima, Japan. The SF6 concentration data in spring water observed from April 2015 to November 2016 shows the mean residence time of springs ranged from zero to 14 years. We also observed a clear negative correlation between discharge rate and residence time in the spring. The residence time in shallow groundwater in rainy season was younger as compared with that in low rainfall period. Therefore, the shallow groundwater with young residence time seems to contribute to the spring in rainy season, causing shorter residence time. Additionally, the residence time of groundwater ranged from 3 to 5 years even in low rainfall period. The residence time in high groundwater table level in ridge was older as compared with that in low groundwater table level. These suggest that the contribution of groundwater with older age in the ridge becomes dominant in the low discharge.

Investigation of residence time and groundwater flux in Venice Lagoon: comparing radium isotope and hydrodynamic models.

PubMed

Rapaglia, John; Ferrarin, Christian; Zaggia, Luca; Moore, Willard S; Umgiesser, Georg; Garcia-Solsona, Ester; Garcia-Orellana, Jordi; Masqué, Pere

2010-07-01

The four naturally-occurring isotopes of radium were coupled with a previously evaluated hydrodynamic model to determine the apparent age of surface waters and to quantify submarine groundwater discharge (SGD) into the Venice Lagoon, Italy. Mean apparent age of water in the Venice Lagoon was calculated using the ratio of 224Ra to 228Ra determined from 30 monitoring stations and a mean pore water end member. Average apparent age was calculated to be 6.0 d using Ra ratios. This calculated age was very similar to average residence time calculated for the same period using a hydrodynamic model (5.8 d). A mass balance of Ra was accomplished by quantifying each of the sources and sinks of Ra in the lagoon, with the unknown variable being attributed to SGD. Total SGD were calculated to be 4.1 +/- 1.5, 3.8 +/- 0.7, 3.0 +/- 1.3, and 3.5 +/- 1.0 x 10(10) L d(-1) for (223,224,226, 228)Ra, respectively, which are an order of magnitude larger than total mean fluvial discharge into the Venice Lagoon (3.1 x 10(9) L d(-1)). The SGD as a source of nutrients in the Venice Lagoon is also discussed and, though significant to the nutrient budget, is likely to be less important as the dominant control on SGD is recirculated seawater rather than freshwater. 2009 Elsevier Ltd. All rights reserved.

The general surgery chief resident operative experience: 23 years of national ACGME case logs.

PubMed

Drake, Frederick Thurston; Horvath, Karen D; Goldin, Adam B; Gow, Kenneth W

2013-09-01

The chief resident (CR) year is a pivotal experience in surgical training. Changes in case volume and diversity may impact the educational quality of this important year. To evaluate changes in operative experience for general surgery CRs. Review of Accreditation Council for Graduate Medical Education case logs from 1989-1990 through 2011-2012 divided into 5 periods. Graduates in period 3 were the last to train with unrestricted work hours; those in period 4 were part of a transition period and trained under both systems; and those in period 5 trained fully under the 80-hour work week. Diversity of cases was assessed based on Accreditation Council for Graduate Medical Education defined categories. Total cases and defined categories were evaluated for changes over time. The average total CR case numbers have fallen (271 in period 1 vs 242 in period 5, P < .001). Total CR cases dropped to their lowest following implementation of the 80-hour work week (236 cases), but rebounded in period 5. The percentage of residents' 5-year operative experience performed as CRs has decreased (30% in period 1 vs 25.6% in period 5, P < .001). Regarding case mix: thoracic, trauma, and vascular cases declined steadily, while alimentary and intra-abdominal operations increased. Recent graduates averaged 80 alimentary and 78 intra-abdominal procedures during their CR years. Compared with period 1, in which these 2 categories represented 47.1% of CR experience, in period 5, they represented 65.2% (P < .001). Endocrine experience has been relatively unchanged. Total CR cases declined especially acutely following implementation of the 80-hour work week but have since rebounded. Chief resident cases contribute less to overall experience, although this proportion stabilized before the 80-hour work week. Case mix has narrowed, with significant increases in alimentary and intra-abdominal cases. Broad-based general surgery training may be jeopardized by reduced case diversity. Chief resident cases are crucial in surgical training and educators should consider these findings as surgical training evolves.

Comparison of Male vs Female Resident Milestone Evaluations by Faculty During Emergency Medicine Residency Training

PubMed Central

Dayal, Arjun; O’Connor, Daniel M.; Qadri, Usama

2017-01-01

Importance Although implicit bias in medical training has long been suspected, it has been difficult to study using objective measures, and the influence of sex and gender in the evaluation of medical trainees is unknown. The emergency medicine (EM) milestones provide a standardized framework for longitudinal resident assessment, allowing for analysis of resident performance across all years and programs at a scope and level of detail never previously possible. Objective To compare faculty-observed training milestone attainment of male vs female residency training Design, Setting, and Participants This multicenter, longitudinal, retrospective cohort study took place at 8 community and academic EM training programs across the United States from July 1, 2013, to July 1, 2015, using a real-time, mobile-based, direct-observation evaluation tool. The study examined 33 456 direct-observation subcompetency evaluations of 359 EM residents by 285 faculty members. Main Outcomes and Measures Milestone attainment for male and female EM residents as observed by male and female faculty throughout residency and analyzed using multilevel mixed-effects linear regression modeling. Results A total of 33 456 direct-observation evaluations were collected from 359 EM residents (237 men [66.0%] and 122 women [34.0%]) by 285 faculty members (194 men [68.1%] and 91 women [31.9%]) during the study period. Female and male residents achieved similar milestone levels during the first year of residency. However, the rate of milestone attainment was 12.7% (0.07 levels per year) higher for male residents through all of residency (95% CI, 0.04-0.09). By graduation, men scored approximately 0.15 milestone levels higher than women, which is equivalent to 3 to 4 months of additional training, given that the average resident gains approximately 0.52 levels per year using our model (95% CI, 0.49-0.54). No statistically significant differences in scores were found based on faculty evaluator gender (effect size difference, 0.02 milestone levels; 95% CI for males, −0.09 to 0.11) or evaluator-evaluatee gender pairing (effect size difference, −0.02 milestone levels; 95% CI for interaction, −0.05 to 0.01). Conclusions and Relevance Although male and female residents receive similar evaluations at the beginning of residency, the rate of milestone attainment throughout training was higher for male than female residents across all EM subcompetencies, leading to a gender gap in evaluations that continues until graduation. Faculty should be cognizant of possible gender bias when evaluating medical trainees. PMID:28264090

The prevalence of lesbian, gay, bisexual, and transgender health education and training in emergency medicine residency programs: what do we know?

PubMed

Moll, Joel; Krieger, Paul; Moreno-Walton, Lisa; Lee, Benjamin; Slaven, Ellen; James, Thea; Hill, Dustin; Podolsky, Susan; Corbin, Theodore; Heron, Sheryl L

2014-05-01

The Institute of Medicine, The Joint Commission, and the U.S. Department of Health and Human Services all have recently highlighted the need for cultural competency and provider education on lesbian, gay, bisexual, and transgender (LGBT) health. Forty percent of LGBT patients cite lack of provider education as a barrier to care. Only a few hours of medical school curriculum are devoted to LGBT education, and little is known about LGBT graduate medical education. The objective of this study was to perform a needs assessment to determine to what degree LGBT health is taught in emergency medicine (EM) residency programs and to determine whether program demographics affect inclusion of LGBT health topics. An anonymous survey link was sent to EM residency program directors (PDs) via the Council of Emergency Medicine Residency Directors listserv. The 12-item descriptive survey asked the number of actual and desired hours of instruction on LGBT health in the past year. Perceived barriers to LGBT health education and program demographics were also sought. There were 124 responses to the survey out of a potential response from 160 programs (response rate of 78%). Twenty-six percent of the respondents reported that they have ever presented a specific LGBT lecture, and 33% have incorporated topics affecting LGBT health in the didactic curriculum. EM programs presented anywhere from 0 to 8 hours on LGBT health, averaging 45 minutes of instruction in the past year (median = 0 minutes, interquartile range [IQR] = 0 to 60 minutes), and PDs support inclusion of anywhere from 0 to 10 hours of dedicated time to LGBT health, with an average of 2.2 hours (median = 2 hours, IQR = 1 to 3.5 hours) recommended. The majority of respondents have LGBT faculty (64.2%) and residents (56.2%) in their programs. The presence of LGBT faculty and previous LGBT education were associated with a greater number of desired hours on LGBT health. The majority of EM residency programs have not presented curricula specific to LGBT health, although PDs desire inclusion of these topics. Further curriculum development is needed to better serve LGBT patients. © 2014 by the Society for Academic Emergency Medicine.

Diagnosis of Child Maltreatment: A Family Medicine Physician's Dilemma.

PubMed

Eniola, Kehinde; Evarts, Lori

2017-05-01

Cases of child maltreatment (CM) in the United States remain high, and primary care providers lack the confidence and training to diagnose these cases. This study provides recommendations to improve family medicine physicians' confidence in diagnosing CM. We e-mailed an electronic survey to family medicine residents and physicians practicing in the United States. Responses were collected during August and September 2015. Respondents were asked about their familiarity and competence level regarding the diagnosis of CM. They also were asked about the frequency of their correctly diagnosing CM, timeliness of diagnosis, barriers to a diagnosis or early diagnosis of CM, and receipt of adequate CM training. Of the 420 surveys emailed, 258 (61%) were completed. The majority of respondents stated their self-reported level of competence in diagnosing CM as average or below average, with few (8%) indicating a competence level of above average. A timely diagnosis of child maltreatment was reported by 46% of respondents, whereas 54% were either late (19.2%) in diagnosing or could not recall (34.6%). The barriers to diagnosis cited by responders were inexperience (58%), lack of confidence and certainty (50%), lack of diagnosis protocol (43.3%), lack of confidence in communicating with parents (38.3%), and inadequate training (34.9%). The introduction of CM training into the family medicine residency training curriculum, coupled with the development of a standardized CM diagnosis protocol, may improve self-reported family medicine physicians' confidence and competence levels in diagnosing CM.

Mind-Body Skills Training for Resident Wellness: A Pilot Study of a Brief Mindfulness Intervention

PubMed Central

Romcevich, Laura E; Reed, Suzanne; Flowers, Stacy R; Kemper, Kathi J; Mahan, John D

2018-01-01

Background: Interventions to address burnout include mind-body skills training (MBST), but few studies have evaluated the feasibility of MBST for busy pediatric residents. Objective: In this pilot study, we tested the feasibility of a brief MBST intervention, using in-person peer-led training supported by online modules, to decrease stress and burnout in pediatric resident physicians. Methods: Of 99 (10%) residents, 10 residents at Nationwide Children’s Hospital in Ohio participated in up to four 90-minute MBST sessions more than 1 month, led by a co-resident with 5 years of informal training in mind-body skills. Participants were offered 8 assigned online modules through OSU Center for Integrative Health and Wellness. Measures including Maslach Burnout Inventory (MBI), Cohen’s Perceived Stress, Smith’s Brief Resilience, Cognitive and Affective Mindfulness Scale-Revised, and Neff’s Self-Compassion Scale (NSS) were administered before (T1) and after (T2) the course. Participants were offered optional monthly “maintenance” sessions for 6 months and completed a third set of measures at this follow-up (T3). Results: The residents completed an average of 4.3/8 online modules and attended an average of 2.8/4 in-person sessions. There was significant improvement in positive attitude, perceived stress, and resilience post intervention (T2). Follow-up evaluation (T3) also demonstrated significant improvement in burnout (depersonalization) and mindfulness. More than 75% of participants found the course worthwhile. Conclusions: A short mixed-method mindfulness-based skills course may be a practical way to offer resilience and stress management training to busy resident physicians. PMID:29780891

Source investigation of personal particulates in relation to identify major routes of exposure among urban residentials

NASA Astrophysics Data System (ADS)

Gadkari, Neelima M.; Pervez, Shamsh

Multiple 24-h average outdoor, indoor and personal respirable particulate matter (RPM) measurements were made in different urban residential colonies to determine major routes of personal exposure. The study area was Bhilai-Durg, District Durg, Chhattisgarh, India. About 100 residentials from each of two selected colonies have been surveyed for consent to participate in the study and for preparation of time-activity diary. On the basis of their time-activity diary, residentials have been categorized into three types: type-A, purely residential; type-B, residents who go out, and type-C, residence who go into work, specially in industrial area. A total of 28 adult participants (14 males and 14 females; mean age 40±15, range 21-61 years) were selected and monitored longitudinally during the summer (15 March-15 June) of 2004. Participants' residential indoor RPM level and also local ambient outdoor RPM levels were measured,and these are done simultaneous with personal monitoring. Residential indoor and ambient outdoors RPM monitoring sessions were throughout the year to obtain infiltration factor more precisely. To compare RPM levels with Indian National Ambient Air Quality Standards (NAAQS) of PM 10, simultaneous measurements of PM 10 were also done with the course of ambient outdoor RPM monitoring. RPM levels in indoors were higher compared to ambient outdoors. The annual average ratio RPM/PM 10 was found to vary significantly among residential sites due to variation in surroundings. Source contribution estimates (SCE) of personal exposure to RPM in selected 12 residences (six from each colony) have been investigated using chemical mass balance model CMB8. Ambient outdoors, residential indoors, soils and road-traffic borne RPM were identified as main routes and principal sources of personal RPM. Results of model output have shown that residential indoors and soil-borne RPM are the major routes of personal exposure.

Indoor Residence Times of Semivolatile Organic Compounds: Model Estimation and Field Evaluation

EPA Science Inventory

Indoor residence times of semivolatile organic compounds (SVOCs) are a major and mostly unavailable input for residential exposure assessment. We calculated residence times for a suite of SVOCs using a fugacity model applied to residential environments. Residence times depend on...

The uneven distribution of women in orthopaedic surgery resident training programs in the United States.

PubMed

Van Heest, Ann E; Agel, Julie

2012-01-18

Although women represented 58% of undergraduate students and 48% of medical students in the U.S. in the 2008-2009 academic year, only 13% of orthopaedic residents and only 4% of American Academy of Orthopaedic Surgeons (AAOS) Fellows in 2009 were women. Are all orthopaedic surgery programs in the U.S. equal in their ability to attract female medical students and train female orthopaedic surgeons? This study was undertaken to test the hypothesis that all Accreditation Council for Graduate Medical Education (ACGME)-accredited orthopaedic surgery residency programs in the U.S. train a similar number of female residents. Data for all ACGME-accredited orthopaedic surgery residency training programs in the U.S. for five academic years (2004-2005 through 2008-2009) were collected with use of the Graduate Medical Education (GME) Track database. Orthopaedic residency programs in the U.S. do not train women at an equal frequency. In the academic years from 2004-2005 through 2008-2009, forty-five programs had no female residents during at least one of the five academic years reviewed, and nine programs had no female residents during any of the years. More than fifty orthopaedic residency programs in the U.S. had an average of <10% female trainees over the five-year period, and more than ten programs had an average of >20%. There was no significant change in the distribution among these categories over the five years examined (p = 0.234). Significant differences in the representation of women exist among orthopaedic residency training programs in the U.S. Further examination of the characteristics of orthopaedic residency programs that are successful in attracting female residents, particularly the composition of their faculty as role models, will be important in furthering our understanding of how orthopaedic surgery can continue to attract the best and the brightest individuals. Changes in the cultural experiences in programs that have not trained female orthopaedic surgeons, such as an increased number of female faculty, and policies that emphasize diversity may provide a greater opportunity for our orthopaedic profession to attract female medical students.

Water availability limits tree productivity, carbon stocks, and carbon residence time in mature forests across the western US

NASA Astrophysics Data System (ADS)

Berner, Logan T.; Law, Beverly E.; Hudiburg, Tara W.

2017-01-01

Water availability constrains the structure and function of terrestrial ecosystems and is projected to change in many parts of the world over the coming century. We quantified the response of tree net primary productivity (NPP), live biomass (BIO), and mean carbon residence time (CRT = BIO / NPP) to spatial variation in water availability in the western US. We used forest inventory measurements from 1953 mature stands (> 100 years) in Washington, Oregon, and California (WAORCA) along with satellite and climate data sets covering the western US. We summarized forest structure and function in both domains along a 400 cm yr-1 hydrologic gradient, quantified with a climate moisture index (CMI) based on the difference between precipitation and reference evapotranspiration summed over the water year (October-September) and then averaged annually from 1985 to 2014 (CMIwy). Median NPP, BIO, and CRT computed at 10 cm yr-1 intervals along the CMIwy gradient increased monotonically with increasing CMIwy across both WAORCA (rs = 0.93-0.96, p < 0.001) and the western US (rs = 0.93-0.99, p < 0.001). Field measurements from WAORCA showed that median NPP increased from 2.2 to 5.6 Mg C ha-1 yr-1 between the driest and wettest 5 % of sites, while BIO increased from 26 to 281 Mg C ha-1 and CRT increased from 11 to 49 years. The satellite data sets revealed similar changes over the western US, though these data sets tended to plateau in the wettest areas, suggesting that additional efforts are needed to better quantify NPP and BIO from satellites in high-productivity, high-biomass forests. Our results illustrate that long-term average water availability is a key environmental constraint on tree productivity, carbon storage, and carbon residence time in mature forests across the western US, underscoring the need to assess potential ecosystem response to projected warming and drying over the coming century.

Perceptions of orthodontic case complexity among orthodontists, general practitioners, orthodontic residents, and dental students.

PubMed

Heath, Elizabeth M; English, Jeryl D; Johnson, Cleverick D; Swearingen, Elizabeth B; Akyalcin, Sercan

2017-02-01

Our aims were to assess the perceptions of orthodontic case complexity among orthodontists, general dentists, orthodontic residents, and dental students and to compare their perceptions with the American Board of Orthodontics Discrepancy Index (DI). Orthodontists, general dentists, orthodontic residents, and dental students (n = 343) participated in a Web-based survey. Pretreatment orthodontic records of 29 cases with varying DI scores were obtained. Respondents were asked to evaluate case complexity on a 100-point visual analog scale. Additional information was collected on participants' orthodontic education and orthodontic treatment preferences. Pearson correlation coefficients were used to assess the relationship between the average complexity score and the DI score. Repeated measures analysis with linear mixed models was used to assess the association between the average complexity score and the DI score and whether the association between the 2 scores varied by level of difficulty or panel group. The level of significance for all analyses was set at P <0.05. The results showed that 71.6% of general dentists provided some orthodontic services, with 21.0% providing full fixed appliances and 38.3% providing clear aligners. DI score was significantly associated with complexity perceptions (P = 0.0168). Associations between average complexity and DI score varied significantly by provider group (P = 0.0033), with orthodontists and residents showing the strongest associations. When the DI score was greater than 15, orthodontists and residents perceived cases as more complex than did the other provider groups. Orthodontists and orthodontic residents had better judgments for evaluating orthodontic case complexity. The high correlation between orthodontic professionals' perceptions and DI scores suggested that additional orthodontic education and training have an influence on the ability to recognize case complexity. Copyright © 2017 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

Measurement of faculty anesthesiologists' quality of clinical supervision has greater reliability when controlling for the leniency of the rating anesthesia resident: a retrospective cohort study.

PubMed

Dexter, Franklin; Ledolter, Johannes; Hindman, Bradley J

2017-06-01

Our department monitors the quality of anesthesiologists' clinical supervision and provides each anesthesiologist with periodic feedback. We hypothesized that greater differentiation among anesthesiologists' supervision scores could be obtained by adjusting for leniency of the rating resident. From July 1, 2013 to December 31, 2015, our department has utilized the de Oliveira Filho unidimensional nine-item supervision scale to assess the quality of clinical supervision provided by faculty as rated by residents. We examined all 13,664 ratings of the 97 anesthesiologists (ratees) by the 65 residents (raters). Testing for internal consistency among answers to questions (large Cronbach's alpha > 0.90) was performed to rule out that one or two questions accounted for leniency. Mixed-effects logistic regression was used to compare ratees while controlling for rater leniency vs using Student t tests without rater leniency. The mean supervision scale score was calculated for each combination of the 65 raters and nine questions. The Cronbach's alpha was very large (0.977). The mean score was calculated for each of the 3,421 observed combinations of resident and anesthesiologist. The logits of the percentage of scores equal to the maximum value of 4.00 were normally distributed (residents, P = 0.24; anesthesiologists, P = 0.50). There were 20/97 anesthesiologists identified as significant outliers (13 with below average supervision scores and seven with better than average) using the mixed-effects logistic regression with rater leniency entered as a fixed effect but not by Student's t test. In contrast, there were three of 97 anesthesiologists identified as outliers (all three above average) using Student's t tests but not by logistic regression with leniency. The 20 vs 3 was significant (P < 0.001). Use of logistic regression with leniency results in greater detection of anesthesiologists with significantly better (or worse) clinical supervision scores than use of Student's t tests (i.e., without adjustment for rater leniency).

Does the introduction of nursing home culture change practices improve quality?

PubMed

Miller, Susan C; Lepore, Michael; Lima, Julie C; Shield, Renee; Tyler, Denise A

2014-09-01

To understand whether nursing home (NH) introduction of culture change practices is associated with improved quality. NH-level panel study using multivariate fixed-effects statistical modeling to estimate the effect of culture change introduction on quality outcomes. Eight hundred twenty-four U.S. NHs with culture change practice involvement beginning between 2005 and 2010. Directors of nursing and nursing home administrators. A culture change practice score (derived from a 2009/10 national NH survey) was used to stratify NHs according to practice implementation (high (scores in the top quartile; n = 217) vs other (n = 607)). NH-level outcomes included prevalence of seven care practices and three resident outcomes, health-related and quality-of-life weighted survey deficiencies, and average number of hospitalizations per resident year. For NHs with high practice implementation, introduction of culture change was associated with a significant decrease in prevalence of restraints, tube feeding, and pressure ulcers; an increase in the proportion of residents on bladder training programs; and a small decrease in the average number of hospitalizations per resident year (coefficient -0.04, standard error (SE) 0.02, P = .06). For NHs with lower practice implementation (practice scores in lower three quartiles), introduction was associated with fewer health-related (coefficient -5.26, SE 3.05; P = .09) and quality-of-life (coefficient -0.10, SE 0.05; P = .04) survey deficiencies, although these NHs also had small statistically significant increases in the prevalence of residents with urinary tract infections and in average hospitalizations per resident year (coefficient 0.03, SE 0.01, P = .02). The introduction of NH culture change appears to result in significant improvements in some care processes and outcomes in NHs with high practice implementation. For other NHs, culture change introduction results in fewer survey deficiencies. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

Association of Resident Coverage with Cost, Length of Stay, and Profitability at a Community Hospital

PubMed Central

Shine, Daniel; Beg, Sumbul; Jaeger, Joseph; Pencak, Dorothy; Panush, Richard

2001-01-01

OBJECTIVE The effect of care by medical residents on hospital length of stay (LOS), indirect costs, and reimbursement was last examined across a range of illnesses in 1981; the issue has never been examined at a community hospital. We studied resource utilization and reimbursement at a community hospital in relation to the involvement of medical residents. DESIGN This nonrandomized observational study compared patients discharged from a general medicine teaching unit with those discharged from nonteaching general medical/surgical units. SETTING A 620-bed community teaching hospital with a general medicine teaching unit (resident care) and several general medicine nonteaching units (no resident care). PATIENTS All medical discharges between July 1998 and February 1999, excluding those from designated subspecialty and critical care units. MEASUREMENTS AND MAIN RESULTS Endpoints included mean LOS in excess of expected LOS, mean cost in excess of expected mean payments, and mean profitability (payments minus total costs). Observed values were obtained from the hospital's database and expected values from a proprietary risk–cost adjustment program. No significant difference in LOS between 917 teaching-unit patients and 697 nonteaching patients was demonstrated. Costs averaged $3,178 (95% confidencence interval (CI) ± $489) less than expected among teaching-unit patients and $4,153 (95% CI ± $422) less than expected among nonteaching-unit patients. Payments were significantly higher per patient on the teaching unit than on the nonteaching units, and as a result mean, profitability was higher: $848 (95% CI ± $307) per hospitalization for teaching-unit patients and $451 (95% CI ± $327) for patients on the nonteaching units. Teaching-unit patients of attendings who rarely admitted to the teaching unit (nonteaching attendings) generated an average profit of $1,299 (95% CI ± $613), while nonteaching patients of nonteaching attendings generated an average profit of $208 (95% CI ± $437). CONCLUSIONS Resident care at our community teaching hospital was associated with significantly higher costs but also with higher payments and greater profitability. PMID:11251744

Quantification of differences between occupancy and total monitoring periods for better assessment of exposure to particles in indoor environments

NASA Astrophysics Data System (ADS)

Wierzbicka, A.; Bohgard, M.; Pagels, J. H.; Dahl, A.; Löndahl, J.; Hussein, T.; Swietlicki, E.; Gudmundsson, A.

2015-04-01

For the assessment of personal exposure, information about the concentration of pollutants when people are in given indoor environments (occupancy time) are of prime importance. However this kind of data frequently is not reported. The aim of this study was to assess differences in particle characteristics between occupancy time and the total monitoring period, with the latter being the most frequently used averaging time in the published data. Seven indoor environments were selected in Sweden and Finland: an apartment, two houses, two schools, a supermarket, and a restaurant. They were assessed for particle number and mass concentrations and number size distributions. The measurements using a Scanning Mobility Particle Sizer and two photometers were conducted for seven consecutive days during winter in each location. Particle concentrations in residences and schools were, as expected, the highest during occupancy time. In the apartment average and median PM2.5 mass concentrations during the occupancy time were 29% and 17% higher, respectively compared to total monitoring period. In both schools, the average and medium values of the PM2.5 mass concentrations were on average higher during teaching hours compared to the total monitoring period by 16% and 32%, respectively. When it comes to particle number concentrations (PNC), in the apartment during occupancy, the average and median values were 33% and 58% higher, respectively than during the total monitoring period. In both houses and schools the average and median PNC were similar for the occupancy and total monitoring periods. General conclusions on the basis of measurements in the limited number of indoor environments cannot be drawn. However the results confirm a strong dependence on type and frequency of indoor activities that generate particles and site specificity. The results also indicate that the exclusion of data series during non-occupancy periods can improve the estimates of particle concentrations and characteristics suitable for exposure assessment, which is crucial for estimating health effects in epidemiological and toxicological studies.

Learning strategies used by cardiology residents: assessment of learning styles and their correlations.

PubMed

de Lima, Alberto Alves; Bettati, María Ines; Baratta, Sergio; Falconi, Mariano; Sokn, Fernando; Galli, Amanda; Barrero, Carlos; Cagide, Arturo; Iglesias, Ricardo

2006-11-01

To identify the learning styles of a group of cardiology residents (R) undergoing a training program at the University of Buenos Aires and to identify correlations of these styles. Statistical data were obtained through a 120-question survey developed by Vermunt and colleagues, which identified four different learning styles: construction-directed; reproduction-directed; application-directed; and undirected. Four variables were identified [gender, previous experience as a teaching assistant (TA) in medical school, university final average (FA) and the public or private institution/centre of origin] in order to analyse level of correlation with learning styles (LS). Between April 2001 and April 2002, 149 residents (R) completed the survey. Average age was 29 (+/-2.7) years old; with 63% being men. The predominant LS were oriented toward knowledge application. In terms of variables, no differences regarding gender were detected; the R with TA showed undirected LS characteristics; those with a low FA registered a tendency towards reproduction-directed LS; and those residents at public/state medical centres indicated construction-directed LS tendencies. An application-directed learning style predominates in this group of residents. Information regarding learning styles can provide foundations upon which arguments can be made for changes in education that are traditionally not evidence-based.

Nurse Workforce Characteristics and Infection Risk in VA Community Living Centers: A Longitudinal Analysis

PubMed Central

Uchida-Nakakoji, Mayuko; Stone, Patricia W.; Schmitt, Susan K.; Phibbs, Ciaran S.

2015-01-01

Objective To examine effects of workforce characteristics on resident infections in Veterans Affairs (VA) Community Living Centers (CLCs). Data Sources A six-year panel of monthly, unit-specific data included workforce characteristics (from the VA Decision Support System and Payroll data) and characteristics of residents and outcome measures (from the Minimum Data Set). Study Design A resident infection composite was the dependent variable. Workforce characteristics of registered nurses (RN), licensed practical nurses (LPN), nurse aides (NA), and contract nurses included: staffing levels, skill mix and tenure. Descriptive statistics and unit-level fixed effects regressions were conducted. Robustness checks varying workforce and outcome parameters were examined. Principal Findings Average nursing hours per resident day was 4.59 hours (sd = 1.21). RN tenure averaged 4.7 years (sd = 1.64) and 4.2 years for both LPN (sd= 1.84) and NA (sd= 1.72). In multivariate analyses RN and LPN tenure were associated with decreased infections by 3.8% (IRR= 0.962 p<0.01) and 2% (IRR=0.98 p<0.01) respectively. Robustness checks consistently found RN and LPN tenure to be associated with decreased infections. Conclusions Increasing RN and LPN tenure are likely to reduce CLC resident infections. Administrators and policymakers need to focus on recruiting and retaining a skilled nursing workforce. PMID:25634087

Perspectives on the changing healthcare system: teaching systems-based practice to medical residents

PubMed Central

Martinez, Johanna; Phillips, Erica; Fein, Oliver

2013-01-01

Purpose The Accreditation Council for Graduate Medical Education restructured its accreditation system to be based on educational outcomes in six core competencies. Systems-based practice is one of the six core competencies. The purpose of this report is to describe Weill Cornell Medical College's Internal Medicine Residency program curriculum for systems-based practice (SBP) and its evaluation process. Methods To examine potential outcomes of the POCHS curriculum, an evaluation was conducted, examining participants': (1) knowledge gain; (2) course ratings; and (3) qualitative feedback. Results On average, there was a 19 percentage point increase in knowledge test scores for all three cohorts. The course was rated overall highly, receiving an average of 4.6 on a 1–5 scale. Lastly, the qualitative comments supported that the material is needed and valued. Conclusion The course, entitled Perspectives on the Changing Healthcare System (POCHS) and its evaluation process support that systems-based practice is crucial to residency education. The course is designed not only to educate residents about the current health care system but also to enable them to think critically about the risk and benefits of the changes. POCHS provides a framework for teaching and assessing this competency and can serve as a template for other residency programs looking to create or restructure their SBP curriculum. PMID:24001523

Nurse workforce characteristics and infection risk in VA Community Living Centers: a longitudinal analysis.

PubMed

Uchida-Nakakoji, Mayuko; Stone, Patricia W; Schmitt, Susan K; Phibbs, Ciaran S

2015-03-01

To examine effects of workforce characteristics on resident infections in Veterans Affairs (VA) Community Living Centers (CLCs). A 6-year panel of monthly, unit-specific data included workforce characteristics (from the VA Decision Support System and Payroll data) and characteristics of residents and outcome measures (from the Minimum Data Set). A resident infection composite was the dependent variable. Workforce characteristics of registered nurses (RN), licensed practical nurses (LPN), nurse aides (NA), and contract nurses included: staffing levels, skill mix, and tenure. Descriptive statistics and unit-level fixed effects regressions were conducted. Robustness checks varying workforce and outcome parameters were examined. Average nursing hours per resident day was 4.59 hours (SD=1.21). RN tenure averaged 4.7 years (SD=1.64) and 4.2 years for both LPN (SD=1.84) and NA (SD=1.72). In multivariate analyses RN and LPN tenure were associated with decreased infections by 3.8% (incident rate ratio [IRR]=0.962, P<0.01) and 2% (IRR=0.98, P<0.01) respectively. Robustness checks consistently found RN and LPN tenure to be associated with decreased infections. Increasing RN and LPN tenure are likely to reduce CLC resident infections. Administrators and policymakers need to focus on recruiting and retaining a skilled nursing workforce.

Residence times and nitrate transport in ground water discharging to streams in the Chesapeake Bay Watershed

USGS Publications Warehouse

Lindsey, Bruce D.; Phillips, Scott; Donnelly, Colleen A.; Speiran, Gary K.; Plummer, Niel; Bohlke, John Karl; Focazio, Michael J.; Burton, William C.; Busenberg, Eurybiades

2003-01-01

One of the major water-quality problems in the Chesapeake Bay is an overabundance of nutrients from the streams and rivers that discharge to the Bay. Some of these nutrients are from nonpoint sources such as atmospheric deposition, agricultural manure and fertilizer, and septic systems. The effects of efforts to control nonpoint sources, however, can be difficult to quantify because of the lag time between changes at the land surface and the response in the base-flow (ground water) component of streams. To help resource managers understand the lag time between implementation of management practices and subsequent response in the nutrient concentrations in the base-flow component of streamflow, a study of ground-water discharge, residence time, and nitrate transport in springs throughout the Chesapeake Bay Watershed and in four smaller watersheds in selected hydrogeomorphic regions (HGMRs) was conducted. The four watersheds were in the Coastal Plain Uplands, Piedmont crystalline, Valley and Ridge carbonate, and Valley and Ridge siliciclastic HGMRs.A study of springs to estimate an apparent age of the ground water was based on analyses for concentrations of chlorofluorocarbons in water samples collected from 48 springs in the Chesapeake Bay Watershed. Results of the analysis indicate that median age for all the samples was 10 years, with the 25th percentile having an age of 7 years and the 75th percentile having an age of 13 years. Although the number of samples collected in each HGMR was limited, there did not appear to be distinct differences in the ages between the HGMRs. The ranges were similar between the major HGMRs above the Fall Line (modern to about 50 years), with only two HGMRs of small geographic extent (Piedmont carbonate and Mesozoic Lowland) having ranges of modern to about 10 years. The median values of all the HGMRs ranged from 7 to 11 years. Not enough samples were collected in the Coastal Plain for comparison. Spring samples showed slightly younger water under wet conditions than under dry conditions. The apparent age of water from wells, springs, and other ground-water discharge points in the four targeted watersheds was modern to 60 years, which was similar to the apparent ages from the spring study. In the Pocomoke River Watershed in the Coastal Plain Uplands HGMR, the apparent age of ground-water samples ranged from 0 to 60 years; the ages in the vicinity of the streams ranged from 0 to 23 years.The apparent ages of ground water in the Polecat Creek Watershed in the Piedmont crystalline HGMR ranged from 2 to 30 years. The apparent ages of water from wells in the Muddy Creek Watershed in the Valley and Ridge carbonate HGMR ranged from 10 to 20 years (except for a single sample that was 45 years). The ages in the East Mahantango Creek Watershed in the Valley and Ridge siliciclastic HGMR ranged from 0 to 50 years. The distribution in apparent age of water from wells in the targeted watersheds, however, generally is older than that for water from the springs. The median age of water from wells in the Muddy Creek Watershed, for example, was 15 years, compared to 11 years for the water from the springs in that watershed, and less than 10 years for water from all springs in the spring study. The similarity in the ranges in apparent age of water from the wells and from the springs shows that the samples from the targeted watersheds and springs have bracketed the range of apparent ages that would be expected in the shallow ground-water-flow systems throughout the Chesapeake Bay Watershed.The apparent age of water from individual wells does not necessarily represent the entire distribution of ages of the discharging ground water, and it is this distribution of ages that affects the response of nutrient concentrations in stream base flow. Nutrient-reduction scenarios were modeled for two watersheds for which the distribution of apparent ground-water ages was available, the East Mahantango Creek Watershed in the Valley and Ridge siliciclastic HGMR and the Locust Grove Watershed in the Coastal Plain Uplands HGMR. A nutrient-reduction scenario was created for East Mahantango Creek, where the average residence time was determined to be approximately 10 years on the basis of the output of particle tracking from a ground-water-flow model. This scenario showed decreases of nearly 50 percent in base-flow concentrations of nitrate in streams within the first year after the reduction in nitrogen input; smaller reductions in nitrate concentration occurred in each subsequent year. A second scenario for that same watershed, in which the same 10-year average residence time was assumed and an exponential model was used for analysis, showed that a 50-percent reduction in base-flow concentrations of nitrate could take up to 5 years. For the Locust Grove Watershed, in which an average residence time of 32 years was assumed, simulation with the exponential model showed that it may take more than 20 years to achieve a 50-percent reduction in base-flow concentra-tions of nitrate. Although it was not possible to construct such scenarios for all watersheds, these examples show the range of possible responses to changes in nutrient inputs in two very different types of watersheds.Findings from this study include information on factors that affect ground-water age, spatial distribution of ages, and nitrogen transport. In the East Mahantango Creek Watershed and the Polecat Creek Watershed, the residence time varied spatially depending on the position of the flow path, and temporally depending on the recharge conditions. Generally, ground water in areas near the stream had short residence times and the water in upland areas had longer residence times. Water traveling through deep layers had longer residence times than water traveling through shallow layers, and residence times were faster under high recharge conditions than low recharge conditions. Ground water in the Pocomoke Watershed exhibits a similar pattern: younger water discharges to small order streams in headwater basins and older water discharges to larger streams near the basin outlet.Factors affecting nitrogen transport in ground water include spatial and temporal variation in input sources, ground-water age, and aquifer processes that lead to denitrification. Spatial and temporal variations in nitrogen sources affect all the watersheds. Tributaries with higher inputs of nitrogen have higher concentrations in stream base flow. Areas where nitrogen application rates have increased over time show an age-nitrate relation in ground-water samples. The age-nitrate relation can be affected by denitrification, which occurs in Pocomoke and East Mahantango Creeks but is not evident in Polecat and Muddy Creeks. In East Mahantango Creek, the level of denitrification is significant in water with residence times greater than 20 years, but because this is a small component of overall ground-water discharge to a stream, it may not remove a significant quantity of nitrogen from the system. Denitrification in Pocomoke Creek is significant and appears to affect mostly older water discharging to streams. Therefore, if most of the nitrogen entering these two streams is associated with the discharge of younger ground water, denitrification may not greatly affect the overall nitrogen delivery to these streams.Other findings of this study show that nitrate in ground water discharging along preferential flow paths may not be affected by natural processes, such as denitrification or uptake by riparian vegetation. Seeps to swales and ditches beneath the north uplands at Polecat Creek indicate a shallow water table and discharge of young ground water whereas the absence of such seeps on the south side indicates a deep water table and a lack of young ground water. Similarly, discharge at the base of the slope and to the valley wetland south of the creek but not north of the creek indicates a different role for the riparian forest on the two sides of the creek. In many of the systems where water discharges at the base of slopes to wetlands, ditches have been dug to drain the valley. Such drainage circumvents possible removal of nitrate by riparian vegetation.Because ground-water residence times do not appear directly related to the HGMRs, the targeting of management practices will achieve the most rapid response in water quality if directed at 1) watersheds with large agricultural sources of nitrate, 2) areas with the shortest ground-water-flow paths and 3) areas not affected by significant denitrification. The fastest response in stream base-flow concentrations of nitrogen to implementation of management practices would be to implement practices in those areas with the highest loads rather than attempt to target practices on the basis of HGMR stratification. Overall findings of the study indicate that 1) ground-water contributions to nitrogen in streamflow are significant, 2) some response to management practices should be evident in base-flow concentrations of nitrogen and loads within 1 to 5 years in watersheds with the shortest average residence times, but response time may be closer to 20 years in watersheds with longer average ground-water residence times, 3) the majority of the response in ground-water discharge to any changes in management practices will be distributed over a 10-year time period even in the watersheds with the fastest response times, and 4) given that half the streamflow is from ground-water discharge and the other half is runoff or soil water, about 90 percent of total water being discharged to a stream will be less than about a decade old; therefore, full implementation of nutrient reductions may result in improved streamwater quality in about a decade. In the more-likely scenario of gradual source reduction, the reduction in concentrations of nitrate in streams and aquifers would take longer than the examples shown here.

Financing Residency Training Redesign.

PubMed

Carney, Patricia A; Waller, Elaine; Green, Larry A; Crane, Steven; Garvin, Roger D; Pugno, Perry A; Kozakowski, Stanley M; Douglass, Alan B; Jones, Samuel; Eiff, M Patrice

2014-12-01

Redesign in the health care delivery system creates a need to reorganize resident education. How residency programs fund these redesign efforts is not known. Family medicine residency program directors participating in the Preparing Personal Physicians for Practice (P(4)) project were surveyed between 2006 and 2011 on revenues and expenses associated with training redesign. A total of 6 university-based programs in the study collectively received $5,240,516 over the entire study period, compared with $4,718,943 received by 8 community-based programs. Most of the funding for both settings came from grants, which accounted for 57.8% and 86.9% of funding for each setting, respectively. Department revenue represented 3.4% of university-based support and 13.1% of community-based support. The total average revenue (all years combined) per program for university-based programs was just under $875,000, and the average was nearly $590,000 for community programs. The vast majority of funds were dedicated to salary support (64.8% in university settings versus 79.3% in community-based settings). Based on the estimated ratio of new funding relative to the annual costs of training using national data for a 3-year program with 7 residents per year, training redesign added 3% to budgets for university-based programs and about 2% to budgets for community-based programs. Residencies undergoing training redesign used a variety of approaches to fund these changes. The costs of innovations marginally increased the estimated costs of training. Federal and local funding sources were most common, and costs were primarily salary related. More research is needed on the costs of transforming residency training.

[Medication use among community-dwelling older Icelanders. Population-based study in urban and rural areas].

PubMed

Sigurdardottir, Arun K; Arnadottir, Solveig Asa; Gunnarsdottir, Elín Díanna

2011-12-01

To describe medication use among older community-dwelling Icelanders by collecting information on number of medicine, polypharmacy (>5 medications), and medications by ATC categories. Moreover, to explore the relationship between medication use and various influential factors emphasizing residency in urban and rural areas. Population-based, cross-sectional study. Participants were randomly selected from the National registry in one urban (n=118) and two rural (n=68) areas. 1) ≥ 65 years old, 2) community-dwelling, 3) able to communicate verbally. Information on medication use was obtained from each person's medication list and interviews. A questionnaire and five standardized instruments were used to assess the potential influencing factors. On average, participants used 3.9 medications and prevalence of polypharmacy was 41%. Men used 3.5 medications on average and women 4.4 (p=0.018). Compared to rural residents, urban residents had fewer medical diagnoses, better mobility, less pain, and fewer depressive symptoms. By controlling for the effects of these variables, more medications were associated with urban living (p<0.001) and more medical diagnoses (p<0.001). Likewise, adjusted odds for polypharmacy increased with urban residency (p=0.023) and more medical diagnoses (p=0.005). Urban residency, more medical diagnoses, higher age, and male gender were related to use of drugs for blood and blood forming organs. The results reveal an unexplained regional difference in medications use by older Icelanders. Further studies are required on why urban residents use at least equal amount of medications as rural residents despite better scores on health assessments.

Examining Racial and Ethnic Differences in Nursing Home Quality.

PubMed

Hefele, Jennifer Gaudet; Ritter, Grant A; Bishop, Christine E; Acevedo, Andrea; Ramos, Candi; Nsiah-Jefferson, Laurie A; Katz, Gabrielle

2017-11-01

Identifying racial/ethnic differences in quality is central to identifying, monitoring, and reducing disparities. Although disparities across all individual nursing home residents and disparities associated with between-nursing home differences have been established, little is known about the degree to which quality of care varies by race//ethnicity within nursing homes. A study was conducted to measure within-facility differences for a range of publicly reported nursing home quality measures. Resident assessment data on approximately 15,000 nursing homes and approximately 3 million residents (2009) were used to assess eight commonly used and publicly reported long-stay quality measures: the proportion of residents with weight loss, with high-risk and low-risk pressure ulcers, with incontinence, with depressive symptoms, in restraints daily, and who experienced a urinary tract infection or functional decline. Each measure was stratified by resident race/ethnicity (non-Hispanic white, non-Hispanic black, and Hispanic), and within-facility differences were examined. Small but significant differences in care on average were found, often in an unexpected direction; in many cases, white residents were experiencing poorer outcomes than black and Hispanic residents in the same facility. However, a broad range of differences in care by race/ethnicity within nursing homes was also found. The results suggest that care is delivered equally across all racial/ethnic groups in the same nursing home, on average. The results support the call for publicly reporting stratified nursing home quality measures and suggest that nursing home providers should attempt to identify racial/ethnic within-facility differences in care. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

Enhancement of anesthesiology in-training exam performance with institution of an academic improvement policy.

PubMed

Joseph, Julie A; Terry, Chris M; Waller, Eva J; Bortsov, Andrey V; Zvara, David A; Mayer, David C; Martinelli, Susan M

2014-01-01

Anesthesiology resident physicians across the United States complete an annual in-training examination (ITE). The ITE evaluates resident knowledge and provides personalized feedback to guide future study in low scoring sections(1). Performance on the ITE correlates with outcomes on the American Board of Anesthesiology (ABA) written board examination(2). Over the last several years, declining ITE scores were observed at the University of North Carolina (UNC). In response to this decline, our department reprioritized the ITE by instituting an academic improvement policy (AIP). The AIP employed both reward for satisfactory achievement and consequence for under-performance to elevate the ITE as a "high stakes" examination. Our hypothesis was that implementation of this AIP would improve ITE scores. ITE scores were compiled from 150 residents in the Department of Anesthesiology at UNC for graduating classes from 2004-2015. Data is presented as the number of residents scoring below the 20th percentile when compared to the national distribution before and after the AIP. In addition, average USMLE Step 1 three-digit scores for each graduating class were compared to average ITE percentile scores of the corresponding graduating class (USMLE does not provide percentile scores). Between 2009 and 2013, the number of residents who scored below the 20th percentile on the ITE increased steadily to a peak of 10 in 2011. After implementation of the AIP in July 2011, there was an 80% decrease in those scoring below the 20th percentile, from 10 to 2 residents (p<0.05). Anesthesiology resident ITE scores improved after implementation of an academic improvement policy.

The role of topography on catchment‐scale water residence time

USGS Publications Warehouse

McGuire, K.J.; McDonnell, Jeffery J.; Weiler, M.; Kendall, C.; McGlynn, B.L.; Welker, J.M.; Seibert, J.

2005-01-01

The age, or residence time, of water is a fundamental descriptor of catchment hydrology, revealing information about the storage, flow pathways, and source of water in a single integrated measure. While there has been tremendous recent interest in residence time estimation to characterize watersheds, there are relatively few studies that have quantified residence time at the watershed scale, and fewer still that have extended those results beyond single catchments to larger landscape scales. We examined topographic controls on residence time for seven catchments (0.085–62.4 km2) that represent diverse geologic and geomorphic conditions in the western Cascade Mountains of Oregon. Our primary objective was to determine the dominant physical controls on catchment‐scale water residence time and specifically test the hypothesis that residence time is related to the size of the basin. Residence times were estimated by simple convolution models that described the transfer of precipitation isotopic composition to the stream network. We found that base flow mean residence times for exponential distributions ranged from 0.8 to 3.3 years. Mean residence time showed no correlation to basin area (r2 < 0.01) but instead was correlated (r2 = 0.91) to catchment terrain indices representing the flow path distance and flow path gradient to the stream network. These results illustrate that landscape organization (i.e., topography) rather than basin area controls catchment‐scale transport. Results from this study may provide a framework for describing scale‐invariant transport across climatic and geologic conditions, whereby the internal form and structure of the basin defines the first‐order control on base flow residence time.

Orthopaedic Surgery Residents and Program Directors Agree on How Time Is Currently Spent in Training and Targets for Improvement.

PubMed

Camp, Christopher L; Martin, John R; Karam, Matthew D; Ryssman, Daniel B; Turner, Norman S

2016-04-01

Although much attention has been paid to the role of deliberate practice as a means of achieving expert levels of performance in other medical specialties, little has been published regarding its role in maximizing orthopaedic surgery resident potential. As an initial step in this process, this study seeks to determine how residents and program directors (PDs) feel current time spent in training is allocated compared with a theoretical ideal distribution of time. According to residents and PDs, (1) how do resident responsibilities change by level of training as perceived and idealized by residents and PDs? (2) How do resident and PD perceptions of current and ideal time distributions compare with one another? (3) Do the current training structures described by residents and PDs differ from what they feel represents an ideal time allocation construct that maximizes the educational value of residency training? A survey was sent to orthopaedic surgery resident and PD members of the Midwest Orthopedic Surgical Skills Consortium asking how they felt residents' time spent in training was distributed across 10 domains and four operating room (OR) roles and what they felt would be an ideal distribution of that time. Responses were compared between residents and PDs and between current schedules and ideal schedules. Both residents and PDs agreed that time currently spent in training differs by postgraduate year with senior-level residents spending more time in the OR (33.7% ± 8.3% versus 17.9% ± 6.2% [interns] and 27.4% ± 10.2% [juniors] according to residents, p < 0.001; and 38.6% ± 8.1% versus 11.8% ± 6.4% [interns] and 26.1% ± 5.7% [juniors] according to PD, p < 0.001). The same holds true for their theoretical ideals. Residents and PDs agree on current resident time allocation across the 10 domains; however, they disagree on multiple components of the ideal program with residents desiring more time spent in the OR than what PDs prefer (residents 40.3% ± 10.3% versus PD 32.6% ± 14.6% [mean difference {MD}, 7.7; 95% confidence interval {CI}, 4.4, 11.0], p < 0.001). Residents would also prefer to have more time spent deliberately practicing surgical skills outside of the OR (current 1.8% ± 2.1% versus ideal 3.7% ± 3.2% [MD, -1.9; 95% CI, -.2.4 to -1.4], p < 0.001). Both residents and PDs want residents to spend less time completing paperwork (current 4.4% ± 4.1% versus ideal 0.8% ± 1.6% [MD, 3.6; 95% CI, 3.0-4.2], p < 0.001 for residents; and current 3.6% ± 4.1% versus ideal 1.5% ± 1.9% [MD, 2.1; 95% CI, 0.9-3.3], p < 0.001 for PDs). Residents and PDs seem to agree on how time is currently spent in residency training. Some differences of opinions continue to exist regarding how an ideal program should be structured; however, this work identifies a few potential targets for improvement that are agreed on by both residents and PDs. These areas include increasing OR time, finding opportunities for deliberate practice of surgical skills outside of the OR, and decreased clerical burden. This study may serve as a template to allow programs to continue to refine their educational models in an effort to achieve curricula that meet the desired goals of both learners and educators. Additionally, it is an initial step toward more objective identification of the optimal educational structure of an orthopaedic residency program.

[Young French neurosurgeons: Working conditions and outlook].

PubMed

Pommier, B; Manet, R; Gay, E; Vassal, F; Nuti, C; Hladky, J-P

2015-10-01

Due to the increase in the number of French neurosurgeon residents the neurosurgical workforce is changing. The main objective of this survey was to assess working conditions and perspectives for young French neurosurgeons. An on-line survey was sent to young French neurosurgeons based on a mailing-list (219 mail addresses of Residents and Fellows obtained during previous meetings). The form contained questions about career, amount of work, salary, quality of life, teaching and university work. We received 78 replies from January to March 2014. A total of 56% from fellows saying they had undergone difficulties in obtaining a fellowship, although 78% were satisfied. Fellows considered a private career more often than residents. Overall, young neurosurgeons were worried about future employment. Some 33% admitted contemplating a different career from one they originally wanted. The average weekly working time of 76.8 hours was deemed to be excessive. Security rests after overnight shifts were lacking or incomplete in 91% of cases. The work atmosphere was good overall (3.7/5), and so was the quality of life (3.2/5). Theoretical teaching was unsatisfactory (2.43/5) as well as the time allowed for academic work (approximately 1.58 half-days per month). However, practical teaching was considered rewarding (3.63/5). This study provides some guidance for upcoming reforms, and should be considered again at a later date to evaluate progress. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

The metro area of Montreal.

PubMed

1986-10-01

Montreal, one of the most civilized and cosmopolitan of North American cities, is the 2nd city in Canada in size and the largest French-speaking city. Of the 2.8 million people who lived there at census time in 1981, 45% chose both French and English as their official language, 41% chose French, and 1% used some other language. Fully 68% of Montreal residents said their mother tongue was French, and 68% also said they spoke French at home. The importance of bilingualism to the business culture of Montreal cannot be overemphasized. In the last decade, French-Canadians have taken an increasingly stronger role in business. Upper-middle-class suburbs that as little as 10 years ago had only 10% of their residents who were of French-Canadian descent now have as many as 50-60% of their residents who are French-Canadians. Most residents of Montreal willingly learn 2 languages. US firms should assume that all representatives who are sent to Montreal should be fluent in both French and English. Montreal's 2,828,349 people create a population density of 1004.9 persons per square kilometer. Montreal has 665 census tracts, which are described in the Metropolitan Atlas Series. Nearly 62% of Montreal's population fall between the ages of 20 and 64--the prime working ages. Although Montreal is 79% Catholic, it does not have the high fertility levels often associated with Catholic areas. There were 1,026,920 households in Montreal in 1981 with an average of 2.7 persons per household. 71% of these were census family households. Montreal had 1,026,895 occupied dwellings in 1985 with an average of 5 rooms each. About 71% of the population aged 15 and over that were not in school were in the labor force; 41% of the labor force was female. The largest employment category for men was manufacturing (16%) and the largest for women was clerical work (39%).

Veterans Affairs general surgery service: the last bastion of integrated specialty care.

PubMed

Poteet, Stephen; Tarpley, Margaret; Tarpley, John L; Pearson, A Scott

2011-11-01

In a time of increasing specialization, academic training institutions provide a compartmentalized learning environment that often does not reflect the broad clinical experience of general surgery practice. This study aimed to evaluate the contribution of the Veterans Affairs (VA) general surgery surgical experience to both index Accreditation Council for Graduate Medical Education (ACGME) requirements and as a unique integrated model in which residents provide concurrent care of multiple specialty patients. Institutional review board approval was obtained for retrospective analysis of electronic medical records involving all surgical cases performed by the general surgery service from 2005 to 2009 at the Nashville VA. Over a 5-year span general surgery residents spent an average of 5 months on the VA general surgery service, which includes a postgraduate year (PGY)-5, PGY-3, and 2 PGY-1 residents. Surgeries involved the following specialties: surgical oncology, endocrine, colorectal, hepatobiliary, transplant, gastrointestinal laparoscopy, and elective and emergency general surgery. The surgeries were categorized according to ACGME index requirements. A total of 2,956 surgeries were performed during the 5-year period from 2005 through 2009. Residents participated in an average of 246 surgeries during their experience at the VA; approximately 50 cases are completed during the chief year. On the VA surgery service alone, 100% of the ACGME requirement was met for the following categories: endocrine (8 cases); skin, soft tissue, and breast (33 cases); alimentary tract (78 cases); and abdominal (88 cases). Approximately 50% of the ACGME requirement was met for liver, pancreas, and basic laparoscopic categories. The VA hospital provides an authentic, broad-based, general surgery training experience that integrates complex surgical patients simultaneously. Opportunities for this level of comprehensive care are decreasing or absent in many general surgery training programs. The increasing level of responsibility and simultaneous care of multiple specialty patients through the VA hospital systems offers a crucial experience for those pursuing a career in general surgery. Published by Elsevier Inc.

Do international rotations make surgical residents more resource-efficient? A preliminary study.

PubMed

Oliphant, Jason L; Ruhlandt, Ronell R; Sherman, Stanley R; Schlatter, Marc G; Green, Joel A

2012-01-01

Interest in international surgery among general surgery residents in the United States has been shown in several publications. Several general surgery residency programs have reported their experiences with international surgery rotations (ISRs). Learning to use limited resources more efficiently is often cited as a benefit of such rotations. We hypothesized that general surgery residents become more resource efficient after they have completed an ISR. Laboratory, radiologic, and diagnostic studies ordered on 2900 patients by 21 general surgery residents over 65 months at a single institution were analyzed retrospectively. The patient populations they wrote orders on were assessed for similarity in age, gender, and diagnoses. The outcomes in those patient populations were assessed by duration of stay and in-hospital mortality. Six (29%) of these residents (ISR residents) completed a 1-month ISR during their third year of residency. Their orders were compared with their classmates who did not participate in an ISR (NISR residents). The results were compared between the 2 cohorts from both before and after their international rotations. An analysis focused on comparing the changes from pre-ISR to post-ISR. A survey was also sent after objective data were collected to all residents and alumni involved in the study to assess their subjective perception of changes in their resource efficiency and to characterize their ISRs. Patient populations were similar in terms of demographics and diagnoses. ISR residents generated an average of $122 less in orders per patient per month after their ISR compared with before. NISR residents generated an average of $338 more in orders per patient per month after the ISRs compared with before (p = 0.04). Pre-ISR order charges were statistically similar. Similar results were observed when radiologic/diagnostic study orders were analyzed independently. Differences in outcomes were statistically insignificant. The survey revealed that most of the ISR residents perceived that their attitude toward ordering tests and laboratories was influenced greatly by their ISR, and all the ISR residents perceived that they became more resource efficient than their peers after their ISRs. These preliminary findings seem to indicate increased resource efficiency among general surgery residents who completed an ISR. However, the sample size of residents was small, and we could not establish conclusively a causal relationship to their ISRs. A more extensive study is needed if reliable conclusions are to be drawn regarding the effect of ISRs on the resource efficiency of residents. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Improving Resident Performance Through a Simulated Rapid Response Team: A Pilot Study.

PubMed

Burke, Peter A; Vest, Michael T; Kher, Hemant; Deutsch, Joseph; Daya, Sneha

2015-07-01

The Joint Commission requires hospitals to develop systems in which a team of clinicians can rapidly recognize and respond to changes in a patient's condition. The rapid response team (RRT) concept has been widely adopted as the solution to this mandate. The role of house staff in RRTs and the impact on resident education has been controversial. At Christiana Care Health System, eligible residents in their second through final years lead the RRTs. To evaluate the use of a team-based, interdisciplinary RRT training program for educating and training first-year residents in an effort to improve global RRT performance before residents start their second year. This pilot study was administered in 3 phases. Phase 1 provided residents with classroom-based didactic sessions using case-based RRT scenarios. Multiple choice examinations were administered, as well as a confidence survey based on a Likert scale before and after phase 1 of the program. Phase 2 involved experiential training in which residents engaged as mentored participants in actual RRT calls. A qualitative survey was used to measure perceived program effectiveness after phase 2. In phase 3, led by senior residents, simulated RRTs using medical mannequins were conducted. Participants were divided into 5 teams, in which each resident would rotate in the roles of leader, nurse, and respiratory therapist. This phase measured resident performance with regard to medical decision making, data gathering, and team behaviors during the simulated RRT scenarios. Performance was scored by an attending and a senior resident. A total of 18 residents were eligible (N=18) for participation. The average multiple choice test score improved by 20% after didactic training. The average confidence survey score before training was 3.44 out of 5 (69%) and after training was 4.13 (83%), indicating a 14% improvement. High-quality team behaviors correlated with medical decision making (0.92) more closely than did high-quality data gathering (0.11). This difference narrowed during high-pressure scenarios (0.84 and 0.72, respectively). Our data suggest that resident training using a team-based, interdisciplinary RRT training program may improve resident education, interdisciplinary team-based dynamics, and global RRT performance. In turn, data gathering and medical decision making may be enhanced, which may result in better patient outcomes during RRT scenarios.

Plastic surgery residency websites: a critical analysis of accessibility and content.

PubMed

Silvestre, Jason; Tomlinson-Hansen, Sandra; Fosnot, Joshua; Taylor, Jesse A

2014-03-01

Medical students applying for plastic surgery residency utilize the Internet to manage their residency applications. Applicants often apply to many programs and rely on advice from colleagues, mentors, and information gathered from plastic surgery residency websites (PSRWs). The purpose of the present study was to evaluate integrated and combined PSRWs with respect to accessibility, resident recruitment, and education. Websites from all 63 integrated and combined plastic surgery residencies available to graduating medical students during the 2013 academic year were available for study inclusion. Databases from national bodies for plastic surgery education were analyzed for accessibility of information. PSRWs were evaluated for comprehensiveness in the domains of resident education and recruitment. Residency programs were compared according to program characteristics using the Student t test and ANOVA with Tukey method. Of the 63 residencies available to graduating medical students, only 57 had combined or integrated program information on their PSRWs (90.5%). In the domain of resident recruitment, evaluators found an average of 5.5 of 15 content items (36.7%). As a whole, 26.3% of PSRWs had academic conference schedules, 17.5% had call schedules, and only 8.8% had operative case listings. For resident education, PSRWs provided an average of 4.6 of 15 content items (30.7%). Only 31.6% of PSRWs had interview schedules, 24.6% had graduate fellowship information, and 5.3% had information on board exam performance. Upon comparison, programs in the Midwest had more online recruitment content than programs in the West (47.1% vs. 24.2%, P < 0.01). Additionally, programs with a larger class of incoming residents (2 vs. 1) had greater online recruitment content (40.0% vs. 26.7%, P < 0.05). Larger programs with 3 integrated spots had more online education content than smaller programs with only 1 integrated spot (40.0% vs. 19.4%, P < 0.01). PSRWs are often not readily accessible and do not provide basic information that allow residency applicants to use this recruitment tool effectively. The paucity of online content suggests PSRWs are underutilized as an educational and recruitment tool. These findings have implications for applicants and plastic surgery residency programs, and there may be future opportunity to utilize this tool more effectively.

Inference from habitat-selection analysis depends on foraging strategies.

PubMed

Bastille-Rousseau, Guillaume; Fortin, Daniel; Dussault, Christian

2010-11-01

1. Several methods have been developed to assess habitat selection, most of which are based on a comparison between habitat attributes in used vs. unused or random locations, such as the popular resource selection functions (RSFs). Spatial evaluation of residency time has been recently proposed as a promising avenue for studying habitat selection. Residency-time analyses assume a positive relationship between residency time within habitat patches and selection. We demonstrate that RSF and residency-time analyses provide different information about the process of habitat selection. Further, we show how the consideration of switching rate between habitat patches (interpatch movements) together with residency-time analysis can reveal habitat-selection strategies. 2. Spatially explicit, individual-based modelling was used to simulate foragers displaying one of six foraging strategies in a heterogeneous environment. The strategies combined one of three patch-departure rules (fixed-quitting-harvest-rate, fixed-time and fixed-amount strategy), together with one of two interpatch-movement rules (random or biased). Habitat selection of simulated foragers was then assessed using RSF, residency-time and interpatch-movement analyses. 3. Our simulations showed that RSFs and residency times are not always equivalent. When foragers move in a non-random manner and do not increase residency time in richer patches, residency-time analysis can provide misleading assessments of habitat selection. This is because the overall time spent in the various patch types not only depends on residency times, but also on interpatch-movement decisions. 4. We suggest that RSFs provide the outcome of the entire selection process, whereas residency-time and interpatch-movement analyses can be used in combination to reveal the mechanisms behind the selection process. 5. We showed that there is a risk in using residency-time analysis alone to infer habitat selection. Residency-time analyses, however, may enlighten the mechanisms of habitat selection by revealing central components of resource-use strategies. Given that management decisions are often based on resource-selection analyses, the evaluation of resource-use strategies can be key information for the development of efficient habitat-management strategies. Combining RSF, residency-time and interpatch-movement analyses is a simple and efficient way to gain a more comprehensive understanding of habitat selection. © 2010 The Authors. Journal compilation © 2010 British Ecological Society.

Resource Allocation and Resident Outcomes In Nursing Homes: Comparisons between the Best and Worst1

PubMed Central

Anderson, Ruth A.; Hsieh, Pi-Ching; Su, Hui-Fang

2005-01-01

The purpose of this study was to identify patterns of resource allocation that related to resident outcomes in nursing homes. Data on structure, staffing levels, salaries, cost, casemix, and resident outcomes were obtained from state-level, administrative databases on 494 nursing homes. We identified two sets of comparison groups and showed that the group of homes with the greatest percentage of improvement in resident outcomes had higher levels of RN staffing and higher costs. However, comparison groups based on best/worst average outcomes did not differ in resource allocation patterns. Additional analysis demonstrated that when controlling for RN staffing, resident outcomes in high and low cost homes did not differ. The results suggest that, although RN staffing is more expensive, it is key to improving resident outcomes. PMID:9679807

Characteristic correlation study of UV disinfection performance for ballast water treatment

NASA Astrophysics Data System (ADS)

Ba, Te; Li, Hongying; Osman, Hafiiz; Kang, Chang-Wei

2016-11-01

Characteristic correlation between ultraviolet disinfection performance and operating parameters, including ultraviolet transmittance (UVT), lamp power and water flow rate, was studied by numerical and experimental methods. A three-stage model was developed to simulate the fluid flow, UV radiation and the trajectories of microorganisms. Navier-Stokes equation with k-epsilon turbulence was solved to model the fluid flow, while discrete ordinates (DO) radiation model and discrete phase model (DPM) were used to introduce UV radiation and microorganisms trajectories into the model, respectively. The UV dose statistical distribution for the microorganisms was found to move to higher value with the increase of UVT and lamp power, but moves to lower value when the water flow rate increases. Further investigation shows that the fluence rate increases exponentially with UVT but linearly with the lamp power. The average and minimum resident time decreases linearly with the water flow rate while the maximum resident time decrease rapidly in a certain range. The current study can be used as a digital design and performance evaluation tool of the UV reactor for ballast water treatment.

Scrutinizing the carbon cycle and CO2 residence time in the atmosphere

NASA Astrophysics Data System (ADS)

Harde, Hermann

2017-05-01

Climate scientists presume that the carbon cycle has come out of balance due to the increasing anthropogenic emissions from fossil fuel combustion and land use change. This is made responsible for the rapidly increasing atmospheric CO2 concentrations over recent years, and it is estimated that the removal of the additional emissions from the atmosphere will take a few hundred thousand years. Since this goes along with an increasing greenhouse effect and a further global warming, a better understanding of the carbon cycle is of great importance for all future climate change predictions. We have critically scrutinized this cycle and present an alternative concept, for which the uptake of CO2 by natural sinks scales proportional with the CO2 concentration. In addition, we consider temperature dependent natural emission and absorption rates, by which the paleoclimatic CO2 variations and the actual CO2 growth rate can well be explained. The anthropogenic contribution to the actual CO2 concentration is found to be 4.3%, its fraction to the CO2 increase over the Industrial Era is 15% and the average residence time 4 years.

Subcritical hydrothermal liquefaction of cattle manure to bio-oil: Effects of conversion parameters on bio-oil yield and characterization of bio-oil.

PubMed

Yin, Sudong; Dolan, Ryan; Harris, Matt; Tan, Zhongchao

2010-05-01

In this study, cattle manure was converted to bio-oil by subcritical hydrothermal liquefaction in the presence of NaOH. The effects of conversion temperature, process gas, initial conversion pressure, residence time and mass ratio of cattle manure to water on the bio-oil yield were studied. The bio-oil was characterized in terms of elemental composition, higher heating value, ultraviolet-visible (UV/Vis) spectroscopy, Fourier transform infrared spectroscopy (FTIR), gas chromatography (GC) and gas chromatography-mass spectrometry (GC-MS). Results showed that the bio-oil yield depended on the conversion temperature and the process gas. Higher initial conversion pressure, longer residence time and larger mass ratio of cattle manure to water, however, had negative impacts on the bio-oil yield. The higher heating value of bio-oil was 35.53MJ/kg on average. The major non-polar components of bio-oil were toluene, ethyl benzene and xylene, which are components of crude oil, gasoline and diesel. Copyright 2010 Elsevier Ltd. All rights reserved.

[ESTIMATION OF THE EFFICIENCY OF THE TREATMENT OF SPLIT-SYSTEMS IN RESIDENTIAL AREAS IN ORDER TO REDUCE THE LEVEL OF THE PREVALENCE OF DISEASES OF THE RESPIRATORY SYSTEM].

PubMed

Rakhmanin Yu A; Shibanov, S E; Kozulya, S V

2016-01-01

The purpose of work: comparison of prevalence among residents, which use or fail to use to clean split systems. Collected information about morbidity rate in 235 cases people during 3 years. The usage of split-systems without their regular cleaning leads to the gain in the level of the prevalence of respiratory diseases by 172.7% if compared with persons, who have no air conditioning systems at home. Also, the average number of disability days increases by 218.1%) and average time of the duration of the disease increases by 71.9%. The annual treatment of split-systems and regular cleaning of filters allowed to reduce the number of diseases. In comparison with the group of people, who fail to clean air conditioning systems, the drop of morbidity rate by 56.6%, average number of disability days by 63.3% and average time of diseases by 30.9% was observed. Regular treatment of air conditioning systems cannot completely repay the morbidity rates to the level of the control group. In comparison with the people, who use no air conditioning systems, the owners of split-systems with regular treatment have lung diseases by 18.4% more often. The average number of disability days and the average time of diseases increased by 16.9% and 18.8%. These changes can be explained by the impact of unfavorable (cooling) microclimate. The impact of split-systems on the health of the population requires a comprehensive study and the subsequent development of normative documents regulating their safe use.

Impact of Pregnancy and Gender on Internal Medicine Resident Evaluations: A Retrospective Cohort Study.

PubMed

Krause, Megan L; Elrashidi, Muhamad Y; Halvorsen, Andrew J; McDonald, Furman S; Oxentenko, Amy S

2017-06-01

Pregnancy and its impact on graduate medical training are not well understood. To examine the effect of gender and pregnancy for Internal Medicine (IM) residents on evaluations by peers and faculty. This was a retrospective cohort study. All IM residents in training from July 1, 2004-June 30, 2014, were included. Female residents who experienced pregnancy and male residents whose partners experienced pregnancy during training were identified using an existing administrative database. Mean evaluation scores by faculty and peers were compared relative to pregnancy (before, during, and after), accounting for the gender of both the evaluator and resident in addition to other available demographic covariates. Potential associations were assessed using mixed linear models. Of 566 residents, 117 (20.7%) experienced pregnancy during IM residency training. Pregnancy was more common in partners of male residents (24.7%) than female residents (13.2%) (p = 0.002). In the post-partum period, female residents had lower peer evaluation scores on average than their male counterparts (p = 0.0099). A large number of residents experience pregnancy during residency. Mean peer evaluation scores were lower after pregnancy for female residents. Further study is needed to fully understand the mechanisms behind these findings, develop ways to optimize training throughout pregnancy, and explore any unconscious biases that may exist.

Clouds of different colors: A prospective look at head and neck surgical resident call experience.

PubMed

Melzer, Jonathan

2017-12-01

Graduate medical education programs typically set up call under the assumption that residents will have similar experiences. The terms black cloud and white cloud have frequently been used to describe residents with more difficult (black) or less difficult (white) call experiences. This study followed residents in the department of head and neck surgery during call to determine whether certain residents have a significantly different call experience than the norm. It is a prospective observational study conducted over 16 months in a tertiary care center with a resident training program in otolaryngology. Resident call data on total pages, consults, and operative interventions were examined, as well as subjective survey data about sleep and perceived difficulty of resident call. Analysis showed no significant difference in call activity (pages, consults, operative interventions) among residents. However, data from the resident call surveys revealed perceived disparities in call difficulty that were significant. Two residents were clearly labeled as black clouds compared to the rest. These residents did not have the highest average number of pages, consults, or operative interventions. This study suggests that factors affecting call perception are outside the objective, absolute workload. These results may be used to improve resident education on sleep training and nighttime patient management in the field of otolaryngology and may influence otolaryngology residency programs.

High average daily intake of PCDD/Fs and serum levels in residents living near a deserted factory producing pentachlorophenol (PCP) in Taiwan: influence of contaminated fish consumption.

PubMed

Lee, C C; Lin, W T; Liao, P C; Su, H J; Chen, H L

2006-05-01

An abandoned pentachlorophenol plant and nearby area in southern Taiwan was heavily contaminated by dioxins, impurities formed in the PCP production process. The investigation showed that the average serum PCDD/Fs of residents living nearby area (62.5 pg WHO-TEQ/g lipid) was higher than those living in the non-polluted area (22.5 and 18.2 pg WHO-TEQ/g lipid) (P<0.05). In biota samples, average PCDD/F of milkfish in sea reservoir (28.3 pg WHO-TEQ/g) was higher than those in the nearby fish farm (0.15 pg WHO-TEQ/g), and Tilapia and shrimp showed the similar trend. The average daily PCDD/Fs intake of 38% participants was higher than 4 pg WHO-TEQ/kg/day suggested by the world health organization. Serum PCDD/F was positively associated with average daily intake (ADI) after adjustment for age, sex, BMI, and smoking status. In addition, a prospective cohort study is suggested to determine the long-term health effects on the people living near factory.

Optimization of Injection Molding Parameters for HDPE/TiO2 Nanocomposites Fabrication with Multiple Performance Characteristics Using the Taguchi Method and Grey Relational Analysis

PubMed Central

Pervez, Hifsa; Mozumder, Mohammad S.; Mourad, Abdel-Hamid I.

2016-01-01

The current study presents an investigation on the optimization of injection molding parameters of HDPE/TiO2 nanocomposites using grey relational analysis with the Taguchi method. Four control factors, including filler concentration (i.e., TiO2), barrel temperature, residence time and holding time, were chosen at three different levels of each. Mechanical properties, such as yield strength, Young’s modulus and elongation, were selected as the performance targets. Nine experimental runs were carried out based on the Taguchi L9 orthogonal array, and the data were processed according to the grey relational steps. The optimal process parameters were found based on the average responses of the grey relational grades, and the ideal operating conditions were found to be a filler concentration of 5 wt % TiO2, a barrel temperature of 225 °C, a residence time of 30 min and a holding time of 20 s. Moreover, analysis of variance (ANOVA) has also been applied to identify the most significant factor, and the percentage of TiO2 nanoparticles was found to have the most significant effect on the properties of the HDPE/TiO2 nanocomposites fabricated through the injection molding process. PMID:28773830

Meteorologic, oceanographic, and geomorphic controls on circulation and residence time in a coral reef-lined embayment: Faga'alu Bay, American Samoa

NASA Astrophysics Data System (ADS)

Storlazzi, C. D.; Cheriton, O. M.; Messina, A. M.; Biggs, T. W.

2018-06-01

Water circulation over coral reefs can determine the degree to which reef organisms are exposed to the overlying waters, so understanding circulation is necessary to interpret spatial patterns in coral health. Because coral reefs often have high geomorphic complexity, circulation patterns and the duration of exposure, or "local residence time" of a water parcel, can vary substantially over small distances. Different meteorologic and oceanographic forcings can further alter residence time patterns over reefs. Here, spatially dense Lagrangian surface current drifters and Eulerian current meters were used to characterize circulation patterns and resulting residence times over different regions of the reefs in Faga'alu Bay, American Samoa, during three distinct forcing periods: calm, strong winds, and large waves. Residence times varied among different geomorphic zones of the reef and were reflected in the spatially varying health of the corals across the embayment. The relatively healthy, seaward fringing reef consistently had the shortest residence times, as it was continually flushed by wave breaking at the reef crest, whereas the degraded, sheltered, leeward fringing reef consistently had the longest residence times, suggesting this area is more exposed to land-based sources of pollution. Strong wind forcing resulted in the longest residence times by pinning the water in the bay, whereas large wave forcing flushed the bay and resulted in the shortest residence times. The effect of these different forcings on residence times was fairly consistent across all reef geomorphic zones, with the shift from wind to wave forcing shortening mean residence times by approximately 50%. Although ecologically significant to the coral organisms in the nearshore reef zones, these shortened residence times were still 2-3 times longer than those associated with the seaward fringing reef across all forcing conditions, demonstrating how the geomorphology of a reef environment sets a first-order control on reef health.

Fuel/air nonuniformity - Effect on nitric oxide emissions

NASA Technical Reports Server (NTRS)

Lyons, V. J.

1981-01-01

An analytical and experimental study was performed to determine the effect of inlet fuel/air profile nonuniformity on NO(x) emissions. The theoretical NO(x) levels were verified in a flame-tube rig at inlet air temperatures of 600, 700, and 800 K, 0.3 MPa rig pressure, 25 m/sec reference velocity, overall equivalence ratio of 0.6 and residence time near 0.002 sec. The theory predicts an increase in NO(x) emissions for increased fuel/air nonuniformity for average equivalence ratios less than 0.7, while for average equivalence ratios near stoichiometric, increasing the nonuniformity will decrease NO(x) emissions. The results can be used to predict the degree of uniformity of fuel/air profiles necessary to achieve NO(x) emissions goals for actual engines that use lean premixed, prevaporized combustion systems.