40 CFR 141.531 - What criteria must a State use to determine that a profile is unnecessary?

Code of Federal Regulations, 2010 CFR

2010-07-01

... PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS Enhanced Filtration and Disinfection-Systems Serving Fewer Than 10,000 People Disinfection Profile § 141.531 What... the month with the warmest water temperature, and at the point of maximum residence time in your...

40 CFR 141.531 - What criteria must a State use to determine that a profile is unnecessary?

Code of Federal Regulations, 2014 CFR

2014-07-01

... PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS Enhanced Filtration and Disinfection-Systems Serving Fewer Than 10,000 People Disinfection Profile § 141.531 What... the month with the warmest water temperature, and at the point of maximum residence time in your...

40 CFR 141.531 - What criteria must a State use to determine that a profile is unnecessary?

Code of Federal Regulations, 2013 CFR

2013-07-01

... PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS Enhanced Filtration and Disinfection-Systems Serving Fewer Than 10,000 People Disinfection Profile § 141.531 What... the month with the warmest water temperature, and at the point of maximum residence time in your...

40 CFR 141.531 - What criteria must a State use to determine that a profile is unnecessary?

Code of Federal Regulations, 2011 CFR

2011-07-01

... PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS Enhanced Filtration and Disinfection-Systems Serving Fewer Than 10,000 People Disinfection Profile § 141.531 What... the month with the warmest water temperature, and at the point of maximum residence time in your...

40 CFR 141.531 - What criteria must a State use to determine that a profile is unnecessary?

Code of Federal Regulations, 2012 CFR

2012-07-01

... PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS Enhanced Filtration and Disinfection-Systems Serving Fewer Than 10,000 People Disinfection Profile § 141.531 What... the month with the warmest water temperature, and at the point of maximum residence time in your...

US public opinion regarding proposed limits on resident physician work hours

PubMed Central

2010-01-01

Background In both Europe and the US, resident physician work hour reduction has been a source of controversy within academic medicine. In 2008, the Institute of Medicine (IOM) recommended a reduction in resident physician work hours. We sought to assess the American public perspective on this issue. Methods We conducted a national survey of 1,200 representative members of the public via random digit telephone dialing in order to describe US public opinion on resident physician work hour regulation, particularly with reference to the IOM recommendations. Results Respondents estimated that resident physicians currently work 12.9-h shifts (95% CI 12.5 to 13.3 h) and 58.3-h work weeks (95% CI 57.3 to 59.3 h). They believed the maximum shift duration should be 10.9 h (95% CI 10.6 to 11.3 h) and the maximum work week should be 50 h (95% CI 49.4 to 50.8 h), with 1% approving of shifts lasting >24 h (95% CI 0.6% to 2%). A total of 81% (95% CI 79% to 84%) believed reducing resident physician work hours would be very or somewhat effective in reducing medical errors, and 68% (95% CI 65% to 71%) favored the IOM proposal that resident physicians not work more than 16 h over an alternative IOM proposal permitting 30-h shifts with ≥5 h protected sleep time. In all, 81% believed patients should be informed if a treating resident physician had been working for >24 h and 80% (95% CI 78% to 83%) would then want a different doctor. Conclusions The American public overwhelmingly favors discontinuation of the 30-h shifts without protected sleep routinely worked by US resident physicians and strongly supports implementation of restrictions on resident physician work hours that are as strict, or stricter, than those proposed by the IOM. Strong support exists to restrict resident physicians' work to 16 or fewer consecutive hours, similar to current limits in New Zealand, the UK and the rest of Europe. PMID:20515479

Have Residents Produced More Research Since the Inception of the 80-Hour Workweek?

PubMed Central

Levy, David M.; Luchetti, Timothy J.; Levine, Brett R.

2017-01-01

Abstract Background This study hypothesizes that resident involvement in research has increased since institution of the maximum 80-hour workweek in 2002. Methods All 571 papers published in the Journal of Bone and Joint Surgery (JBJS) in 1997 and 2007 (five years before and after the start of the 80-hour workweek) were reviewed. To identify resident authors, a search was performed in the American Board of Orthopaedic Surgery (ABOS) database for any U.S. author with a medical doctorate (MD). Any authors who were board-certified more than two years after the publication date were identified as “residents.” Two-tailed Fisher’s exact tests were used to assess proportional changes over time. Results Between 1997 and 2007, the percentage of U.S. MD authors who were orthopaedic residents increased significantly from 12% to 18% (p = 0.01). U.S. publications with a resident first-author increased from 17% to 27% (p = 0.02), and contributions from foreign nations also increased significantly (p < 0.001). The number of total authors per paper increased (p < 0.001), but linear regression showed that this had no particular association with the proportion of residents (p = 0.20). The relative proportions of MD and non-MD authors did not change between years. The LOE of resident-authored papers improved significantly over time (p = 0.005), while that of international papers did not. Conclusions Proportional resident authorship has increased significantly in one of the highest-impact, peer-reviewed orthopaedic journals. LOE of resident-authored papers has improved, and basic science papers are more likely to have a resident first author. Level of Evidence: III, retrospective cohort study PMID:28852359

Effect of viscosity on tear drainage and ocular residence time.

PubMed

Zhu, Heng; Chauhan, Anuj

2008-08-01

An increase in residence time of dry eye medications including artificial tears will likely enhance therapeutic benefits. The drainage rates and the residence time of eye drops depend on the viscosity of the instilled fluids. However, a quantitative understanding of the dependence of drainage rates and the residence time on viscosity is lacking. The current study aims to develop a mathematical model for the drainage of Newtonian fluids and also for power-law non-Newtonian fluids of different viscosities. This study is an extension of our previous study on the mathematical model of tear drainage. The tear drainage model is modified to describe the drainage of Newtonian fluids with viscosities higher than the tear viscosity and power-law non-Newtonian fluids with rheological parameters obtained from fitting experimental data in literature. The drainage rate through canaliculi was derived from the modified drainage model and was incorporated into a tear mass balance to calculate the transients of total solute quantity in ocular fluids and the bioavailability of instilled drugs. For Newtonian fluids, increasing the viscosity does not affect the drainage rate unless the viscosity exceeds a critical value of about 4.4 cp. The viscosity has a maximum impact on drainage rate around a value of about 100 cp. The trends are similar for shear thinning power law fluids. The transients of total solute quantity, and the residence time agrees at least qualitatively with experimental studies. A mathematical model has been developed for the drainage of Newtonian fluids and power-law fluids through canaliculi. The model can quantitatively explain different experimental observations on the effect of viscosity on the residence of instilled fluids on the ocular surface. The current study is helpful for understanding the mechanism of fluid drainage from the ocular surface and for improving the design of dry eye treatments.

Population structure and residency patterns of whale sharks, Rhincodon typus, at a provisioning site in Cebu, Philippines.

PubMed

Araujo, Gonzalo; Lucey, Anna; Labaja, Jessica; So, Catherine Lee; Snow, Sally; Ponzo, Alessandro

2014-01-01

This study represents the first description of whale sharks, Rhincodon typus, occurring at a provisioning site in Oslob, Cebu, Philippines. Frequent observations of sharks are often difficult, even at tourism sites, giving rise to provisioning activities to attract them. The present study provides repeated longitudinal data at a site where daily provisioning activities took place, and whale sharks were present every day. A total of 158 individual whale sharks were photographically identified between Mar 2012 and Dec 2013, with 129 males (82%), 19 females (12%) and 10 (6%) of undetermined sex. Mean estimated total length was 5.5 m (±1.3 m S.D.). Twenty individuals were measured with laser photogrammetry to validate researchers' estimated sizes, yielding a good correlation (r (2) = 0.83). Fifty-four (34%) individuals were observed being hand-fed by local fishermen (provisioned), through in-water behavioural observations. Maximum likelihood methods were used to model mean residency time of 44.9 days (±20.6 days S.E.) for provisioned R. typus contrasting with 22.4 days (±8.9 days S.E.) for non-provisioned individuals. Propeller scars were observed in 47% of the animals. A mean of 12.7 (±4.3 S.D.) R. typus were present in the survey area daily, with a maximum of 26 individuals (Aug 10 2013) and a minimum of 2 (Dec 6 2012). Twelve (8%) individuals were seen on at least 50% of survey days (n = 621), with a maximum residency of 572 days for one individual (P-396). Twenty four individuals were photographically identified across regional hotsposts, highlighting the species' migratory nature and distribution. Extended residency and differences in lagged identification rates suggest behavioural modification on provisioned individuals, underlying the necessity for proper management of this tourism activity.

Effects of gas residence time of CH4/H2 on sp2 fraction of amorphous carbon films and dissociated methyl density during radical-injection plasma-enhanced chemical vapor deposition

NASA Astrophysics Data System (ADS)

Sugiura, Hirotsugu; Jia, Lingyun; Kondo, Hiroki; Ishikawa, Kenji; Tsutsumi, Takayoshi; Hayashi, Toshio; Takeda, Keigo; Sekine, Makoto; Hori, Masaru

2018-06-01

Quadruple mass spectrometric measurements of CH3 density during radical-injection plasma-enhanced chemical vapor deposition to consider the sp2 fraction of amorphous carbon (a-C) films were performed. The sp2 fraction of the a-C films reached a minimum of 46%, where the CH3 density was maximum for a residence time of 6 ms. The sp2 fraction of the a-C films was tailored with the gaseous phase CH3 density during the deposition. This knowledge is useful for understanding the formation mechanism of bonding structures in the a-C films, which enables the precise control of their electronic properties.

Stable isotope and noble gas constraints on the source and residence time of spring water from the Table Mountain Group Aquifer, Paarl, South Africa and implications for large scale abstraction

NASA Astrophysics Data System (ADS)

Miller, J. A.; Dunford, A. J.; Swana, K. A.; Palcsu, L.; Butler, M.; Clarke, C. E.

2017-08-01

Large scale groundwater abstraction is increasingly being used to support large urban centres especially in areas of low rainfall but presents particular challenges in the management and sustainability of the groundwater system. The Table Mountain Group (TMG) Aquifer is one of the largest and most important aquifer systems in South Africa and is currently being considered as an alternative source of potable water for the City of Cape Town, a metropolis of over four million people. The TMG aquifer is a fractured rock aquifer hosted primarily in super mature sandstones, quartzites and quartz arenites. The groundwater naturally emanates from numerous springs throughout the cape region. One set of springs were examined to assess the source and residence time of the spring water. Oxygen and hydrogen isotopes indicate that the spring water has not been subject to evaporation and in combination with Na/Cl ratios implies that recharge to the spring systems is via coastal precipitation. Although rainfall in the Cape is usually modelled on orographic rainfall, δ18O and δ2H values of some rainfall samples are strongly positive indicating a stratiform component as well. Comparing the spring water δ18O and δ2H values with that of local rainfall, indicates that the springs are likely derived from continuous bulk recharge over the immediate hinterland to the springs and not through large and/or heavy downpours. Noble gas concentrations, combined with tritium and radiocarbon activities indicate that the residence time of the TMG groundwater in this area is decadal in age with a probable maximum upper limit of ∼40 years. This residence time is probably a reflection of the slow flow rate through the fractured rock aquifer and hence indicates that the interconnectedness of the fractures is the most important factor controlling groundwater flow. The short residence time of the groundwater suggest that recharge to the springs and the Table Mountain Group Aquifer as a whole is vulnerable to climate change and reductions in regional precipitation. Any plans for large scale abstraction to supplement the City of Cape Town water supply would need to factor this into models of maximum sustainable yield.

Pharmacokinetics of tramadol after subcutaneous administration in a critically ill population and in a healthy cohort

PubMed Central

2014-01-01

Background Tramadol is an atypical centrally acting analgesic agent available as both oral and parenteral preparations. For patients who are unable to take tramadol orally, the subcutaneous route of administration offers an easy alternative to intravenous or intramuscular routes. This study aimed to characterise the absorption pharmacokinetics of a single subcutaneous dose of tramadol in severely ill patients and in healthy subjects. Methods/design Blood samples (5 ml) taken at intervals from 2 minutes to 24 hours after a subcutaneous dose of tramadol (50 mg) in 15 patients (13 male, two female) and eight healthy male subjects were assayed using high performance liquid chromatography. Pharmacokinetic parameters were derived using a non-compartmental approach. Results There were no statistically significant differences between the two groups in the following parameters (mean ± SD): maximum venous concentration 0.44 ± 0.18 (patients) vs. 0.47 ± 0.13 (healthy volunteers) mcg/ml (p = 0.67); area under the plasma concentration-time curve 177 ± 109 (patients) vs. 175 ± 75 (healthy volunteers) mcg/ml*min (p = 0.96); time to maximum venous concentration 23.3 ± 2 (patients) vs. 20.6 ± 18.8 (healthy volunteers) minutes (p = 0.73) and mean residence time 463 ± 233 (patients) vs. 466 ± 224 (healthy volunteers) minutes (p = 0.97). Conclusions The similar time to maximum venous concentration and mean residence time suggest similar absorption rates between the two groups. These results indicate that the same dosing regimens for subcutaneous tramadol administration may therefore be used in both healthy subjects and severely ill patients. Trial registration ACTRN12611001018909 PMID:24914400

Aerosol reactor production of uniform submicron powders

NASA Technical Reports Server (NTRS)

Flagan, Richard C. (Inventor); Wu, Jin J. (Inventor)

1991-01-01

A method of producing submicron nonagglomerated particles in a single stage reactor includes introducing a reactant or mixture of reactants at one end while varying the temperature along the reactor to initiate reactions at a low rate. As homogeneously small numbers of seed particles generated in the initial section of the reactor progress through the reactor, the reaction is gradually accelerated through programmed increases in temperature along the length of the reactor to promote particle growth by chemical vapor deposition while minimizing agglomerate formation by maintaining a sufficiently low number concentration of particles in the reactor such that coagulation is inhibited within the residence time of particles in the reactor. The maximum temperature and minimum residence time is defined by a combination of temperature and residence time that is necessary to bring the reaction to completion. In one embodiment, electronic grade silane and high purity nitrogen are introduced into the reactor and temperatures of approximately 770.degree. K. to 1550.degree. K. are employed. In another embodiment silane and ammonia are employed at temperatures from 750.degree. K. to 1800.degree. K.

Numerical modelling of biophysicochemical effects on multispecies reactive transport in porous media involving Pseudomonas putida for potential microbial enhanced oil recovery application.

PubMed

Sivasankar, P; Rajesh Kanna, A; Suresh Kumar, G; Gummadi, Sathyanarayana N

2016-07-01

pH and resident time of injected slug plays a critical role in characterizing the reservoir for potential microbial enhanced oil recovery (MEOR) application. To investigate MEOR processes, a multispecies (microbes-nutrients) reactive transport model in porous media was developed by coupling kinetic and transport model. The present work differs from earlier works by explicitly determining parametric values required for kinetic model by experimental investigations using Pseudomonas putida at different pH conditions and subsequently performing sensitivity analysis of pH, resident time and water saturation on concentrations of microbes, nutrients and biosurfactant within reservoir. The results suggest that nutrient utilization and biosurfactant production are found to be maximum at pH 8 and 7.5 respectively. It is also found that the sucrose and biosurfactant concentrations are highly sensitive to pH rather than reservoir microbial concentration, while at larger resident time and water saturation, the microbial and nutrient concentrations were lesser due to enhanced dispersion. Copyright © 2016 Elsevier Ltd. All rights reserved.

Aerosol reactor production of uniform submicron powders

DOEpatents

Flagan, Richard C.; Wu, Jin J.

1991-02-19

A method of producing submicron nonagglomerated particles in a single stage reactor includes introducing a reactant or mixture of reactants at one end while varying the temperature along the reactor to initiate reactions at a low rate. As homogeneously small numbers of seed particles generated in the initial section of the reactor progress through the reactor, the reaction is gradually accelerated through programmed increases in temperature along the length of the reactor to promote particle growth by chemical vapor deposition while minimizing agglomerate formation by maintaining a sufficiently low number concentration of particles in the reactor such that coagulation is inhibited within the residence time of particles in the reactor. The maximum temperature and minimum residence time is defined by a combination of temperature and residence time that is necessary to bring the reaction to completion. In one embodiment, electronic grade silane and high purity nitrogen are introduced into the reactor and temperatures of approximately 770.degree. K. to 1550.degree. K. are employed. In another embodiment silane and ammonia are employed at temperatures from 750.degree. K. to 1800.degree. K.

Preliminary evaluation of the SimPORTAL major vessel injury (MVI) repair model.

PubMed

Veneziano, Domenico; Poniatowski, Lauren H; Reihsen, Troy E; Sweet, Robert M

2016-04-01

Major vessel injury (MVI) is a dangerous complication associated with laparoscopic surgery that leads, if not properly handled, to blood loss, conversion to open surgery, and eventually death. In this paper, we describe the preliminary evaluation of the SimPORTAL MVI model, created with the goal of simulating an intra-corporeal injury to a large vessel. For this study, we created MVI models for 17 residents (PGY 1-4). Each resident was asked to perform an intracorporeal knot on a penrose drain within a maximum time limit of 6 min (in accordance with European basic laparoscopic urological skills rules) and then to subsequently repair a vessel injury on the MVI model, which was perfused with synthetic blood, within a maximum blood loss of 3 L. During the vessel repair, low lights and pulse sounds were used to simulate the operating room environment. All participants filled out a survey pre- and post-task to score various aspects of the model. We successfully created a model that simulates a critical surgical event. None of the participants reported having previous experience repairing a MVI. Six participants were able to perform the intracorporeal knot, and 12 residents (70.5%) were able to repair the MVI model under the given time and blood loss limits. Eleven participants agreed that the MVI model behaves like a real vessel, and six felt to be capable of performing the task prior to attempting it. Sixteen participants thought that the MVI model should be part of laparoscopic curriculums during residency. The SimPORTAL MVI model is a feasible low-cost model that would be well appreciated as a part of laparoscopic curriculum for residents. Minor improvements, including pressure measurement in the vessel for task assessment, will be made in the future, and further studies are necessary to definitively validate this model.

Valuing the health benefits of improving indoor air quality in residences.

PubMed

Chau, C K; Hui, W K; Tse, M S

2008-05-01

Unlike commercial premises, the indoor air quality of residences is more dynamic, uncontrolled, and prone to human behavioral changes. In consequence, measuring the health benefit gains derived from improving indoor air quality in residences is more complicated. To overcome this, a human thermal comfort model was first integrated with indoor microenvironment models, and subsequently linked with appropriate concentration-response and economic data for estimating the economic benefit gains derived from improving indoor air quality in residences for an adult and an elderly person. In this study, the development of the model is illustrated by using a typical residential apartment locating at the worst air quality neighborhood in Hong Kong and the daily weather profiles between 2002 and 2006. Three types of personal intervention measures were examined in the study: (i) using air cleaner in residence, (ii) changing time spent in residence, and (iii) relocating to a better air quality neighborhood. Our results revealed that employing air cleaners with windows closed in residence throughout the entire year was the most beneficial measure as it could provide the greatest annual health benefit gains. It would give a maximum of HK$2072 in 5-year cumulative benefit gain for an adult and HK$1700 for an elderly person. Employing air cleaners with windows closed in only cool season (October through March) could give the highest marginal return per dollar spent. The benefit gains would become smaller when windows were opened to a greater extent. By contrast, relocating to a better air quality neighborhood and changing the time spent in residence did not appeal to be beneficial intervention measures.

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.

A model for the implementation of a two-shift municipal solid waste and recyclable material collection plan that offers greater convenience to residents.

PubMed

Lin, Hung-Yueh; Tsai, Zong-Pei; Chen, Guan-Hwa; Kao, Jehng-Jung

2011-01-01

Separating recyclables from municipal solid waste (MSW) before collection reduces not only the quantity of MSW that needs to be treated but also the depletion of resources. However, the participation of residents is essential for a successful recycling program, and the level of participation usually depends on the degree of convenience associated with accessing recycling collection points. The residential accessing convenience (RAC) of a collection plan is determined by the proximity of its collection points to all residents and its temporal flexibility in response to resident requirements. The degree of proximity to all residents is determined by using a coverage radius that represents the maximum distance residents need to travel to access a recycling point. The temporal flexibility is assessed by the availability of proximal recycling points at times suitable to the lifestyles of all residents concerned. In Taiwan, the MSW collection is implemented at fixed locations and at fixed times. Residents must deposit their garbage directly into the collection vehicle. To facilitate the assignment of collection vehicles and to encourage residents to thoroughly separate their recyclables, in Taiwan MSW and recyclable materials are usually collected at the same time by different vehicles. A heuristic procedure including an integer programming (IP) model and ant colony optimization (ACO) is explored in this study to determine an efficient two-shift collection plan that takes into account RAC factors. The IP model has been developed to determine convenient collection points in each shift on the basis of proximity, and then the ACO algorithm is applied to determine the most effective routing plan of each shift. With the use of a case study involving a city in Taiwan, this study has demonstrated that collection plans generated using the above procedure are superior to current collection plans on the basis of proximity and total collection distance.

Atlantic meridional overturning circulation during the Last Glacial Maximum.

PubMed

Lynch-Stieglitz, Jean; Adkins, Jess F; Curry, William B; Dokken, Trond; Hall, Ian R; Herguera, Juan Carlos; Hirschi, Joël J-M; Ivanova, Elena V; Kissel, Catherine; Marchal, Olivier; Marchitto, Thomas M; McCave, I Nicholas; McManus, Jerry F; Mulitza, Stefan; Ninnemann, Ulysses; Peeters, Frank; Yu, Ein-Fen; Zahn, Rainer

2007-04-06

The circulation of the deep Atlantic Ocean during the height of the last ice age appears to have been quite different from today. We review observations implying that Atlantic meridional overturning circulation during the Last Glacial Maximum was neither extremely sluggish nor an enhanced version of present-day circulation. The distribution of the decay products of uranium in sediments is consistent with a residence time for deep waters in the Atlantic only slightly greater than today. However, evidence from multiple water-mass tracers supports a different distribution of deep-water properties, including density, which is dynamically linked to circulation.

Personal digital assistant use in Florida obstetrics and gynecology residency programs.

PubMed

Joy, Saju; Benrubi, Guy

2004-05-01

Improvements in electronic technologies have resulted in affordable, smaller computers that operate at faster speeds. The personal digital assistant (PDA) is a tool that has the potential to enhance residency education by allowing residents immediate access to an abundance of information. This article assesses the current use of this tool at obstetrics and gynecology residency programs in the state of Florida. The authors conducted a statewide survey addressing the general question: is the PDA useful in an obstetrics and gynecology residency training program? Specifically, the authors asked residents how much time was perceived to be saved weekly with the use of this tool, and in what aspect of their training use of this tool was most helpful. At the survey's close, five of seven programs had returned the survey for evaluation. These five institutions included both university- and community-based residency programs. Forty percent of obstetrics and gynecology residents at these programs responded to this questionnaire. Resident responses to the survey revealed that most of the perceived benefit was in maintaining procedural statistics logs, pharmacology reference manuals, and personal clinical protocols. Most responses revealed that only minimal time savings (<2 h/wk) were gained with using this tool. However, many residents felt they were not using this tool to its maximum potential. Nearly 90% of those who responded felt that the PDA should be available at residency programs and anticipated using it after completing residency. This study posed the question of PDA usefulness at obstetric and gynecology residency programs in the state of Florida. Although not all programs provided their residents with a PDA, 95% of the respondents revealed that they owned one of these tools. Experience at the authors' institution revealed high expectations for the potential uses of a PDA. Although many residents were not using this tool to its full potential, a PDA tutorial session could educate residents on the many applications available for PDAs, including applications to maintain on-call schedules and sign-out lists, statistics and procedure logs for credentialing and board certification, electronic billing, and electronic prescriptions.

Anaerobic biodegradability and treatment of grey water in upflow anaerobic sludge blanket (UASB) reactor.

PubMed

Elmitwalli, Tarek A; Otterpohl, Ralf

2007-03-01

Feasibility of grey water treatment in an upflow anaerobic sludge blanket (UASB) reactor operated at different hydraulic retention time (HRT) of 16, 10 and 6h and controlled temperature of 30 degrees C was investigated. Moreover, the maximum anaerobic biodegradability without inoculum addition and maximum removal of chemical oxygen demand (COD) fractions in grey water were determined in batch experiments. High values of maximum anaerobic biodegradability (76%) and maximum COD removal in the UASB reactor (84%) were achieved. The results showed that the colloidal COD had the highest maximum anaerobic biodegradability (86%) and the suspended and dissolved COD had similar maximum anaerobic biodegradability of 70%. Furthermore, the results of the UASB reactor demonstrated that a total COD removal of 52-64% was obtained at HRT between 6 and 16 h. The UASB reactor removed 22-30% and 15-21% of total nitrogen and total phosphorous in the grey water, respectively, mainly due to the removal of particulate nutrients. The characteristics of the sludge in the UASB reactor confirmed that the reactor had a stable performance. The minimum sludge residence time and the maximum specific methanogenic activity of the sludge ranged between 27 and 93 days and 0.18 and 0.28 kg COD/(kg VS d).

Incorporating temporal and clinical reasoning in a new measure of continuity of care.

PubMed Central

Spooner, S. A.

1994-01-01

Previously described quantitative methods for measuring continuity of care have assumed that perfect continuity exists when a patient sees only one provider, regardless of the temporal pattern and clinical context of the visits. This paper describes an implementation of a new operational model of continuity--the Temporal Continuity Index--that takes into account time intervals between well visits in a pediatric residency continuity clinic. Ideal continuity in this model is achieved when intervals between visits are appropriate based on the age of the patient and clinical context of the encounters. The fundamental concept in this model is the expectation interval, which contains the length of the maximum ideal follow-up interval for a visit and the maximum follow-up interval. This paper describes an initial implementation of the TCI model and compares TCI calculations to previous quantitative methods and proposes its use as part of the assessment of resident education in outpatient settings. PMID:7950019

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.

Particle transport and stochastic acceleration in the giant lobes of Centaurus A

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

O'Sullivan, Stephen

2011-09-22

The conditions within the giant lobes of Centaurus A are reviewed in light of recent radio and {gamma}-ray observations. Data from WMAP and ground-based telescopes in conjunction with measurements from Fermi-LAT constrain the characteristic field strength and the maximum electron energy. The implications for the transport of energetic particles are discussed in terms of residence times and cooling times within the lobes. Acceleration of electrons and UHECR via the second order Fermi mechanism is discussed.

A novel Web-based graduate medical education management system including ACGME compliance algorithms.

PubMed

Gauger, Paul G; Davis, Janice W; Orr, Peter J

2002-09-01

Administration of graduate medical education programs has become more difficult as compliance with ACGME work guidelines has assumed increased importance. These guidelines have caused many changes in the resident work environment, including the emergence of complicated cross-cover arrangements. Many participating residents (each with his or her own individual scheduling requirements) usually generate these schedules. Accordingly, schedules are often not submitted in a timely fashion and they may not be in compliance with the ACGME guidelines for maximum on-call assignments and mandatory days off. Our objective was the establishment of a Web-based system that guides residents in creating on-call schedules that follow ACGME guidelines while still allowing maximum flexibility -- thus allowing each resident to maintain an internal locus of control. A versatile and scalable system with password-protected user (resident) and administrator interfaces was created. An entire academic year is included, and past months and years are automatically archived. The residents log on within the first 15 days of the preceding month and choose their positions in a schedule template. They then make adjustments while receiving immediate summary feedback on compliance with ACGME guidelines. The schedule is electronically submitted to the educational administrator for final approval. If a cross-cover system is required, the program automatically generates an optimal schedule using both of the approved participating service schedules. The residents then have an additional five-day period to make adjustments in the cross-cover schedule while still receiving compliance feedback. The administrator again provides final approval electronically. The communication interface automatically pages or e-mails the residents when schedules are updated or approved. Since the information exists in a relational database, simple reporting tools are included to extract the information necessary to generate records for institutional GME management. Implementation of this program has been met with great enthusiasm from the institutional stakeholders. Specifically, residents have embraced the ability to directly control their schedules and have gained appreciation for the regulatory matrix in which they function. Institutional administrators have praised the improvement in compliance and the ease of documentation. We anticipate that the system will also meet with approval from reviewing regulatory bodies, as it generates and stores accurate information about the resident work environment. This program is robust and versatile enough to be modified for any GME training program in the country.

Experimental study of the effect of cycle pressure on lean combustion emissions

NASA Technical Reports Server (NTRS)

Roffe, G.; Venkataramani, K. S.

1978-01-01

Experiments were conducted in which a stream of premixed propane and air was burned under conditions representative of gas turbine operation. Emissions of NOx, CO, and unburned hydrocarbons (UHC) were measured over a range of combustor inlet temperature, pressure, and residence time at equivalence ratios from 0.7 down to the lean stability limit. At an inlet temperature of 600 K, observed NOx levels dropped markedly with decreasing pressure for pressures below 20 atm. The NOx levels are proportional to combustor residence time and formation rates were principally a function of adiabatic flame temperature. For adiabatic flame temperatures of 2050 K and higher, CO reached chemical equilibrium within 2 msec. Unburned hydrocarbon species dropped to a negligible level within 2 msec regardless of inlet temperature, pressure, or equivalence ratio. For a combustor residence time of 2.5 msec, combustion inefficiency became less than 0.01% at an adiabatic flame temperature of 2050 K. The maximum combustion inefficiency observed was on the order of 1% and corresponded to conditions near the lean stability limit. Using a perforated plate flameholder, this limit is well represented by the condition of 1800 K adiabatic flame temperature.

Singlet delta oxygen production in a 2D micro-discharge array in air: effect of gas residence time and discharge power

NASA Astrophysics Data System (ADS)

Nayak, Gaurav; Santos Sousa, João; Bruggeman, Peter J.

2017-03-01

The production of singlet delta oxygen (O2(a 1Δg)) is of growing interest for many applications. We report on the measurement of O2(a 1Δg) and ozone (O3) in a room temperature atmospheric pressure discharge in dry air. The plasma source is a 2D array of micro-discharges generated by an alternating current voltage at 20 kHz. The study focuses on the effect of gas flow through the discharge. The maximum investigated flow rate allows reducing the gas residence time in the discharge zone to half the discharge period. Results indicate that the residence time and discharge power have a major effect on the O2(a 1Δg) production. Different O2(a 1Δg) density dependencies on power are observed for different flow rates. Effects of collisional quenching on the as-produced and measured O2(a 1Δg) densities are discussed. The flow rate also allows for control of the O2(a 1Δg) to O3 density ratio in the effluent from 0.7 to conditions of pure O3.

Population structure and residency patterns of whale sharks, Rhincodon typus, at a provisioning site in Cebu, Philippines

PubMed Central

Lucey, Anna; Labaja, Jessica; So, Catherine Lee; Snow, Sally; Ponzo, Alessandro

2014-01-01

This study represents the first description of whale sharks, Rhincodon typus, occurring at a provisioning site in Oslob, Cebu, Philippines. Frequent observations of sharks are often difficult, even at tourism sites, giving rise to provisioning activities to attract them. The present study provides repeated longitudinal data at a site where daily provisioning activities took place, and whale sharks were present every day. A total of 158 individual whale sharks were photographically identified between Mar 2012 and Dec 2013, with 129 males (82%), 19 females (12%) and 10 (6%) of undetermined sex. Mean estimated total length was 5.5 m (±1.3 m S.D.). Twenty individuals were measured with laser photogrammetry to validate researchers’ estimated sizes, yielding a good correlation (r2 = 0.83). Fifty-four (34%) individuals were observed being hand-fed by local fishermen (provisioned), through in-water behavioural observations. Maximum likelihood methods were used to model mean residency time of 44.9 days (±20.6 days S.E.) for provisioned R. typus contrasting with 22.4 days (±8.9 days S.E.) for non-provisioned individuals. Propeller scars were observed in 47% of the animals. A mean of 12.7 (±4.3 S.D.) R. typus were present in the survey area daily, with a maximum of 26 individuals (Aug 10 2013) and a minimum of 2 (Dec 6 2012). Twelve (8%) individuals were seen on at least 50% of survey days (n = 621), with a maximum residency of 572 days for one individual (P-396). Twenty four individuals were photographically identified across regional hotsposts, highlighting the species’ migratory nature and distribution. Extended residency and differences in lagged identification rates suggest behavioural modification on provisioned individuals, underlying the necessity for proper management of this tourism activity. PMID:25279256

Removal of hydrogen sulfide by sulfate-resistant Acidithiobacillus thiooxidans AZ11.

PubMed

Lee, Eun Young; Lee, Nae Yoon; Cho, Kyung-Suk; Ryu, Hee Wook

2006-04-01

Toxic H2S gas is an important industrial pollutant that is applied to biofiltration. Here, we examined the effects of factors such as inlet concentration and space velocity on the removal efficiency of a bacterial strain capable of tolerating high sulfate concentrations and low pH conditions. We examined three strains of Acidithiobacillus thiooxidans known to have sulfur-oxidizing activity, and identified strain AZ11 as having the highest tolerance for sulfate. A. thiooxidans AZ11 could grow at pH 0.2 in the presence of 74 g l(-1) sulfate, the final oxidation product of elemental sulfur, in the culture broth. Under these conditions, the specific sulfur oxidation rate was 2.9 g-S g-DCW (dry cell weight)(-1) d(-1). The maximum specific sulfur oxidation rate of A. thiooxidans AZ11 was 21.2 g-S g-DCW(-1) d(-1), which was observed in the presence of 4.2 g-SO4(2-) l(-1) and pH 1.5, in the culture medium. To test the effects of various factors on biofiltration by this strain, A. thiooxidans AZ11 was inoculated into a porous ceramic biofilter. First, a maximum inlet loading of 670 g-S m(-3) h(-1) was applied with a constant space velocity (SV) of 200 h(-1) (residence time, 18 s) and the inlet concentration of H2S was experimentally increased from 200 ppmv to 2200 ppmv. Under these conditions, less than 0.1 ppmv H2S was detected at the biofilter outlet. When the inlet H2S was maintained at a constant concentration of 200 ppmv and the SV was increased from 200 h(-1) to 400 h(-1) (residence time, 9 s), an H2S removal of 99.9% was obtained. However, H2S removal efficiencies decreased to 98% and 94% when the SV was set to 500 h(-1) (residence time, 7.2 s) and 600 h(-1) (residence time, 6 s), respectively. The critical elimination capacity guaranteeing 96% removal of the inlet H2S was determined to be 160 g-S m(-3) h(-1) at a space velocity of 600 h(-1). Collectively, these findings show for the first time that a sulfur oxidizing bacterium has a high sulfate tolerance and a high sulfur oxidizing activity below pH 1.

Dynamics of melt generation beneath mid-ocean ridge axes: Theoretical analysis based on 238- 230Th- 226Ra and 235U- 231Pa disequilibria

NASA Astrophysics Data System (ADS)

Qin, Zhenwei

1993-04-01

Although slow melting favors the generation of basaltic melt from a mantle matrix with large radioactive disequilibrium between two actinide nuclides ( MCKENZIE, 1985a), it results in long residence time in a magma chamber, during which the disequilibrium may be removed. An equilibrium melting model modified after MCKENZIE (1985a) is presented here which suggests that, for a given actinide parent-daughter pair, there exists a specific melting rate at which disequilibrium between these two nuclides reaches its maximum. This melting rate depends on the decay constant of the daughter nuclide concerned and the magma chamber volume scaled to that of its source. For a given scaled chamber size, large radioactive disequilibrium between two actinide nuclides in basalts will be observed if the melting rate is such that the residence time of the magma in the chamber is comparable to the mean life of the daughter nuclide. With a chamber size 1% in volume of the melting source, the melting rates at which maximum disequilibrium in basalts is obtained are 10 -7, 2 × 10 -7 and 3 × 10 -6y-1, respectively, for 238U- 230Th, 235U- 231Pa and 230Th- 226Ra. This implies that, while large disequilibrium between 238U- 230Th and between 235U- 231Pa may occur together, large 230Th- 226Ra disequilibrium will not coexist with large 238U- 230Th disequilibrium, consistent with some observations. The active mantle melting zone which supplies melt to a ridge axis is inferred to be only about 10 km thick and 50 km wide. The fraction of melt present in such a mantle source at any time is about 0.01 and 0.04, respectively, if melting rate is 10 -7 and 10 -6 y -1. The corresponding residence time of the residual melt in the matrix is 10 5 and 4 × 10 4y.

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

Prediction of Normal Organ Absorbed Doses for [177Lu]Lu-PSMA-617 Using [44Sc]Sc-PSMA-617 Pharmacokinetics in Patients With Metastatic Castration Resistant Prostate Carcinoma.

PubMed

Khawar, Ambreen; Eppard, Elisabeth; Sinnes, Jean Phlippe; Roesch, Frank; Ahmadzadehfar, Hojjat; Kürpig, Stefan; Meisenheimer, Michael; Gaertner, Florian C; Essler, Markus; Bundschuh, Ralph A

2018-04-23

In vivo pharmacokinetic analysis of [Sc]Sc-PSMA-617 was used to determine the normal organ-absorbed doses that may result from therapeutic activity of [Lu]Lu-PSMA-617 and to predict the maximum permissible activity of [Lu]Lu-PSMA-617 for patients with metastatic castration-resistant prostate carcinoma. Pharmacokinetics of [Sc]Sc-PSMA-617 was evaluated in 5 patients with metastatic castration-resistant prostate carcinoma using dynamic PET/CT, followed by 3 static PET/CT acquisitions and blood sample collection over 19.5 hours, as well as urine sample collection at 2 time points. Total activity measured in source organs by PET imaging, as well as counts per milliliter measured in blood and urine samples, was decay corrected back to the time of injection using the half-life of Sc. Afterward, forward decay correction using the half-life of Lu was performed, extrapolating the pharmacokinetics of [Sc]Sc-PSMA-617 to that of [Lu]Lu-PSMA-617. Source organs residence times and organ-absorbed doses for [Lu]Lu-PSMA-617 were calculated using OLINDA/EXM software. Bone marrow self-dose was determined with indirect blood-based method, and urinary bladder contents residence time was estimated by trapezoidal approximation. The maximum permissible activity of [Lu]Lu-PSMA-617 was calculated for each patient considering external beam radiotherapy toxicity limits for radiation absorbed doses to kidneys, bone marrow, salivary glands, and whole body. The predicted mean organ-absorbed doses were highest in the kidneys (0.44 mSv/MBq), followed by the salivary glands (0.23 mSv/MBq). The maximum permissible activity was highly variable among patients; limited by whole body-absorbed dose (1 patient), marrow-absorbed dose (1 patient), and kidney-absorbed dose (3 patients). [Sc]Sc-PSMA-617 PET/CT imaging is feasible and allows theoretical extrapolation of the pharmacokinetics of [Sc]Sc-PSMA-617 to that of [Lu]Lu-PSMA-617, with the intent of predicting normal organ-absorbed doses and maximum permissible activity in patients scheduled for therapy with [Lu]Lu-PSMA-617.

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.

Numerical prediction of algae cell mixing feature in raceway ponds using particle tracing methods.

PubMed

Ali, Haider; Cheema, Taqi A; Yoon, Ho-Sung; Do, Younghae; Park, Cheol W

2015-02-01

In the present study, a novel technique, which involves numerical computation of the mixing length of algae particles in raceway ponds, was used to evaluate the mixing process. A value of mixing length that is higher than the maximum streamwise distance (MSD) of algae cells indicates that the cells experienced an adequate turbulent mixing in the pond. A coupling methodology was adapted to map the pulsating effects of a 2D paddle wheel on a 3D raceway pond in this study. The turbulent mixing was examined based on the computations of mixing length, residence time, and algae cell distribution in the pond. The results revealed that the use of particle tracing methodology is an improved approach to define the mixing phenomenon more effectively. Moreover, the algae cell distribution aided in identifying the degree of mixing in terms of mixing length and residence time. © 2014 Wiley Periodicals, Inc.

Study of the motion and deposition of micro particles in a vertical tube containing uniform gas flow

NASA Astrophysics Data System (ADS)

Abolpour, Bahador; Afsahi, M. Mehdi; Soltani Goharrizi, Ataallah; Azizkarimi, Mehdi

2017-12-01

In this study, effects of a gaseous jet, formed in a vertical tube containing a uniform gas flow, on the injected micro particles have been investigated. A CFD model has been developed to simulate the particle motion in the tube. This simulation is very close to the experimental data. The results show that, increasing the flow rate of carrier gas or decreasing the flow rate of surrounding gas increases the effect of gaseous jet and also increases trapping rate of the particles by the tube wall. The minimum and maximum residence times of particles approach together with increasing the size of solid particles. Particles larger than 60 μm have a certain and fixed residence time at different flow rates of the carrier or surrounding gas. About 40 μm particle size has minimal trapping by the tube wall at various experimental conditions.

A multicenter analysis of the ophthalmic knowledge assessment program and American Board of Ophthalmology written qualifying examination performance.

PubMed

Lee, Andrew G; Oetting, Thomas A; Blomquist, Preston H; Bradford, Geoffrey; Culican, Susan M; Kloek, Carolyn; Krishnan, Chandrasekharan; Lauer, Andreas K; Levi, Leah; Naseri, Ayman; Rubin, Steven E; Scott, Ingrid U; Tao, Jeremiah; Tuli, Sonal; Wright, Martha M; Wudunn, Darrell; Zimmerman, M Bridget

2012-10-01

To compare the performance on the American Board of Ophthalmology Written Qualifying Examination (WQE) with the performance on step 1 of the United States Medical Licensing Examination (USMLE) and the Ophthalmic Knowledge Assessment Program (OKAP) examination for residents in multiple residency programs. Comparative case series. Fifteen residency programs with 339 total residents participated in this study. The data were extracted from the 5-year American Board of Ophthalmology report to each participating program in 2009 and included residency graduating classes from 2003 through 2007. Residents were included if data were available for the USMLE, OKAP examination in ophthalmology years 1 through 3, and the WQE score. Residents were excluded if one or more of the test scores were not available. Two-sample t tests, logistic regression analysis, and receiver operating characteristic (ROC) curves were used to examine the association of the various tests (USMLE, OKAP examination year 1, OKAP examination year 2, OKAP examination year 3, and maximum OKAP examination score) as a predictor for a passing or failing grade on the WQE. The primary outcome measure of this study was first time pass rate for the WQE. Using ROC analysis, the OKAP examination taken at the third year of ophthalmology residency best predicted performance on the WQE. For the OKAP examination taken during the third year of residency, the probability of passing the WQE was at least 80% for a score of 35 or higher and at least 95% for a score of 72 or higher. The OKAP examination, especially in the third year of residency, can be useful to residents to predict the likelihood of success on the high-stakes WQE examination. Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Counteracting "Not in My Backyard": The Positive Effects of Greater Occupancy within Mutual-Help Recovery Homes

ERIC Educational Resources Information Center

Jason, Leonard A.; Groh, David R.; Durocher, Megan; Alvarez, Josefina; Aase, Darrin M.; Ferrari, Joseph R.

2008-01-01

Group homes sometimes face significant neighborhood opposition, and municipalities frequently use maximum occupancy laws to close down these homes. This study examined how the number of residents in Oxford House recovery homes impacted residents' outcomes. Larger homes (i.e., eight or more residents) may reduce the cost per person and offer more…

Robot flow, clogging and jamming in confined spaces

NASA Astrophysics Data System (ADS)

Monaenkova, Daria; Linevich, Vadim; Goodisman, Michael A. D.; Goldman, Daniel I.

We hypothesized that when a collection of robots operate in confined space, maximization of individual effort could negatively affect the collective performance by impeding the mobility of the individuals. To test our hypothesis, we built and programmed groups of 1-4 autonomous robotic diggers to construct a tunnel in a model cohesive soil. The robots' mobility, defined in terms of the residence time (T) required for a robot to move one body-length within the tunnel, was compared between groups of maximally active robots (mode 1), groups with different levels of activity between individuals (mode 2), and maximally active robots with a ``giving up'' behavior (mode 3), in which the robot ceased the attempt to excavate in a crowded tunnel. In small groups of two robots, T was ~3 sec and did not depend on the mode of operation. However, an increase in the number of robots caused an increase in T which depended upon mode. The residence time in groups of four robots in mode 1 (~9 sec) significantly exceeded the residence time in mode 2 and 3 (~4 sec), indicating that crowding was causing slower movement of individuals, particularly under maximum effort (mode 1). We will use our robophysical studies to discover principles of collective construction in subterranean social animals.

The transient response of ice-shelf melting to ocean change

NASA Astrophysics Data System (ADS)

Holland, P.

2017-12-01

Idealised modelling studies show that the melting of ice shelves varies as a quadratic function of ocean temperature. This means that warm-water ice shelves have higher melt rates and are also more sensitive to ocean warming. However, this result is the equilibrium response, derived from a set of ice—ocean simulations subjected to a fixed ocean forcing and run until steady. This study considers instead the transient response of melting, using unsteady simulations subjected to forcing conditions that are oscillated in time with a range of periods. The results show that when the ocean forcing is varied slowly, the melt rates follow the equililbrium response. However, for rapid ocean change melting deviates from the equilibrium response in interesting ways. The residence time of water in the sub-ice cavity offers a critical timescale. When the forcing varies slowly (period of oscillation >> residence time), the cavity is fully-flushed with forcing anomalies at all stages of the cycle and melting follows the equilibrium response. When the forcing varies rapidly (period ≤ residence time), multiple cold and warm anomalies coexist in the cavity, cancelling each other in the spatial mean and thus inducing a relatively steady melt rate. This implies that all ice shelves have a maximum frequency of ocean variability that can be manifested in melting. The results also show that ice shelves forced by warm water have high melt rates, high equilibrium sensitivity, and short residence times, hence a short timescale over which the equilibrium sensitivity is manifest. The most rapid melting adjustment is induced by warm anomalies that are also saline. Thus, ice shelves in the Amundsen and Bellingshausen seas, Antarctica, are highly sensitive to ocean change.

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.

Importation, Antibiotics, and Clostridium difficile Infection in Veteran Long-Term Care: A Multilevel Case-Control Study.

PubMed

Brown, Kevin A; Jones, Makoto; Daneman, Nick; Adler, Frederick R; Stevens, Vanessa; Nechodom, Kevin E; Goetz, Matthew B; Samore, Matthew H; Mayer, Jeanmarie

2016-06-21

Although clinical factors affecting a person's susceptibility to Clostridium difficile infection are well-understood, little is known about what drives differences in incidence across long-term care settings. To obtain a comprehensive picture of individual and regional factors that affect C difficile incidence. Multilevel longitudinal nested case-control study. Veterans Health Administration health care regions, from 2006 through 2012. Long-term care residents. Individual-level risk factors included age, number of comorbid conditions, and antibiotic exposure. Regional risk factors included importation of cases of acute care C difficile infection per 10 000 resident-days and antibiotic use per 1000 resident-days. The outcome was defined as a positive result on a long-term care C difficile test without a positive result in the prior 8 weeks. 6012 cases (incidence, 3.7 cases per 10 000 resident-days) were identified in 86 regions. Long-term care C difficile incidence (minimum, 0.6 case per 10 000 resident-days; maximum, 31.0 cases per 10 000 resident-days), antibiotic use (minimum, 61.0 days with therapy per 1000 resident-days; maximum, 370.2 days with therapy per 1000 resident-days), and importation (minimum, 2.9 cases per 10 000 resident-days; maximum, 341.3 cases per 10 000 resident-days) varied substantially across regions. Together, antibiotic use and importation accounted for 75% of the regional variation in C difficile incidence (R2 = 0.75). Multilevel analyses showed that regional factors affected risk together with individual-level exposures (relative risk of regional antibiotic use, 1.36 per doubling [95% CI, 1.15 to 1.60]; relative risk of importation, 1.23 per doubling [CI, 1.14 to 1.33]). Case identification was based on laboratory criteria. Admission of residents with recent C difficile infection from non-Veterans Health Administration acute care sources was not considered. Only 25% of the variation in regional C difficile incidence in long-term care remained unexplained after importation from acute care facilities and antibiotic use were accounted for, which suggests that improved infection control and antimicrobial stewardship may help reduce the incidence of C difficile in long-term care settings. U.S. Department of Veterans Affairs and Centers for Disease Control and Prevention.

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.

A pilot study of orthopaedic resident self-assessment using a milestones’ survey just prior to milestones implementation

PubMed Central

Bradley, Kendall E.

2016-01-01

Objectives To pilot test if Orthopaedic Surgery residents could self-assess their performance using newly created milestones, as defined by the Accreditation Council on Graduate Medical Education.  Methods In June 2012, an email was sent to Program Directors and administrative coordinators of the154 accredited Orthopaedic Surgery Programs, asking them to send their residents a link to an online survey. The survey was adapted from the Orthopaedic Surgery Milestone Project. Completed surveys were aggregated in an anonymous, confidential database. SAS 9.3 was used to perform the analyses. Results Responses from 71 residents were analyzed. First and second year residents indicated through self-assessment that they had substantially achieved Level 1 and Level 2 milestones. Third year residents reported they had substantially achieved 30/41, and fourth year residents, all Level 3 milestones. Fifth year, graduating residents, reported they had substantially achieved 17 Level 4 milestones, and were extremely close on another 15. No milestone was rated at Level 5, the maximum possible.  Earlier in training, Patient Care and Medical Knowledge milestones were rated lower than the milestones reflecting the other four competencies of Practice Based Learning and Improvement, Systems Based Practice, Professionalism, and Interpersonal Communication. The gap was closed by the fourth year. Conclusions Residents were able to successfully self-assess using the 41 Orthopaedic Surgery milestones. Respondents’ rate improved proficiency over time. Graduating residents report they have substantially, or close to substantially, achieved all Level 4 milestones.  Milestone self-assessment may be a useful tool as one component of a program’s overall performance assessment strategy. PMID:26752012

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.

An embedded checklist in the Anesthesia Information Management System improves pre-anaesthetic induction setup: a randomised controlled trial in a simulation setting.

PubMed

Wetmore, Douglas; Goldberg, Andrew; Gandhi, Nishant; Spivack, John; McCormick, Patrick; DeMaria, Samuel

2016-10-01

Anaesthesiologists work in a high stress, high consequence environment in which missed steps in preparation may lead to medical errors and potential patient harm. The pre-anaesthetic induction period has been identified as a time in which medical errors can occur. The Anesthesia Patient Safety Foundation has developed a Pre-Anesthetic Induction Patient Safety (PIPS) checklist. We conducted this study to test the effectiveness of this checklist, when embedded in our institutional Anesthesia Information Management System (AIMS), on resident performance in a simulated environment. Using a randomised, controlled, observer-blinded design, we compared performance of anaesthesiology residents in a simulated operating room under production pressure using a checklist in completing a thorough pre-anaesthetic induction evaluation and setup with that of residents with no checklist. The checklist was embedded in the simulated operating room's electronic medical record. Data for 38 anaesthesiology residents shows a statistically significant difference in performance in pre-anaesthetic setup and evaluation as scored by blinded raters (maximum score 22 points), with the checklist group performing better by 7.8 points (p<0.01). The effects of gender and year of residency on total score were not significant. Simulation duration (time to anaesthetic agent administration) was increased significantly by the use of the checklist. Required use of a pre-induction checklist improves anaesthesiology resident performance in a simulated environment. The PIPS checklist as an integrated part of a departmental AIMS warrant further investigation as a quality measure. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Advanced direct coal liquefaction concepts. Quarterly report, January 1, 1993--March 31, 1993

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

Berger, D.J.; Parker, R.J.; Simpson, P.L.

1993-07-01

Five barrels of a Wilsonville process derived solvent (V-1074) from Black Thunder coal were obtained. This material boils within the preferred gas oil range, is more aromatic than previous solvents, and will therefore be used for the bench unit studies. Several repeat runs were performed in the autoclave to confirm the results of the matrix study. In addition, runs were carried out with different catalysts, with agglomerates and with the V-1074 solvent. The results of the autoclave runs were analyzed with respect to coal conversion, CO conversion, oil yield, hydrogen consumption and oxygen removal. It was concluded that the bestmore » operating conditions for the first stage operation was a temperature of at least 390{degrees}C, residence time of at least 30 minutes, cold CO pressure of at least 600 psig and potassium carbonate catalyst (2% wt on total feed). The data also indicated however, that the coal conversion goes through a maximum, and too high a severity leads to retrograde reaction and lower coal solubilization. The scope for increasing temperature and time is therefore limited. Petrographic examination of the THF insoluble resids from the autoclave program indicated a maximum coal conversion of about 90% for Black Thunder coal. The bench unit construction was also essentially completed and the bench unit program to be carded out in the next twelve months was defined.« less

Assessing the experience in complex hepatopancreatobiliary surgery among graduating chief residents: Is the operative experience enough?

PubMed Central

Sachs, Teviah E.; Ejaz, Aslam; Weiss, Matthew; Spolverato, Gaya; Ahuja, Nita; Makary, Martin A.; Wolfgang, Christopher L.; Hirose, Kenzo; Pawlik, Timothy M.

2015-01-01

Introduction Resident operative autonomy and case volume is associated with posttraining confidence and practice plans. Accreditation Council for Graduate Medical Education requirements for graduating general surgery residents are four liver and three pancreas cases. We sought to evaluate trends in resident experience and autonomy for complex hepatopancreatobiliary (HPB) surgery over time. Methods We queried the Accreditation Council for Graduate Medical Education General Surgery Case Log (2003–2012) for all cases performed by graduating chief residents (GCR) relating to liver, pancreas, and the biliary tract (HPB); simple cholecystectomy was excluded. Mean (±SD), median [10th–90th percentiles] and maximum case volumes were compared from 2003 to 2012 using R2 for all trends. Results A total of 252,977 complex HPB cases (36% liver, 43% pancreas, 21% biliary) were performed by 10,288 GCR during the 10-year period examined (Mean = 24.6 per GCR). Of these, 57% were performed during the chief year, whereas 43% were performed as postgraduate year 1–4. Only 52% of liver cases were anatomic resections, whereas 71% of pancreas cases were major resections. Total number of cases increased from 22,516 (mean = 23.0) in 2003 to 27,191 (mean = 24.9) in 2012. During this same time period, the percentage of HPB cases that were performed during the chief year decreased by 7% (liver: 13%, pancreas 8%, biliary 4%). There was an increasing trend in the mean number of operations (mean ± SD) logged by GCR on the pancreas (9.1 ± 5.9 to 11.3 ± 4.3; R2 = .85) and liver (8.0 ± 5.9 to 9.4 ± 3.4; R2 = .91), whereas those for the biliary tract decreased (5.9 ± 2.5 to 3.8 ± 2.1; R2 = .96). Although the median number of cases [10th:90th percentile] increased slightly for both pancreas (7.0 [4.0:15] to 8.0 [4:20]) and liver (7.0 [4:13] to 8.0 [5:14]), the maximum number of cases preformed by any given GCR remained stable for pancreas (51 to 53; R2 = .18), but increased for liver (38 to 45; R2 = .32). The median number of HPB cases that GCR performed as teaching assistants (TAs) remained at zero during this time period. The 90th percentile of cases performed as TA was less than two for both pancreas and liver. Conclusion Roughly one-half of GCR have performed fewer than 10 cases in each of the liver, pancreas, or biliary categories at time of completion of residency. Although the mean number of complex liver and pancreatic operations performed by GCR increased slightly, the median number remained low, and the number of TA cases was virtually zero. Most GCR are unlikely to be prepared to perform complex HPB operations. PMID:24953270

Prediction of endoplasmic reticulum resident proteins using fragmented amino acid composition and support vector machine.

PubMed

Kumar, Ravindra; Kumari, Bandana; Kumar, Manish

2017-01-01

The endoplasmic reticulum plays an important role in many cellular processes, which includes protein synthesis, folding and post-translational processing of newly synthesized proteins. It is also the site for quality control of misfolded proteins and entry point of extracellular proteins to the secretory pathway. Hence at any given point of time, endoplasmic reticulum contains two different cohorts of proteins, (i) proteins involved in endoplasmic reticulum-specific function, which reside in the lumen of the endoplasmic reticulum, called as endoplasmic reticulum resident proteins and (ii) proteins which are in process of moving to the extracellular space. Thus, endoplasmic reticulum resident proteins must somehow be distinguished from newly synthesized secretory proteins, which pass through the endoplasmic reticulum on their way out of the cell. Approximately only 50% of the proteins used in this study as training data had endoplasmic reticulum retention signal, which shows that these signals are not essentially present in all endoplasmic reticulum resident proteins. This also strongly indicates the role of additional factors in retention of endoplasmic reticulum-specific proteins inside the endoplasmic reticulum. This is a support vector machine based method, where we had used different forms of protein features as inputs for support vector machine to develop the prediction models. During training leave-one-out approach of cross-validation was used. Maximum performance was obtained with a combination of amino acid compositions of different part of proteins. In this study, we have reported a novel support vector machine based method for predicting endoplasmic reticulum resident proteins, named as ERPred. During training we achieved a maximum accuracy of 81.42% with leave-one-out approach of cross-validation. When evaluated on independent dataset, ERPred did prediction with sensitivity of 72.31% and specificity of 83.69%. We have also annotated six different proteomes to predict the candidate endoplasmic reticulum resident proteins in them. A webserver, ERPred, was developed to make the method available to the scientific community, which can be accessed at http://proteininformatics.org/mkumar/erpred/index.html. We found that out of 124 proteins of the training dataset, only 66 proteins had endoplasmic reticulum retention signals, which shows that these signals are not an absolute necessity for endoplasmic reticulum resident proteins to remain inside the endoplasmic reticulum. This observation also strongly indicates the role of additional factors in retention of proteins inside the endoplasmic reticulum. Our proposed predictor, ERPred, is a signal independent tool. It is tuned for the prediction of endoplasmic reticulum resident proteins, even if the query protein does not contain specific ER-retention signal.

Vegetation over hydrologic control of sediment transport over the past 100,000 yr

NASA Astrophysics Data System (ADS)

Dosseto, A.; Maher, K.; Turner, S. P.; Hesse, P.; Fryirs, K.

2008-12-01

Uranium isotopes can be used to determine the residence time of sediments in a catchment, i.e. how long they are stored in weathering profiles and transported through the catchment by rivers. We have measured uranium isotopes in sediments from palaeo-channels of the Murrumbidgee River (Murray-Darling Basin, southeastern Australia) to quantify variations in sediment residence times over the past 100,000 years. Results indicate that sediments transported through the Murrumbidgee catchment during the Last Glacial Maximum (LGM) resided for 10's of thousands of years in the catchment. This contrasts with modern and 100ka-old channel sediments where the residence time reaches values as high as 400,000-500,000 years. Variations in sediment residence time in the Murrumbidgee basin do not strictly follow changes in bankfull discharge but instead are correlated with shifts in vegetation and atmospheric CO2. In the absence of significant glacial erosion in this basin during LGM, this is at odds with what is expected from the links between climate and erosion (a decrease in CO2 and temperature is expected to induce a decrease in weathering and erosion). Vegetation may be the link between climate and sediment transport: sparse vegetation in the upper catchment allows significant hillslope erosion during LGM but dense woodlands in the Holocene and during the last interglacial inhibit sediment delivery to the river from hillslopes and sediments are derived from the re-working of old (a few 100s ka) alluvial deposits. These observations would suggest that (i) changes in hydrology cannot explain alone changes in sediment transport and (ii) the impact of climate change on catchment erosion is operating indirectly, via changes in vegetation type and density. These hypothesis will be tested with studies of a more detailed sedimentary record of the Late Holocene in the Murrumbidgee and sedimentary deposits in Eastern US.

Comparative studies of various hyaluronic acids produced by microbial fermentation for potential topical ophthalmic applications.

PubMed

Guillaumie, Fanny; Furrer, Pascal; Felt-Baeyens, Olivia; Fuhlendorff, Birgit L; Nymand, Søren; Westh, Peter; Gurny, Robert; Schwach-Abdellaoui, Khadija

2010-03-15

This work presents a comparative study of various hyaluronic acids (HA) produced by fermentation of either Bacillus subtilis or Streptococcus towards the selection of an optimal molecular weight (MW) HA for the preparation of topical ophthalmic formulations. The influence of HA MW on water binding capacity, sterile filtration, rheological properties, precorneal residence time and ocular tolerance of ophthalmic solutions was investigated. Molecular weight did not affect hydration of hyaluronic acid according to differential scanning calorimetry (DSC). In general, medium MW HA (0.6-1 MDa) resulted in solutions that were superior in terms of sterile filtration and kinematic viscosity requirements compared to high MW HA (>1 MDa). Moreover, all HA-based solutions exhibited well-defined viscoelastic properties that depend on MW. Gamma scintigraphic data indicated that HA MW at 0.1% concentration (w/v) and HA origin did not significantly affect the corneal residence time on rabbit eyes. A 0.3% solution of high MW HA had a prolonged residence time in the precorneal area compared to a medium MW HA at the same concentration. Finally, an in vivo ocular irritation test based on confocal laser scanning ophthalmoscopy (CLSO) conclusively showed the excellent tolerance of both Bacillus-derived HA and Streptococcus-derived HA after topical instillation onto the corneal surface. Overall, this comprehensive work highlights the superiority of medium MW hyaluronic acid for topical ophthalmic formulations based on their physico-chemical and biological properties, tolerance and handling. Such solutions are expected to enhance tear film stability, to allow for maximum comfort, and to exhibit high residence times, while being biocompatible and easy to sterile filter. (c) 2009 Wiley Periodicals, Inc.

24 CFR 965.505 - Standards for allowances for utilities.

Code of Federal Regulations, 2010 CFR

2010-04-01

... PHA installs air conditioning, it shall provide, to the maximum extent economically feasible, systems... systems that offer each resident the option to choose air conditioning shall include retail meters or... allowances. For systems that offer residents the option to choose air conditioning but cannot be checkmetered...

Traffic Noise Assessment at Residential Areas in Skudai, Johor

NASA Astrophysics Data System (ADS)

Sulaiman, F. S.; Darus, N.; Mashros, N.; Haron, Z.; Yahya, K.

2018-03-01

Vehicles passing by on roadways in residential areas may produce unpleasant traffic noise that affects the residents. This paper presents the traffic noise assessment of three selected residential areas located in Skudai, Johor. The objectives of this study are to evaluate traffic characteristics at selected residential areas, determine related noise indices, and assess impact of traffic noise. Traffic characteristics such as daily traffic volume and vehicle speed were evaluated using automatic traffic counter (ATC). Meanwhile, noise indices like equivalent continuous sound pressure level (LAeq), noise level exceeded 10% (L10) and 90% (L90) of measurement time were determined using sound level meter (SLM). Besides that, traffic noise index (TNI) and noise pollution level (LNP) were calculated based on the measured noise indices. The results showed an increase in noise level of 60 to 70 dBA maximum due to increase in traffic volume. There was also a significant change in noise level of more than 70 dBA even though average vehicle speed did not vary significantly. Nevertheless, LAeq, TNI, and LNP values for all sites during daytime were lower than the maximum recommended levels. Thus, residents in the three studied areas were not affected in terms of quality of life and health.

The size of the irregular migrant population in the European Union – counting the uncountable?

PubMed

Vogel, Dita; Kovacheva, Vesela; Prescott, Hannah

2011-01-01

It is difficult to estimate the size of the irregular migrant population in a specific city or country, and even more difficult to arrive at estimates at the European level. A review of past attempts at European-level estimates reveals that they rely on rough and outdated rules-of-thumb. In this paper, we present our own European level estimates for 2002, 2005, and 2008. We aggregate country-specific information, aiming at approximate comparability by consistent use of minimum and maximum estimates and by adjusting for obvious differences in definition and timescale. While the aggregated estimates are not considered highly reliable, they do -- for the first time -- provide transparency. The provision of more systematic medium quality estimates is shown to be the most promising way for improvement. The presented estimate indicates a minimum of 1.9 million and a maximum of 3.8 million irregular foreign residents in the 27 member states of the European Union (2008). Unlike rules-of-thumb, the aggregated EU estimates indicate a decline in the number of irregular foreign residents between 2002 and 2008. This decline has been influenced by the EU enlargement and legalisation programmes.

Increased prevalence of hypertension in a population exposed to aircraft noise

PubMed Central

Rosenlund, M; Berglind, N; Pershagen, G; Jarup, L; Bluhm, G

2001-01-01

OBJECTIVES—To investigate whether there is a relation between residential exposure to aircraft noise and hypertension.
METHODS—The study population comprised two random samples of subjects aged 19-80 years, one including 266 residents in the vicinity of Stockholm Arlanda airport, and another comprising 2693 inhabitants in other parts of Stockholm county. The subjects were classified according to the time weighted equal energy and maximum aircraft noise levels at their residence. A questionnaire provided information on individual characteristics including history of hypertension.
RESULTS—The prevalence odds ratio for hypertension adjusted for age, sex, smoking, and education was 1.6 (95% confidence interval (95% CI) 1.0 to 2.5) among those with energy averaged aircraft noise levels exceeding 55 dBA, and 1.8 (95% CI 1.1 to 2.8) among those with maximum aircraft noise levels exceeding 72 dBA. An exposure-response relation was suggested for both exposure measures. The exposure to aircraft noise seemed particularly important for older subjects and for those not reporting impaired hearing ability.
CONCLUSIONS—Community exposure to aircraft noise may be associated with hypertension. PMID:11706142

Assessment of radiation exposure from cesium-137 contaminated roads for epidemiological studies in Seoul, Korea.

PubMed

Lee, Yun-Keun; Ju, Young-Su; Lee, Won Jin; Hwang, Seung Sik; Yim, Sang-Hyuk; Yoo, Sang-Chul; Lee, Jieon; Choi, Kyung-Hwa; Burm, Eunae; Ha, Mina

2015-01-01

We aimed to assess the radiation exposure for epidemiologic investigation in residents exposed to radiation from roads that were accidentally found to be contaminated with radioactive cesium-137 ((137)Cs) in Seoul. Using information regarding the frequency and duration of passing via the (137)Cs contaminated roads or residing/working near the roads from the questionnaires that were obtained from 8875 residents and the measured radiation doses reported by the Nuclear Safety and Security Commission, we calculated the total cumulative dose of radiation exposure for each person. Sixty-three percent of the residents who responded to the questionnaire were considered as ever-exposed and 1% of them had a total cumulative dose of more than 10 mSv. The mean (minimum, maximum) duration of radiation exposure was 4.75 years (0.08, 11.98) and the geometric mean (minimum, maximum) of the total cumulative dose was 0.049 mSv (<0.001, 35.35) in the exposed. An individual exposure assessment was performed for an epidemiological study to estimate the health risk among residents living in the vicinity of (137)Cs contaminated roads. The average exposure dose in the exposed people was less than 5% of the current guideline.

Development of the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial Protocol: A National Cluster-Randomized Trial of Resident Duty Hour Policies.

PubMed

Bilimoria, Karl Y; Chung, Jeanette W; Hedges, Larry V; Dahlke, Allison R; Love, Remi; Cohen, Mark E; Tarpley, John; Mellinger, John; Mahvi, David M; Kelz, Rachel R; Ko, Clifford Y; Hoyt, David B; Lewis, Frank H

2016-03-01

Debate continues regarding whether to further restrict resident duty hour policies, but little high-level evidence is available to guide policy changes. To inform decision making regarding duty hour policies, the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial is being conducted to evaluate whether changing resident duty hour policies to permit greater flexibility in work hours affects patient postoperative outcomes, resident education, and resident well-being. Pragmatic noninferiority cluster-randomized trial of general surgery residency programs with 2 study arms. Participating in the study are Accreditation Council for Graduate Medical Education (ACGME)-approved US general surgery residency programs (n = 118), their affiliated hospitals (n = 154), surgical residents and program directors, and general surgery patients from July 1, 2014, to June 30, 2015, with additional patient safety outcomes collected through June 30, 2016. The data collection platform for patient outcomes is the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), thus only hospitals participating in the ACS NSQIP were included. In the usual care arm, programs adhered to current ACGME resident duty hour standards. In the intervention arm, programs were allowed to deviate from current standards regarding maximum shift lengths and minimum time off between shifts through an ACGME waiver. Death or serious morbidity within 30 days of surgery measured through ACS NSQIP, as well as resident satisfaction and well-being measured through a survey delivered at the time of the 2015 American Board of Surgery in Training Examination (ABSITE). A total of 118 general surgery residency programs and 154 hospitals were enrolled in the FIRST Trial and randomized. Fifty-nine programs (73 hospitals) were randomized to the usual care arm and 59 programs (81 hospitals) were randomized to the intervention arm. Intent-to-treat analysis will be used to estimate the effectiveness of assignment to the intervention arm on patient outcomes, resident education, and resident well-being compared with the usual care arm. Several sensitivity analyses will be performed to determine whether there were differential effects when examining only inpatients, high-risk patients, and emergent/urgent cases. To our knowledge, the FIRST Trial is the first national randomized clinical trial of duty hour policies. Results of this study may be informative to policymakers and other stakeholders engaged in restructuring graduate medical training to enhance the quality of patient care and resident education. clinicaltrials.org Identifier: NCT02050789.

12 CFR 705.2 - Purpose of the program.

Code of Federal Regulations, 2010 CFR

2010-01-01

... financial and related services to residents in their communities; and (2) Stimulating economic activities in... opportunities for low-income residents, and other community growth efforts. (b) The policy of NCUA is to revolve loan funds to qualifying credit unions as often as practical in order to gain maximum economic impact...

Improving the reliability of verbal communication between primary care physicians and pediatric hospitalists at hospital discharge.

PubMed

Mussman, Grant M; Vossmeyer, Michael T; Brady, Patrick W; Warrick, Denise M; Simmons, Jeffrey M; White, Christine M

2015-09-01

Timely and reliable verbal communication between hospitalists and primary care physicians (PCPs) is critical for prevention of medical adverse events but difficult in practice. Our aim was to increase the proportion of completed verbal handoffs from on-call residents or attendings to PCPs within 24 hours of patient discharge from a hospital medicine service to ≥90% within 18 months. A multidisciplinary team collaborated to redesign the process by which PCPs were contacted following patient discharge. Interventions focused on the key drivers of obtaining stakeholder buy-in, standardization of the communication process, including assigning primary responsibility for discharge communication to a single resident on each team and batching calls during times of maximum resident availability, reliable automated process initiation through leveraging the electronic health record (EHR), and transparency of data. A run chart assessed the impact of interventions over time. The percentage of calls initiated within 24 hours of discharge improved from 52% to 97%, and the percentage of calls completed improved to 93%. Results were sustained for 18 months. Standardization of the communication process through hospital telephone operators, use of the discharge order to ensure initiation of discharge communication, and batching of phone calls were associated with improvements in our measures. Reliable verbal discharge communication can be achieved through the use of a standardized discharge communication process coupled with the EHR. © 2015 Society of Hospital Medicine.

[Acute rhabdomyolysis after spinal anesthesia for knee arthroscopy].

PubMed

Bouché, P M; Chavagnac, B; Cognet, V; Banssillon, V

2001-08-01

We report an observation of acute rhabdomyolysis of gluteus maximum muscles occurring in a non-obese patient installed in supine position that underwent knee arthroscopy under spinal anaesthesia. The patient had insulin-dependent diabetes melitus with documented microangiopathy. The interest of this observation resides in the occurrence of the syndrome after a short period of time (one hour) of installation in the supine position in a patient that did not have any of the generally described risk factors of rhabdomyolysis.

Predictors of Knowledge and Image Interpretation Skill Development in Radiology Residents.

PubMed

Ravesloot, Cécile J; van der Schaaf, Marieke F; Kruitwagen, Cas L J J; van der Gijp, Anouk; Rutgers, Dirk R; Haaring, Cees; Ten Cate, Olle; van Schaik, Jan P J

2017-09-01

Purpose To investigate knowledge and image interpretation skill development in residency by studying scores on knowledge and image questions on radiology tests, mediated by the training environment. Materials and Methods Ethical approval for the study was obtained from the ethical review board of the Netherlands Association for Medical Education. Longitudinal test data of 577 of 2884 radiology residents who took semiannual progress tests during 5 years were retrospectively analyzed by using a nonlinear mixed-effects model taking training length as input variable. Tests included nonimage and image questions that assessed knowledge and image interpretation skill. Hypothesized predictors were hospital type (academic or nonacademic), training hospital, enrollment age, sex, and test date. Results Scores showed a curvilinear growth during residency. Image scores increased faster during the first 3 years of residency and reached a higher maximum than knowledge scores (55.8% vs 45.1%). The slope of image score development versus knowledge question scores of 1st-year residents was 16.8% versus 12.4%, respectively. Training hospital environment appeared to be an important predictor in both knowledge and image interpretation skill development (maximum score difference between training hospitals was 23.2%; P < .001). Conclusion Expertise developed rapidly in the initial years of radiology residency and leveled off in the 3rd and 4th training year. The shape of the curve was mainly influenced by the specific training hospital. © RSNA, 2017 Online supplemental material is available for this article.

Toxicokinetics of fumonisin B1 in turkey poults and tissue persistence after exposure to a diet containing the maximum European tolerance for fumonisins in avian feeds.

PubMed

Tardieu, Didier; Bailly, Jean-Denis; Skiba, Fabien; Grosjean, François; Guerre, Philippe

2008-09-01

The kinetic of fumonisin B1 (FB1) after a single IV and oral dose, and FB1 persistence in tissue were investigated in turkey poults by HPLC after purification of samples on columns. After IV administration (single-dose: 10mg FB1/kg bw), serum concentration-time curves were best described by a three-compartment open model. Elimination half-life and mean residence time of FB1 were 85 and 52min, respectively. After oral administration (single-dose: 100mg FB1/kg bw) bioavailability was 3.2%; elimination half-life and mean residence time were 214 and 408min, respectively. Clearance of FB1 was 7.6 and 7.5ml/min/kg for IV and oral administration, respectively. Twenty-four hours after the administration of FB1 by the intravenous route, liver and kidney contained the highest levels of FB1 in tissues, level in muscle was low or below the limit of detection (LD, 13microg/kg). The persistence of FB1 in tissue was also studied after administration for 9 weeks of a feed that contained 5, 10 and 20mg FB1+FB2/kg diet. Eight hours after the last intake of 20mg FB1+FB2/kg feed (maximum recommended concentration of fumonisins established by the EU for avian feed), hepatic and renal FB1 concentrations were 119 and 22microg/kg, level in muscles was below the LD.

Do American dippers obtain a survival benefit from altitudinal migration?

PubMed

Green, David J; Whitehorne, Ivy B J; Middleton, Holly A; Morrissey, Christy A

2015-01-01

Studies of partial migrants provide an opportunity to assess the cost and benefits of migration. Previous work has demonstrated that sedentary American dippers (residents) have higher annual productivity than altitudinal migrants that move to higher elevations to breed. Here we use a ten-year (30 period) mark-recapture dataset to evaluate whether migrants offset their lower productivity with higher survival during the migration-breeding period when they occupy different habitat, or early and late-winter periods when they coexist with residents. Mark-recapture models provide no evidence that apparent monthly survival of migrants is higher than that of residents at any time of the year. The best-supported model suggests that monthly survival is higher in the migration-breeding period than winter periods. Another well-supported model suggested that residency conferred a survival benefit, and annual apparent survival (calculated from model weighted monthly apparent survival estimates using the Delta method) of residents (0.511 ± 0.038SE) was slightly higher than that of migrants (0.487 ± 0.032). Winter survival of American dippers was influenced by environmental conditions; monthly apparent survival increased as maximum daily flow rates increased and declined as winter temperatures became colder. However, we found no evidence that environmental conditions altered differences in winter survival of residents and migrants. Since migratory American dippers have lower productivity and slightly lower survival than residents our data suggests that partial migration is likely an outcome of competition for limited nest sites at low elevations, with less competitive individuals being forced to migrate to higher elevations in order to breed.

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.

Restricting resident work hours: the good, the bad, and the ugly.

PubMed

Peets, Adam; Ayas, Najib T

2012-03-01

Inadequate sleep and long work hours are long-standing traditions in the medical profession, and work schedules are especially intense in resident physicians. However, it has been increasingly recognized that the extreme hours commonly worked by residents may have substantial occupational and patient safety consequences. Largely because of these concerns, new regulations related to resident work hours came into effect July 2011, in the United States. Residents in their first year of training are now restricted to a maximum shift length of 16 hrs, with residents in subsequent years restricted to a maximum of 24 hrs. The purpose of this review is to summarize the literature regarding resident work hours in the intensive care unit, focusing on the potential positive and negative impacts of work hour limits. The authors electronically searched MEDLINE, manually searched reference lists from retrieved articles, and reviewed their own personal databases for articles relevant to resident work hour limits. To function well, humans, including physicians, require adequate sleep. Resident work hour limits will likely reduce the incidence of fatigue-related medical errors and improve resident safety and quality of life. However, a reduction in work hours may not represent the panacea for patient safety given the potential for increased errors because of discontinuity. Furthermore, there may be other substantial negative impacts, including reduced clinical exposure, erosion of professionalism, and inadequate preparation for independent practice. Costs of implementation are likely to be substantial. Currently, there is fairly limited evidence available, and a more in-depth understanding of this complex topic is required to design a residency experience that will provide the next generation of physicians the best compromise between education, experience, and quality patient care. In the end, the primary goal of the postgraduate medical education system must be to ensure the creation of healthy physicians who can provide excellent clinical care in this complex interdisciplinary medical industry and who will have long fulfilling careers providing this outstanding care to their patients.

The effect of tongue strength on meal consumption in long term care.

PubMed

Namasivayam, Ashwini M; Steele, Catriona M; Keller, Heather

2016-10-01

As many as 74% of residents in long-term care (LTC) are anticipated to have swallowing difficulties (dysphagia). Low food intake is commonly reported in persons with swallowing problems, but food intake may also be affected by fatigue in the swallowing muscles. As fatigue sets in during mealtimes, the strength of the tongue may decline. Tongue strength is also known to decline with age but it is unclear how this functional change may influence food intake. In this pilot study, we explored the relationship between tongue strength and meal consumption in persons not previously diagnosed with dysphagia. The Iowa Oral Performance Instrument was used to collect maximum anterior isometric tongue-palate pressures from 12 LTC residents (5 male; mean age: 85, range 65-99). Residents were also screened for dysphagia with applesauce and a water swallow test. Each resident was observed at three different meals to record the length of time taken to eat the meal, amount of food consumed, and any indication of overt signs of swallowing difficulty (e.g. coughing). Residents who displayed observable swallowing difficulties at mealtimes had significantly lower tongue strength than those without swallowing difficulties (p < 0.01). Those with lower tongue strength took significantly longer to complete meals (p < 0.05) and consumed less food. Tongue strength was not predictive of performance on the water screen and the water swallow test was not a good predictor of which participants were observed to display mealtime difficulties. Among seniors in long term care, reduced tongue strength is associated with longer meal times, reduced food consumption, and the presence of observable signs of swallowing difficulty. Further exploration of these relationships is warranted. Copyright © 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Assessment of radiation exposure from cesium-137 contaminated roads for epidemiological studies in Seoul, Korea

PubMed Central

Lee, Yun-Keun; Ju, Young-Su; Lee, Won Jin; Hwang, Seung Sik; Yim, Sang-Hyuk; Yoo, Sang-Chul; Lee, Jieon; Choi, Kyung-Hwa; Burm, Eunae; Ha, Mina

2015-01-01

Objectives We aimed to assess the radiation exposure for epidemiologic investigation in residents exposed to radiation from roads that were accidentally found to be contaminated with radioactive cesium-137 (137Cs) in Seoul. Methods Using information regarding the frequency and duration of passing via the 137Cs contaminated roads or residing/working near the roads from the questionnaires that were obtained from 8875 residents and the measured radiation doses reported by the Nuclear Safety and Security Commission, we calculated the total cumulative dose of radiation exposure for each person. Results Sixty-three percent of the residents who responded to the questionnaire were considered as ever-exposed and 1% of them had a total cumulative dose of more than 10 mSv. The mean (minimum, maximum) duration of radiation exposure was 4.75 years (0.08, 11.98) and the geometric mean (minimum, maximum) of the total cumulative dose was 0.049 mSv (<0.001, 35.35) in the exposed. Conclusions An individual exposure assessment was performed for an epidemiological study to estimate the health risk among residents living in the vicinity of 137Cs contaminated roads. The average exposure dose in the exposed people was less than 5% of the current guideline. PMID:26184047

Effectiveness of a Low-Cost Drilling Module in Orthopaedic Surgical Simulation.

PubMed

Ruder, John A; Turvey, Blake; Hsu, Joseph R; Scannell, Brian P

Financial pressures and resident work hour regulations have led to adjunct means of resident education such as surgical simulation. The purpose of this study is to determine the effectiveness of a hands-on training session in orthopaedic drilling technique educational model during a surgical simulation on reducing drill plunging depth and to determine the effectiveness of senior residents teaching a hands-on training session in orthopaedic drilling technique. A total of 13 participants (5 orthopaedic interns and 8 medical students) drilled until they penetrated the far cortex of a synthetic bone model and the plunging depth (PD) was measured. They were then randomized and underwent an education session with an attending orthopaedic surgeon or a senior resident. Next, the subjects drilled again with the PD being calculated. The preeducational and posteducational session were compared to determine if there was any improvement in PD and if there was a difference between educators. The cost of the model was also determined. The mean maximum PD and mean PD before the education session was 1.58 (1.40-2.10) and 1.50cm (1.36-1.76), respectively. Following the educational session, the mean maximum PD and mean PD were 0.53 (0.42-0.75) and 0.50cm (0.40-0.72), respectively. These were both significantly lower than before the education session (p <0.05). After the educational session taught by the attending versus the session taught by the resident, the mean maximum PD was 0.59 (0.42-0.75) and 0.49cm. (0.45-0.75), respectively (p = 0.44). After the educational session taught by the attending versus the session taught by the resident, the mean PD was 0.54 (0.40-0.72) and 0.47cm. (0.40-0.65), respectively (p = 0.44). The cost of the station per participant was $5.44. This study demonstrated a significant reduction in drilling PD with use of a low-cost training model and a formal didactic and skills session on proper drilling technique that can effectively be led by senior residents. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

The Fukushima Health Management Survey: estimation of external doses to residents in Fukushima Prefecture

NASA Astrophysics Data System (ADS)

Ishikawa, Tetsuo; Yasumura, Seiji; Ozasa, Kotaro; Kobashi, Gen; Yasuda, Hiroshi; Miyazaki, Makoto; Akahane, Keiichi; Yonai, Shunsuke; Ohtsuru, Akira; Sakai, Akira; Sakata, Ritsu; Kamiya, Kenji; Abe, Masafumi

2015-08-01

The Fukushima Health Management Survey (including the Basic Survey for external dose estimation and four detailed surveys) was launched after the Fukushima Dai-ichi Nuclear Power Plant accident. The Basic Survey consists of a questionnaire that asks Fukushima Prefecture residents about their behavior in the first four months after the accident; and responses to the questionnaire have been returned from many residents. The individual external doses are estimated by using digitized behavior data and a computer program that included daily gamma ray dose rate maps drawn after the accident. The individual external doses of 421,394 residents for the first four months (excluding radiation workers) had a distribution as follows: 62.0%, <1 mSv 94.0%, <2 mSv 99.4%, <3 mSv. The arithmetic mean and maximum for the individual external doses were 0.8 and 25 mSv, respectively. While most dose estimation studies were based on typical scenarios of evacuation and time spent inside/outside, the Basic Survey estimated doses considering individually different personal behaviors. Thus, doses for some individuals who did not follow typical scenarios could be revealed. Even considering such extreme cases, the estimated external doses were generally low and no discernible increased incidence of radiation-related health effects is expected.

The Fukushima Health Management Survey: estimation of external doses to residents in Fukushima Prefecture

PubMed Central

Ishikawa, Tetsuo; Yasumura, Seiji; Ozasa, Kotaro; Kobashi, Gen; Yasuda, Hiroshi; Miyazaki, Makoto; Akahane, Keiichi; Yonai, Shunsuke; Ohtsuru, Akira; Sakai, Akira; Sakata, Ritsu; Kamiya, Kenji; Abe, Masafumi

2015-01-01

The Fukushima Health Management Survey (including the Basic Survey for external dose estimation and four detailed surveys) was launched after the Fukushima Dai-ichi Nuclear Power Plant accident. The Basic Survey consists of a questionnaire that asks Fukushima Prefecture residents about their behavior in the first four months after the accident; and responses to the questionnaire have been returned from many residents. The individual external doses are estimated by using digitized behavior data and a computer program that included daily gamma ray dose rate maps drawn after the accident. The individual external doses of 421,394 residents for the first four months (excluding radiation workers) had a distribution as follows: 62.0%, <1 mSv; 94.0%, <2 mSv; 99.4%, <3 mSv. The arithmetic mean and maximum for the individual external doses were 0.8 and 25 mSv, respectively. While most dose estimation studies were based on typical scenarios of evacuation and time spent inside/outside, the Basic Survey estimated doses considering individually different personal behaviors. Thus, doses for some individuals who did not follow typical scenarios could be revealed. Even considering such extreme cases, the estimated external doses were generally low and no discernible increased incidence of radiation-related health effects is expected. PMID:26239643

Cardiovascular Surgery Residency Program: Training Coronary Anastomosis Using the Arroyo Simulator and UNIFESP Models.

PubMed

Maluf, Miguel Angel; Gomes, Walter José; Bras, Ademir Massarico; Araújo, Thiago Cavalcante Vila Nova de; Mota, André Lupp; Cardoso, Caio Cesar; Coutinho, Rafael Viana dos S

2015-01-01

Engage the UNIFESP Cardiovascular Surgery residents in coronary anastomosis, assess their skills and certify results, using the Arroyo Anastomosis Simulator and UNIFESP surgical models. First to 6th year residents attended a weekly program of technical training in coronary anastomosis, using 4 simulation models: 1. Arroyo simulator; 2. Dummy with a plastic heart; 3. Dummy with a bovine heart; and 4. Dummy with a beating pig heart. The assessment test was comprised of 10 items, using a scale from 1 to 5 points in each of them, creating a global score of 50 points maximum. The technical performance of the candidate showed improvement in all items, especially manual skill and technical progress, critical sense of the work performed, confidence in the procedure and reduction of the time needed to perform the anastomosis after 12 weeks practice. In response to the multiplicity of factors that currently influence the cardiovascular surgeon training, there have been combined efforts to reform the practices of surgical medical training. 1 - The four models of simulators offer a considerable contribution to the field of cardiovascular surgery, improving the skill and dexterity of the surgeon in training. 2 - Residents have shown interest in training and cooperate in the development of innovative procedures for surgical medical training in the art.

Cardiovascular Surgery Residency Program: Training Coronary Anastomosis Using the Arroyo Simulator and UNIFESP Models

PubMed Central

Maluf, Miguel Angel; Gomes, Walter José; Bras, Ademir Massarico; de Araújo, Thiago Cavalcante Vila Nova; Mota, André Lupp; Cardoso, Caio Cesar; Coutinho, Rafael Viana dos S.

2015-01-01

OBJECTIVE Engage the UNIFESP Cardiovascular Surgery residents in coronary anastomosis, assess their skills and certify results, using the Arroyo Anastomosis Simulator and UNIFESP surgical models. METHODS First to 6th year residents attended a weekly program of technical training in coronary anastomosis, using 4 simulation models: 1. Arroyo simulator; 2. Dummy with a plastic heart; 3. Dummy with a bovine heart; and 4. Dummy with a beating pig heart. The assessment test was comprised of 10 items, using a scale from 1 to 5 points in each of them, creating a global score of 50 points maximum. RESULTS The technical performance of the candidate showed improvement in all items, especially manual skill and technical progress, critical sense of the work performed, confidence in the procedure and reduction of the time needed to perform the anastomosis after 12 weeks practice. In response to the multiplicity of factors that currently influence the cardiovascular surgeon training, there have been combined efforts to reform the practices of surgical medical training. CONCLUSION 1 - The four models of simulators offer a considerable contribution to the field of cardiovascular surgery, improving the skill and dexterity of the surgeon in training. 2 - Residents have shown interest in training and cooperate in the development of innovative procedures for surgical medical training in the art. PMID:26735604

A comparison of weather variables linked to infectious disease patterns using laboratory addresses and patient residence addresses.

PubMed

Djennad, Abdelmajid; Lo Iacono, Giovanni; Sarran, Christophe; Fleming, Lora E; Kessel, Anthony; Haines, Andy; Nichols, Gordon L

2018-04-27

To understand the impact of weather on infectious diseases, information on weather parameters at patient locations is needed, but this is not always accessible due to confidentiality or data availability. Weather parameters at nearby locations are often used as a proxy, but the accuracy of this practice is not known. Daily Campylobacter and Cryptosporidium cases across England and Wales were linked to local temperature and rainfall at the residence postcodes of the patients and at the corresponding postcodes of the laboratory where the patient's specimen was tested. The paired values of daily rainfall and temperature for the laboratory versus residence postcodes were interpolated from weather station data, and the results were analysed for agreement using linear regression. We also assessed potential dependency of the findings on the relative geographic distance between the patient's residence and the laboratory. There was significant and strong agreement between the daily values of rainfall and temperature at diagnostic laboratories with the values at the patient residence postcodes for samples containing the pathogens Campylobacter or Cryptosporidium. For rainfall, the R-squared was 0.96 for the former and 0.97 for the latter, and for maximum daily temperature, the R-squared was 0.99 for both. The overall mean distance between the patient residence and the laboratory was 11.9 km; however, the distribution of these distances exhibited a heavy tail, with some rare situations where the distance between the patient residence and the laboratory was larger than 500 km. These large distances impact the distributions of the weather variable discrepancies (i.e. the differences between weather parameters estimated at patient residence postcodes and those at laboratory postcodes), with discrepancies up to ±10 °C for the minimum and maximum temperature and 20 mm for rainfall. Nevertheless, the distributions of discrepancies (estimated separately for minimum and maximum temperature and rainfall), based on the cases where the distance between the patient residence and the laboratory was within 20 km, still exhibited tails somewhat longer than the corresponding exponential fits suggesting modest small scale variations in temperature and rainfall. The findings confirm that, for the purposes of studying the relationships between meteorological variables and infectious diseases using data based on laboratory postcodes, the weather results are sufficiently similar to justify the use of laboratory postcode as a surrogate for domestic postcode. Exclusion of the small percentage of cases where there is a large distance between the residence and the laboratory could increase the precision of estimates, but there are generally strong associations between daily weather parameters at residence and laboratory.

The Relationship of Endoscopic Proficiency to Educational Expense for Virtual Reality Simulator Training Amongst Surgical Trainees.

PubMed

Raque, Jessica; Goble, Adam; Jones, Veronica M; Waldman, Lindsey E; Sutton, Erica

2015-07-01

With the introduction of Fundamentals of Endoscopic Surgery, training methods in flexible endoscopy are being augmented with simulation-based curricula. The investment for virtual reality simulators warrants further research into its training advantage. Trainees were randomized into bedside or simulator training groups (BED vs SIM). SIM participated in a proficiency-based virtual reality curriculum. Trainees' endoscopic skills were rated using the Global Assessment of Gastrointestinal Endoscopic Skills (GAGES) in the patient care setting. The number of cases to reach 90 per cent of the maximum GAGES score and calculated costs of training were compared. Nineteen residents participated in the study. There was no difference in the average number of cases required to achieve 90 per cent of the maximum GAGES score for esophagogastroduodenoscopy, 13 (SIM) versus11 (BED) (P = 0.63), or colonoscopy 21 (SIM) versus 4 (BED) (P = 0.34). The average per case cost of training for esophagogastroduodenoscopy was $35.98 (SIM) versus $39.71 (BED) (P = 0.50), not including the depreciation costs associated with the simulator ($715.00 per resident over six years). Use of a simulator appeared to increase the cost of training without accelerating the learning curve or decreasing faculty time spent in instruction. The importance of simulation in endoscopy training will be predicated on more cost-effective simulators.

Synthetic Modeling of Autonomous Learning with a Chaotic Neural Network

NASA Astrophysics Data System (ADS)

Funabashi, Masatoshi

We investigate the possible role of intermittent chaotic dynamics called chaotic itinerancy, in interaction with nonsupervised learnings that reinforce and weaken the neural connection depending on the dynamics itself. We first performed hierarchical stability analysis of the Chaotic Neural Network model (CNN) according to the structure of invariant subspaces. Irregular transition between two attractor ruins with positive maximum Lyapunov exponent was triggered by the blowout bifurcation of the attractor spaces, and was associated with riddled basins structure. We secondly modeled two autonomous learnings, Hebbian learning and spike-timing-dependent plasticity (STDP) rule, and simulated the effect on the chaotic itinerancy state of CNN. Hebbian learning increased the residence time on attractor ruins, and produced novel attractors in the minimum higher-dimensional subspace. It also augmented the neuronal synchrony and established the uniform modularity in chaotic itinerancy. STDP rule reduced the residence time on attractor ruins, and brought a wide range of periodicity in emerged attractors, possibly including strange attractors. Both learning rules selectively destroyed and preserved the specific invariant subspaces, depending on the neuron synchrony of the subspace where the orbits are situated. Computational rationale of the autonomous learning is discussed in connectionist perspective.

Policy and Management Issues Surrounding the Development of an Alzheimer's Unit in a Long Term Care Facility.

ERIC Educational Resources Information Center

Monahan, Felicia

A special unit within a nursing home for serving residents with dementia was developed and implemented at the Cape Cod Nursing Home in Buzzards Bay, Massachusetts. The purpose of the special unit is to create a structured and protective environment which holistically supports the residents with dementia in achieving their maximum potential. A…

Geomorphic controls on floodplain organic carbon storage in sediment along five rivers in interior Alaska

NASA Astrophysics Data System (ADS)

Lininger, K.; Wohl, E.; Rose, J. R.

2016-12-01

High latitude permafrost regions contain large amounts of organic carbon (OC) in the subsurface, but little work has quantified OC storage in floodplain sediment in the high latitudes. Floodplains influence the export of OC to the ocean by temporarily storing OC at timescales of 101 to 103 years. To fully understand terrestrial carbon cycling, the storage and residence time of OC in floodplains, and the geomorphic controls on OC storage, must be taken into account. Small-scale spatial variations in OC storage within floodplains likely reflect geomorphic processes of deposition and floodplain development. We present results of floodplain OC storage and residence time in sediment along 5 rivers in the Yukon Flats National Wildlife Refuge in interior Alaska, a region with discontinuous permafrost. We collected sediment samples within the active layer along tributaries to the Yukon River and the mainstem Yukon River and analyzed the sediment samples for OC content. We classified sample locations by geomorphic type (filled secondary channels, levees, point bars) and vegetation type (herbaceous, deciduous/shrub, white spruce, and black spruce wetlands), and found that both geomorphology and vegetation influence OC concentration and OC mass per area. Preliminary results suggest that filled secondary channels contain more OC per area compared to other geomorphic types. We present results of radiocarbon dates from river cutbanks associated with our sampling sites, which give a maximum age for residence times of OC in sediment before erosion and transport. The radiocarbon dates also provide estimates of long-term OC accretion within the Yukon Flats floodplains. Small-scale variations within floodplains as a result of floodplain depositional processes and vegetation communities shed light on the geomorphic controls on OC storage. This work will help constrain the spatial variation in OC storage and OC residence time across the landscape in a region experiencing rapid climate change and permafrost thaw.

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.

Electromagnetic Smart Valves for Cryogenic Applications

NASA Astrophysics Data System (ADS)

Traum, M. J.; Smith, J. L.; Brisson, J. G.; Gerstmann, J.; Hannon, C. L.

2004-06-01

Electromagnetic valves with smart control capability have been developed and demonstrated for use in the cold end of a Collins-style cryocooler. The toroidal geometry of the valves was developed utilizing a finite-element code and optimized for maximum opening force with minimum input current. Electromagnetic smart valves carry two primary benefits in cryogenic applications: 1) magnetic actuation eliminates the need for mechanical linkages and 2) valve timing can be modified during system cool down and in regular operation for cycle optimization. The smart feature of these electromagnetic valves resides in controlling the flow of current into the magnetic coil. Electronics have been designed to shape the valve actuation current, limiting the residence time of magnetic energy in the winding. This feature allows control of flow through the expander via an electrical signal while dissipating less than 0.0071 J/cycle as heat into the cold end. The electromagnetic smart valves have demonstrated reliable, controllable dynamic cycling. After 40 hours of operation, they suffered no perceptible mechanical degradation. These features enable the development of a miniaturized Collins-style cryocooler capable of removing 1 Watt of heat at 10 K.

Cultivation of Chlorella protothecoides with urban wastewater in continuous photobioreactor: biomass productivity and nutrient removal.

PubMed

Ramos Tercero, E A; Sforza, E; Morandini, M; Bertucco, A

2014-02-01

The capability to grow microalgae in nonsterilized wastewater is essential for an application of this technology in an actual industrial process. Batch experiments were carried out with the species in nonsterilized urban wastewater from local treatment plants to measure both the algal growth and the nutrient consumption. Chlorella protothecoides showed a high specific growth rate (about 1 day(-1)), and no effects of bacterial contamination were observed. Then, this microalgae was grown in a continuous photobioreactor with CO₂-air aeration in order to verify the feasibility of an integrated process of the removal of nutrient from real wastewaters. Different residence times were tested, and biomass productivity and nutrients removal were measured. A maximum of microalgae productivity was found at around 0.8 day of residence time in agreement with theoretical expectation in the case of light-limited cultures. In addition, N-NH₄ and P-PO₄ removal rates were determined in order to model the kinetic of nutrients uptake. Results from batch and continuous experiments were used to propose an integrated process scheme of wastewater treatment at industrial scale including a section with C. protothecoides.

Pharmacokinetics of tilmicosin in equine tissues and plasma.

PubMed

Clark, C; Dowling, P M; Ross, S; Woodbury, M; Boison, J O

2008-02-01

The macrolide antibiotic tilmicosin has potential for treating bacterial respiratory tract infections in horses. A pharmacokinetic study evaluated the disposition of tilmicosin in the horse after oral (4 mg/kg) or subcutaneous (s.c.) (10 mg/kg) administration. Tilmicosin was not detected in equine plasma or tissues after oral administration at this dose. With s.c. injection, tilmicosin concentrations reached a maximum concentration of approximately 200 ng/mL in the plasma of the horses. Tilmicosin concentrations in plasma persisted with a mean residence time (MRT) of 19 h. Maximum tissue residue concentrations (C(max)) of tilmicosin measured in equine lung, kidney, liver and muscle tissues after s.c. administration were 2784, 4877, 1398, and 881 ng/g, respectively. The MRT of tilmicosin in these tissues was approximately 27 h. Subcutaneous administration of tilmicosin resulted in severe reactions at the injection sites.

Variations in population exposure and evacuation potential to multiple tsunami evacuation phases on Alameda and Bay Farm Islands, California

NASA Astrophysics Data System (ADS)

Peters, J.

2015-12-01

Planning for a tsunami evacuation is challenging for California communities due to the variety of earthquake sources that could generate a tsunami. A maximum tsunami inundation zone is currently the basis for all tsunami evacuations in California, although an Evacuation Playbook consisting of specific event-based evacuation phases relating to flooding severity is in development. We chose to investigate the Evacuation Playbook approach for the island community of Alameda, CA since past reports estimated a significant difference in numbers of residents in the maximum inundation zone when compared to an event-based inundation zone. In order to recognize variations in the types of residents and businesses within each phase, a population exposure analysis was conducted for each of the four Alameda evacuation phases. A pedestrian evacuation analysis using an anisotropic, path distance model was also conducted to understand the time it would take for populations to reach high ground by foot. Initial results suggest that the two islands of the City of Alameda have different situations when it comes to the four tsunami evacuation phases. Pedestrian evacuation results suggest that Bay Farm Island would have more success evacuating by vehicle due to limited nearby high ground for pedestrians to reach safety. Therefore, agent-based traffic simulation software was used to model vehicle evacuation off Bay Farm Island. Initial results show that Alameda Island could face challenges evacuating numerous boat docks and a large beach for phases 1 and 2, whereas Bay Farm Island is unaffected at these phases but might be challenged with evacuating by vehicle for phases 3 and maximum due to congestion on limited egress routes. A better understanding of the population exposure within each tsunami Evacuation Playbook phase and the time it would take to evacuate out of each phase by foot or vehicle will help emergency managers implement the evacuation phases during an actual tsunami event.

Longevity records and survival estimate of birds in a Guatemala rain forest

USGS Publications Warehouse

Robbins, C.S.; Dowell, B.; Hines, J.

2002-01-01

Birds were mist-netted for ten consecutive 'winter' seasons at two sites on Cerro San Gil and for three to nine seasons at eight other sites on the mountain. Sixteen nets were used at each site for three days; net locations were the same each year. From 1,255 subsequent-year recaptures we computed annual survival using the program MARK. A low annual survival of 0.26+0.03 for Long-tailed Hermit probably reflects extensive wandering in search of food. The only other residents with low survival rates were Ochre-bellied Flycatcher (0.32) and Olive-backed Euphonia (0.38). Other residents tested ranged from 0.49 for Red-capped Manakin to 0.67 for Stub-tailed Spadebill and are within ranges reported from other tropical sites. Rates for migrants were lower, ranging from 0.33 (Worm-eating Warbler) to 0.45 (Kentucky Warbler). Limiting the analysis to known territorial adults (birds that had already returned from a previous year), raised survival rates for residents an average of 0.05, whereas rates for wintering migratory species remained unchanged. The oldest birds recaptured were all residents: Scalythroated Leaftosser (9 years 9 months), Tawny-winged and Wedge-billed Woodcreepers, Northern Bentbill, Tawny-crowned Greenlet, and White-breasted Woodwren (8 years 9 months each). Ages over three years nine months were recorded for 46 species; for the majority of these, new maximum age records were established. A positive relationship was found between survival rate and maximum age and between sample size and maximum age

Analysis of gunshot residues as trace in nasal mucus by GFAAS.

PubMed

Aliste, Marina; Chávez, Luis Guillermo

2016-04-01

When a gun is fired, the majority of gunshot residues are deposited on the shooter's hands. But these residues disappear through contact with surfaces or washing. Therefore, the maximum time frame to find GSR on a suspect's hands is 8h. The mucus, inside of a nostril, forms a surface layer where they are trapped foreign particles. In this way, mucus inside of a gunshot suspect's nostrils could act like an adhesive medium to stick on it gaseous particles from a gunshot. In this study, the presence of GSR in nasal mucus and its residence time is examined. A new procedure for the sampling of possible gunshot residue accumulated in the nasal mucus is designed. Samples are taken with cotton swabs moistened with a solution of EDTA and, after an acid digestion, are analysed by graphite furnace atomic absorption spectrometry. In addition, samples of hands are taken for comparison purposes. GSR recovery has been successful. The concentration of GSR in nasal mucus is found to be lower than on the hands, but with a longer residence time. Thus, it is possible to expand the sampling time of a suspect also, as nasal mucus cannot be contaminated by handling weapons. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The Aerodynamic and Dynamic Loading of a Slender Structure by an Impacting Tornado-Like Vortex: The Influence of Relative Vortex-to-Structure Size on Structural Loading

NASA Astrophysics Data System (ADS)

Strasser, Matthew N.

Structural loading produced by an impacting vortex is a hazardous phenomenon that is encountered in numerous applications ranging from the destruction of residences by tornados to the chopping of tip vortices by rotors. Adequate design of structures to resist vortex-induced structural loading necessitates study of the phenomenon that control the structural loading produced by an impacting vortex. This body of work extends the current knowledge base of vortex-structure interaction by evaluating the influence of the relative vortex-to-structure size on the structural loading that the vortex produces. A computer model is utilized to directly simulate the two-dimensional impact of an impinging vortex with a slender, cylindrical structure. The vortex's tangential velocity profile (TVP) is defined by a normalization of the Vatistas analytical (TVP) which realistically replicates the documented spectrum of measured vortex TVPs. The impinging vortex's maximum tangential velocity is fixed, and the vortex's critical radius is incremented from one to one-hundred times the structure's diameter. When the impinging vortex is small, it interacts with vortices produced on the structure by the free stream, and maximum force coefficient amplitudes vary by more than 400% when the impinging vortex impacts the structure at different times. Maximum drag and lift force coefficient amplitudes reach asymptotic values as the impinging vortex's size increases that are respectively 94.77% and 10.66% less than maximum force coefficients produced by an equivalent maximum velocity free stream. The vortex produces maximum structural loading when its path is shifted above the structure's centerline, and maximum drag and lift force coefficients are respectively up to 4.80% and 34.07% greater than maximum force coefficients produced by an equivalent-velocity free stream. Finally, the dynamic load factor (DLF) concept is used to develop a generalized methodology to assess the dynamic amplification of a structure's response to vortex loading and to assess the dynamic loading threat that tornados pose. Typical civil and residential structures will not experience significant response amplification, but responses of very flexible structures may be amplified by up to 2.88 times.

NIRS external dose estimation system for Fukushima residents after the Fukushima Dai-ichi NPP accident

NASA Astrophysics Data System (ADS)

Akahane, Keiichi; Yonai, Shunsuke; Fukuda, Shigekazu; Miyahara, Nobuyuki; Yasuda, Hiroshi; Iwaoka, Kazuki; Matsumoto, Masaki; Fukumura, Akifumi; Akashi, Makoto

2013-04-01

The great east Japan earthquake and subsequent tsunamis caused Fukushima Dai-ichi Nuclear Power Plant (NPP) accident. National Institute of Radiological Sciences (NIRS) developed the external dose estimation system for Fukushima residents. The system is being used in the Fukushima health management survey. The doses can be obtained by superimposing the behavior data of the residents on the dose rate maps. For grasping the doses, 18 evacuation patterns of the residents were assumed by considering the actual evacuation information before using the survey data. The doses of the residents from the deliberate evacuation area were relatively higher than those from the area within 20 km radius. The estimated doses varied from around 1 to 6 mSv for the residents evacuated from the representative places in the deliberate evacuation area. The maximum dose in 18 evacuation patterns was estimated to be 19 mSv.

NIRS external dose estimation system for Fukushima residents after the Fukushima Dai-ichi NPP accident.

PubMed

Akahane, Keiichi; Yonai, Shunsuke; Fukuda, Shigekazu; Miyahara, Nobuyuki; Yasuda, Hiroshi; Iwaoka, Kazuki; Matsumoto, Masaki; Fukumura, Akifumi; Akashi, Makoto

2013-01-01

The great east Japan earthquake and subsequent tsunamis caused Fukushima Dai-ichi Nuclear Power Plant (NPP) accident. National Institute of Radiological Sciences (NIRS) developed the external dose estimation system for Fukushima residents. The system is being used in the Fukushima health management survey. The doses can be obtained by superimposing the behavior data of the residents on the dose rate maps. For grasping the doses, 18 evacuation patterns of the residents were assumed by considering the actual evacuation information before using the survey data. The doses of the residents from the deliberate evacuation area were relatively higher than those from the area within 20 km radius. The estimated doses varied from around 1 to 6 mSv for the residents evacuated from the representative places in the deliberate evacuation area. The maximum dose in 18 evacuation patterns was estimated to be 19 mSv.

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 McGill simulator for endoscopic sinus surgery (MSESS): a validation study.

PubMed

Varshney, Rickul; Frenkiel, Saul; Nguyen, Lily H P; Young, Meredith; Del Maestro, Rolando; Zeitouni, Anthony; Saad, Elias; Funnell, W Robert J; Tewfik, Marc A

2014-10-24

Endoscopic sinus surgery (ESS) is a technically challenging procedure, associated with a significant risk of complications. Virtual reality simulation has demonstrated benefit in many disciplines as an important educational tool for surgical training. Within the field of rhinology, there is a lack of ESS simulators with appropriate validity evidence supporting their integration into residency education. The objectives of this study are to evaluate the acceptability, perceived realism and benefit of the McGill Simulator for Endoscopic Sinus Surgery (MSESS) among medical students, otolaryngology residents and faculty, and to present evidence supporting its ability to differentiate users based on their level of training through the performance metrics. 10 medical students, 10 junior residents, 10 senior residents and 3 expert sinus surgeons performed anterior ethmoidectomies, posterior ethmoidectomies and wide sphenoidotomies on the MSESS. Performance metrics related to quality (e.g. percentage of tissue removed), efficiency (e.g. time, path length, bimanual dexterity, etc.) and safety (e.g. contact with no-go zones, maximum applied force, etc.) were calculated. All users completed a post-simulation questionnaire related to realism, usefulness and perceived benefits of training on the MSESS. The MSESS was found to be realistic and useful for training surgical skills with scores of 7.97 ± 0.29 and 8.57 ± 0.69, respectively on a 10-point rating scale. Most students and residents (29/30) believed that it should be incorporated into their curriculum. There were significant differences between novice surgeons (10 medical students and 10 junior residents) and senior surgeons (10 senior residents and 3 sinus surgeons) in performance metrics related to quality (p < 0.05), efficiency (p < 0.01) and safety (p < 0.05). The MSESS demonstrated initial evidence supporting its use for residency education. This simulator may be a potential resource to help fill the void in endoscopic sinus surgery training.

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.

Awareness and knowledge of clinical practice guidelines for CKD among internal medicine residents: a national online survey.

PubMed

Agrawal, Varun; Ghosh, Amit K; Barnes, Michael A; McCullough, Peter A

2008-12-01

The National Kidney Foundation published Kidney Disease Outcomes Quality Initiative guidelines that recommend early detection and management of chronic kidney disease (CKD) and timely referral to a nephrologist. Many patients with CKD are seen by primary care physicians who are less experienced than nephrologists to offer optimal pre-end-stage renal disease care. It is not known whether current postgraduate training adequately prepares a future internist in CKD management. Cross-sectional study using an online questionnaire survey. Internal medicine residents in the United States (n = 479) with postgraduate year (PGY) distribution of 166 PGY1, 187 PGY2, and 126 PGY3. Awareness and knowledge of CKD clinical practice guidelines measured by using the questionnaire instrument. Total performance score (maximum = 30). Half the residents did not know that the presence of kidney damage (proteinuria) for 3 or more months defines CKD. One-third of the residents did not know the staging of CKD. All residents (99%) knew the traditional risk factors for CKD of diabetes and hypertension, but were less aware of other risk factors of obesity (38%), elderly age (71%), and African American race (68%). Most residents (87%) were aware of estimated glomerular filtration rate in the evaluation of patients with CKD. Most residents (90%) knew goal blood pressure (<130/80 mm Hg) for patients with CKD. Most residents identified anemia (91%) and bone disorder (82%) as complications of CKD, but only half recognized CKD as a risk factor for cardiovascular disease. Most residents (90%) chose to refer a patient with a glomerular filtration rate less than 30 mL/min/1.73 m(2) to a nephrologist. A small improvement in mean performance score was observed with increasing PGY (PGY1, 68.8% +/- 15.4%; PGY2, 72.9% +/- 14.7%; and PGY3, 74.0% +/- 12.0%; P = 0.004). Self-selection, lack of nonrespondent data. Our survey identified specific gaps in knowledge of CKD guidelines in internal medicine residents. Educational efforts in increasing awareness of these guidelines may improve CKD management and clinical outcomes.

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

Optimisation of Croton gratissimus Oil Extraction by n-Hexane and Ethyl Acetate Using Response Surface Methodology.

PubMed

Jiyane, Phiwe Charles; Tumba, Kaniki; Musonge, Paul

2018-04-01

The extraction of oil from Croton gratissimus seeds was studied using the three-factor five-level full-factorial central composite rotatable design (CCRD) of the response surface methodology (RSM). The effect of the three factors selected, viz., extraction time, extraction temperature and solvent-to-feed ratio on the extraction oil yield was investigated when n-hexane and ethyl acetate were used as extraction solvents. The coefficients of determination (R 2 ) of the models developed were 0.98 for n-hexane extraction and 0.97 for ethyl acetate extraction. These results demonstrated that the models developed adequately represented the processes they described. From the optimized model, maximum extraction yield obtained from n-hexane and ethyl acetate extraction were 23.88% and 23.25%, respectively. In both cases the extraction temperature and solvent-to-feed ratio were 35°C and 5 mL/g, respectively. In n-hexane extraction the maximum conditions were reached only after 6 min whereas in ethyl acetate extraction it took 20 min to get the maximum extraction oil yield. Oil extraction of Croton gratissimus seeds, in this work, favoured the use of n-hexane as an extraction solvent as it offered higher oil yields at low temperatures and reduced residence times.

Pharmacokinetics and distribution of ceftazidime to milk after intravenous and intramuscular administration to lactating female dromedary camels (Camelus dromedarius).

PubMed

Goudah, Ayman M; Hasabelnaby, Sherifa M

2013-08-01

To determine the plasma disposition kinetics, absolute bioavailability, and milk concentrations of ceftazidime in healthy lactating female dromedary camels (Camelus dromedarius) following IV and IM administration of a single dose of 10 mg/kg (4.5 mg/lb). Prospective crossover study. 8 healthy adult lactating female dromedary camels. Camels received ceftazidime (10 mg/kg) IV and IM in a crossover study design with a 15-day washout period between treatments. Plasma and milk samples were collected at predetermined times for 48 hours after drug administration and analyzed by use of high-performance liquid chromatography. A 2-compartment open model best represented the plasma concentration-versus-time data after IV and IM administration of ceftazidime to camels. Plasma ceftazidime concentrations decreased biexponentially after IV administration with mean distribution and elimination half-lives of 0.3 hours and 2.85 hours, respectively. After IM administration, the mean maximum plasma concentration of ceftazidime was 32.43 μg/mL (1.21 hours after administration), mean elimination half-life was 3.20 hours, mean residence time was 4.84 hours, and mean systemic bioavailability was 93.72%. Distribution of ceftazidime from plasma to milk was rapid and extensive as indicated by the ratio of the area under the milk concentration-versus-time curve to the area under the plasma concentration-versus-time curve and the ratio of the maximum milk concentration to the maximum plasma concentration of ceftazidime after IV and IM administration. Results suggested that ceftazidime may be a useful treatment for female camels with mastitis caused by susceptible microorganisms.

Initial hydrologic and geomorphic response following a wildfire in the Colorado front range

USGS Publications Warehouse

Moody, J.A.; Martin, D.A.

2001-01-01

A wildfire in May 1996 burned 4690 hectares in two watersheds forested by ponderosa pine and Douglas fir in a steep, mountainous landscape with a summer, convective thunderstorm precipitation regime. The wildfire lowered the erosion threshold in the watersheds, and consequently amplified the subsequent erosional response to shorter time interval episodic rainfall and created both erosional and depositional features in a complex pattern throughout the watersheds. The initial response during the first four years was an increase in runoff and erosion rates followed by decreases toward pre-fire rates. The maximum unit-area peak discharge was 24 m3 s-1 km-2 for a rainstorm in 1996 with a rain intensity of 90 mm h-1. Recovery to pre-fire conditions seems to have occured by 2000 because for a maximum 30-min rainfall intensity of 50 mm h-1, the unit-area peak discharge in 1997 was 6.6 m3 s-1 km-2, while in 2000 a similar intensity produced only 0.11 m3 s-1 km-2. Rill erosion accounted for 6 per cent, interrill erosion for 14 per cent, and drainage erosion for 80 per cent of the initial erosion in 1996. This represents about a 200-fold increase in erosion rates on hillslopes which had a recovery or relaxation time of about three years. About 67 per cent of the initially eroded sediment is still stored in the watersheds after four years with an estimated residence time greater than 300 years. This residence time is much greater than the fire recurrence interval so erosional and depositional features may become legacies from the wildfire and may affect landscape evolution by acting as a new set of initial conditions for subsequent wildfire and flood sequences. Published in 2001 by John Wiley and Sons, Ltd.

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.

Understanding the diurnal cycle in fluvial dissolved organic carbon - The interplay of in-stream residence time, day length and organic matter turnover

NASA Astrophysics Data System (ADS)

Worrall, F.; Howden, N. J. K.; Burt, T. P.

2015-04-01

There is increasing interest in characterising the diurnal fluctuation of stream solute concentrations because observed data series derived from spot samples may be highly subjective if such diurnal fluctuations are large. This can therefore lead to large uncertainties, bias or systematic errors in calculation of fluvial solute fluxes, depending upon the particular sampling regime. A simplistic approach would be to assume diurnal fluctuations are constant throughout the water year, but this study proposes diurnal cycles in stream water quality can only be interpreted in the context of stream residence time and changing day length. Three years of hourly dissolved organic carbon (DOC) concentration and flow data from the River Dee catchment (1674 km2) were analysed, and statistical analysis of the entire record shows there is no consistent diurnal cycle in the record. From the 3-year record (1095 days) there were only 96 diurnal cycles could be analysed. Cycles were quantified in terms of their: relative and absolute amplitude; duration; time to maximum concentration; asymmetry; percentile flow and in-stream residence time. The median diurnal cycle showed an amplitude that was 9.2% of the starting concentration; it was not significantly asymmetric; and occurred at the 19th percentile flow. The median DOC removal rate was 0.07 mg C/l/hr with an inter-quartile range of 0.052-0.100 mg C/l/hr. Results were interpreted as controlled by two, separate, zero-order kinetic rate laws, one for the day and one for the night. There was no single diurnal cycle present across the record, rather a number of different cycles controlled by the combination of in-stream residence time and exposure to contrasting light conditions. Over the 3-year period the average in-stream loss of DOC was 32%. The diurnal cycles evident in high resolution DOC data are interpretable, but require contextual information for their influence on in-stream processes to be understood or for them to be utilised.

National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training.

PubMed

Bilimoria, Karl Y; Chung, Jeanette W; Hedges, Larry V; Dahlke, Allison R; Love, Remi; Cohen, Mark E; Hoyt, David B; Yang, Anthony D; Tarpley, John L; Mellinger, John D; Mahvi, David M; Kelz, Rachel R; Ko, Clifford Y; Odell, David D; Stulberg, Jonah J; Lewis, Frank R

2016-02-25

Concerns persist regarding the effect of current surgical resident duty-hour policies on patient outcomes, resident education, and resident well-being. We conducted a national, cluster-randomized, pragmatic, noninferiority trial involving 117 general surgery residency programs in the United States (2014-2015 academic year). Programs were randomly assigned to current Accreditation Council for Graduate Medical Education (ACGME) duty-hour policies (standard-policy group) or more flexible policies that waived rules on maximum shift lengths and time off between shifts (flexible-policy group). Outcomes included the 30-day rate of postoperative death or serious complications (primary outcome), other postoperative complications, and resident perceptions and satisfaction regarding their well-being, education, and patient care. In an analysis of data from 138,691 patients, flexible, less-restrictive duty-hour policies were not associated with an increased rate of death or serious complications (9.1% in the flexible-policy group and 9.0% in the standard-policy group, P=0.92; unadjusted odds ratio for the flexible-policy group, 0.96; 92% confidence interval, 0.87 to 1.06; P=0.44; noninferiority criteria satisfied) or of any secondary postoperative outcomes studied. Among 4330 residents, those in programs assigned to flexible policies did not report significantly greater dissatisfaction with overall education quality (11.0% in the flexible-policy group and 10.7% in the standard-policy group, P=0.86) or well-being (14.9% and 12.0%, respectively; P=0.10). Residents under flexible policies were less likely than those under standard policies to perceive negative effects of duty-hour policies on multiple aspects of patient safety, continuity of care, professionalism, and resident education but were more likely to perceive negative effects on personal activities. There were no significant differences between study groups in resident-reported perception of the effect of fatigue on personal or patient safety. Residents in the flexible-policy group were less likely than those in the standard-policy group to report leaving during an operation (7.0% vs. 13.2%, P<0.001) or handing off active patient issues (32.0% vs. 46.3%, P<0.001). As compared with standard duty-hour policies, flexible, less-restrictive duty-hour policies for surgical residents were associated with noninferior patient outcomes and no significant difference in residents' satisfaction with overall well-being and education quality. (FIRST ClinicalTrials.gov number, NCT02050789.).

75 FR 60846 - Bureau of Consular Affairs; Registration for the Diversity Immigrant (DV-2012) Visa Program

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-01

... need to submit a photo for a child who is already a U.S. citizen or a Legal Permanent Resident. Group... Joint Photographic Experts Group (JPEG) format; it must have a maximum image file size of two hundred... (dpi); the image file format in Joint Photographic Experts Group (JPEG) format; the maximum image file...

Spatial generalised linear mixed models based on distances.

PubMed

Melo, Oscar O; Mateu, Jorge; Melo, Carlos E

2016-10-01

Risk models derived from environmental data have been widely shown to be effective in delineating geographical areas of risk because they are intuitively easy to understand. We present a new method based on distances, which allows the modelling of continuous and non-continuous random variables through distance-based spatial generalised linear mixed models. The parameters are estimated using Markov chain Monte Carlo maximum likelihood, which is a feasible and a useful technique. The proposed method depends on a detrending step built from continuous or categorical explanatory variables, or a mixture among them, by using an appropriate Euclidean distance. The method is illustrated through the analysis of the variation in the prevalence of Loa loa among a sample of village residents in Cameroon, where the explanatory variables included elevation, together with maximum normalised-difference vegetation index and the standard deviation of normalised-difference vegetation index calculated from repeated satellite scans over time. © The Author(s) 2013.

Multi-step approach to add value to corncob: Production of biomass-degrading enzymes, lignin and fermentable sugars.

PubMed

Michelin, Michele; Ruiz, Héctor A; Polizeli, Maria de Lourdes T M; Teixeira, José A

2018-01-01

This work presents an integrated and multi-step approach for the recovery and/or application of the lignocellulosic fractions from corncob in the production of high value added compounds as xylo-oligosaccharides, enzymes, fermentable sugars, and lignin in terms of biorefinery concept. For that, liquid hot water followed by enzymatic hydrolysis were used. Liquid hot water was performed using different residence times (10-50min) and holding temperature (180-200°C), corresponding to severities (log(R 0 )) of 3.36-4.64. The most severe conditions showed higher xylo-oligosaccharides extraction (maximum of 93%) into the hydrolysates and higher recovery of cellulose on pretreated solids (maximum of 65%). Subsequently, hydrolysates and solids were used in the production of xylanases and cellulases, respectively, as well as, pretreated solids were also subjected to enzymatic hydrolysis for the recovery of lignin and fermentable sugars from cellulose. Maximum glucose yield (100%) was achieved for solids pretreated at log(R 0 ) of 4.42 and 5% solid loading. Copyright © 2017 Elsevier Ltd. All rights reserved.

[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.

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.

An obstetrics and gynaecology graduate residency programme in Venezuela.

PubMed Central

Faneite, P.

1998-01-01

We present our experience on the design and development of a gynaecology and obstetrics graduate residency programme, developed in the Department of Obstetrics and Gynecology at the Dr Adolfo Prince Lara Hospital, Puerto Cabello, Venezuela, in which medical specialists and residents participate synergistically. From January to September 1993, curricular activities were planned and students selected. The programme started in October 1993, with six residents for a three-year programme. Courses were given by medical specialists from the Department. In addition to a Programme Coordinator, there is also a Residents' Coordinator, appointed for a two-month term of office; specific functions were assigned for residents occupying this position. All the programmed activities for three years were accomplished, including lectures and rotations, with an important record of surgical interventions. In our grade system, residents got an average of 18 over a maximum of 20 points. Residents also participated as speakers in workshops, special courses and national medicinal meetings, in which they presented a total of nine papers. Activities were evaluated bimonthly in meetings with students and each semester by the Graduate Committee. The first class graduated in September 1996. Results suggest that resident participation in graduate programmes is an important part of their education. PMID:9538482

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.

Response surface methodology for the optimization of sludge solubilization by ultrasonic pre-treatment

NASA Astrophysics Data System (ADS)

Zheng, Mingyue; Zhang, Xiaohui; Lu, Peng; Cao, Qiguang; Yuan, Yuan; Yue, Mingxing; Fu, Yiwei; Wu, Libin

2018-02-01

The present study examines the optimization of the ultrasonic pre-treatment conditions with response surface experimental design in terms of sludge disintegration efficiency (solubilisation of organic components). Ultrasonic pre-treatment for the maximum solubilization with residual sludge enhanced the SCOD release. Optimization of the ultrasonic pre-treatment was conducted through a Box-Behnken design (three variables, a total of 17 experiments) to determine the effects of three independent variables (power, residence time and TS) on COD solubilization of sludge. The optimal COD was obtained at 17349.4mg/L, when the power was 534.67W, the time was 10.77, and TS was 2%, while the SE of this condition was 28792J/kg TS.

Thyroid doses for evacuees from the Fukushima nuclear accident.

PubMed

Tokonami, Shinji; Hosoda, Masahiro; Akiba, Suminori; Sorimachi, Atsuyuki; Kashiwakura, Ikuo; Balonov, Mikhail

2012-01-01

A primary health concern among residents and evacuees in affected areas immediately after a nuclear accident is the internal exposure of the thyroid to radioiodine, particularly I-131, and subsequent thyroid cancer risk. In Japan, the natural disasters of the earthquake and tsunami in March 2011 destroyed an important function of the Fukushima Daiichi Nuclear Power Plant (F1-NPP) and a large amount of radioactive material was released to the environment. Here we report for the first time extensive measurements of the exposure to I-131 revealing I-131 activity in the thyroid of 46 out of the 62 residents and evacuees measured. The median thyroid equivalent dose was estimated to be 4.2 mSv and 3.5 mSv for children and adults, respectively, much smaller than the mean thyroid dose in the Chernobyl accident (490 mSv in evacuees). Maximum thyroid doses for children and adults were 23 mSv and 33 mSv, respectively.

Thyroid doses for evacuees from the Fukushima nuclear accident

NASA Astrophysics Data System (ADS)

Tokonami, Shinji; Hosoda, Masahiro; Akiba, Suminori; Sorimachi, Atsuyuki; Kashiwakura, Ikuo; Balonov, Mikhail

2012-07-01

A primary health concern among residents and evacuees in affected areas immediately after a nuclear accident is the internal exposure of the thyroid to radioiodine, particularly I-131, and subsequent thyroid cancer risk. In Japan, the natural disasters of the earthquake and tsunami in March 2011 destroyed an important function of the Fukushima Daiichi Nuclear Power Plant (F1-NPP) and a large amount of radioactive material was released to the environment. Here we report for the first time extensive measurements of the exposure to I-131 revealing I-131 activity in the thyroid of 46 out of the 62 residents and evacuees measured. The median thyroid equivalent dose was estimated to be 4.2 mSv and 3.5 mSv for children and adults, respectively, much smaller than the mean thyroid dose in the Chernobyl accident (490 mSv in evacuees). Maximum thyroid doses for children and adults were 23 mSv and 33 mSv, respectively.

Dose Calculation For Accidental Release Of Radioactive Cloud Passing Over Jeddah

NASA Astrophysics Data System (ADS)

Alharbi, N. D.; Mayhoub, A. B.

2011-12-01

For the evaluation of doses after the reactor accident, in particular for the inhalation dose, a thorough knowledge of the concentration of the various radionuclide in air during the passage of the plume is required. In this paper we present an application of the Gaussian Plume Model (GPM) to calculate the atmospheric dispersion and airborne radionuclide concentration resulting from radioactive cloud over the city of Jeddah (KSA). The radioactive cloud is assumed to be emitted from a reactor of 10 MW power in postulated accidental release. Committed effective doses (CEDs) to the public at different distance from the source to the receptor are calculated. The calculations were based on meteorological condition and data of the Jeddah site. These data are: pasquill atmospheric stability is the class B and the wind speed is 2.4m/s at 10m height in the N direction. The residence time of some radionuclides considered in this study were calculated. The results indicate that, the values of doses first increase with distance, reach a maximum value and then gradually decrease. The total dose received by human is estimated by using the estimated values of residence time of each radioactive pollutant at different distances.

Trophic interactions and direct physical effects control phytoplankton biomass and production in an estuary

USGS Publications Warehouse

Alpine, A.E.; Cloern, J.E.

1992-01-01

San Francisco Bay has recently been invaded by the suspension-feeding clam Potamocorbula amurensis. Previous work has shown that phytoplankton biomass in the upper estuary is low (2-3 mg Chl a m-3) during seasonal periods of high river flow and short residence time and it is usually high (peak >30 mg Chl a m-3) during the summer-autumn seasons of low river flow and long residence time. However since P. amurensis became widespread and abundant in 1987, the summer phytoplankton biomass maximum has disappeared, presumably because of increased grazing pressure by this newly introduced species. For 1977-1990, mean estimated primary production was only 39 g C m-2 yr-1 during years when bivalve suspension feeders were abundant (>2000 m-2), compared to 106 g C m-2 yr-1 when bivalves were absent or present in low numbers. These observations support the hypothesis that seasonal and interannual fluctuations in estuarine phytoplankton biomass and primary production can be regulated jointly by direct physical effects (eg river-driven transport) and trophic interactions (episodes of enhanced grazing pressure by immigrant populations of benthic suspension feeders). -from Authors

Transport and fate of nitrate in a glacial outwash aquifer in relation to ground water age, land use practices, and redox processes

USGS Publications Warehouse

Puckett, L.J.; Cowdery, T.K.

2002-01-01

A combination of ground water modeling, chemical and dissolved gas analyses, and chlorofluorocarbon age dating of water was used to determine the relation between changes in agricultural practices, and NO3- concentrations in ground water of a glacial outwash aquifer in west-central Minnesota. The results revealed a redox zonation throughout the saturated zone with oxygen reduction occurring near the water table, NO3- reduction immediately below it, and then a large zone of ferric iron reduction, with a small area of sulfate (SO42-) reduction and methanogenesis (CH4) near the end of the transect. Analytical and NETPATH modeling results supported the hypothesis that organic carbon served as the electron donor for the redox reactions. Denitrification rates were quite small, 0.005 to 0.047 mmol NO3- yr-1, and were limited by the small amounts of organic carbon, 0.01 to 1.45%. In spite of the organic carbon limitation, denitrification was virtually complete because residence time is sufficient to allow even slow processes to reach completion. Ground water sample ages showed that maximum residence times were on the order of 50 to 70 yr. Reconstructed NO3- concentrations, estimated from measured NO3- and dissolved N gas showed that NO3- concentrations have been increasing in the aquifer since the 1940s, and have been above the 714 ??mol L-1 maximum contaminant level at most sites since the mid- to late-1960s. This increase in NO3- has been accompanied by a corresponding increase in agricultural use of fertilizer, identified as the major source of NO3- to the aquifer.

Evaluation of Water Residence Time, Submarine Groundwater Discharge, and Maximum New Production Supported by Groundwater Borne Nutrients in a Coastal Upwelling Shelf System

NASA Astrophysics Data System (ADS)

Luo, Xin; Jiao, Jiu Jimmy; Liu, Yi; Zhang, Xiaolang; Liang, Wenzhao; Tang, Danling

2018-01-01

The biogeochemical processes in the continental shelf systems are usually extensively influenced by coastal upwelling and submarine groundwater discharge (SGD). Using eastern Hainan upwelling shelf system as an example, this study fully investigates SGD and coastal upwelling and their effects on the coastal nutrient loadings to the mixing layer of eastern Hainan shelf. Based on the spatial distributions of 223Ra and 228Ra, water residence time is estimated to be 16.9 ± 8.9 days. Based on the mass balance models of 226Ra and 228Ra, the total SGD of the eastern Hainan shelf is estimated to be 0.8 × 108 and 1.4 × 108 m3 d-1, respectively. The groundwater borne dissolved inorganic nitrogen (DIN) and dissolved inorganic phosphate (DIP) are estimated to be up to 1121.8 and 20.4 μM m2 d-1. The coastal upwelling delivers 2741.8 μM m2 d-1 DIN and 217.7 μM m2 d-1 DIP into the mixing layer, which are predominant in all the exogenous nutrient inputs. The groundwater borne DIN will support a maximum new production of 7.5 mM C m2 d-1, about up to 24.0% of the total new production in the study area. SGD-derived nutrient could be significant as a missing DIN to support the new production in the mixing layer of eastern Hainan shelf. The findings contribute to a better understanding of biogeochemical processes under the influences of SGD and coastal upwelling in the study area and other similar coastal upwelling systems.

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.

Simulation of the effects of different inflows on hydrologic conditions in Lake Houston with a three-dimensional hydrodynamic model, Houston, Texas, 2009–10

USGS Publications Warehouse

Rendon, Samuel H.; Lee, Michael T.

2015-12-08

Lake Houston, an important water resource for the Houston, Texas, area, receives inflows from seven major tributaries that compose the San Jacinto River Basin upstream from the reservoir. The effects of different inflows from the watersheds drained by these tributaries on the residence time of water in Lake Houston and closely associated physical and chemical properties including lake elevation, salinity, and water temperature are not well known. Accordingly, the U.S. Geological Survey (USGS), in cooperation with the City of Houston, developed a three-dimensional hydrodynamic model of Lake Houston as a tool for evaluating the effects of different inflows on residence time of water in the lake and associated physical and chemical properties. The Environmental Fluid Dynamics Code (EFDC), a grid-based, surface-water modeling package for simulating three-dimensional circulation, mass transport, sediments, and biogeochemical processes, was used to develop the model of Lake Houston. The Lake Houston EFDC model was developed and calibrated by using 2009 data and verified by using 2010 data. Three statistics (mean error, root mean square error, and the Nash-Sutcliffe model efficiency coefficient) were used to evaluate how well the Lake Houston EFDC model simulated lake elevation, salinity, and water temperature. The residence time of water in reservoirs is associated with various physical and chemical properties (including lake elevation, salinity, and water temperature). Simulated and measured lake-elevation values were compared at USGS reservoir station 08072000 Lake Houston near Sheldon, Tex. The accuracy of simulated salinity and water temperature values was assessed by using the salinity (computed from measured specific conductance) and water temperature at two USGS monitoring stations: 295826095082200 Lake Houston south Union Pacific Railroad Bridge near Houston, Tex., and 295554095093401 Lake Houston at mouth of Jack’s Ditch near Houston, Tex. Specific conductance and water temperature were measured at as many as four different depths at each of the two monitoring stations during 2009 and then used for assessing the accuracy of simulated values of salinity and water temperature during 2010. The performance evaluation statistics indicate that the model performed satisfactorily. The calibrated model was used to simulate two possible inflow scenarios to evaluate the changes in the residence time of water in Lake Houston. The two scenarios tested were an increased inflow of approximately 300 cubic feet per second for 1 month (May 2010) from two watersheds: the West Fork San Jacinto River and Luce Bayou. These scenarios were chosen to mimic the effects of possible small releases or diversions of water from outside the San Jacinto River Basin into the basin (or directly into the lake) on the residence time of water in Lake Houston. During the time of increased inflow for the two scenarios tested, maximum residence time decreased slightly from approximately 106 to 97 days.

Is the knowledge and attitude of physicians in Nigeria adequate for the diagnosis and management of obstructive sleep apnea?

PubMed

Ozoh, Obianuju B; Ojo, Oluwadamilola O; Iwuala, Sandra O; Akinkugbe, Ayesha O; Desalu, Olufemi O; Okubadejo, Njideka U

2017-05-01

The knowledge and attitude of doctors in Nigeria towards obstructive sleep apnea is not known. We evaluated the level of knowledge and attitude regarding OSA among resident doctors in Internal Medicine and general practitioners in Nigeria. A cross-sectional survey among doctors during continuing medical education programs was conducted. The Obstructive Sleep Apnea Knowledge and Attitude (OSAKA) questionnaire was used to obtain information. Two hundred seventy-three doctors (235 resident doctors and 38 general practitioners) participated in the study. The mean knowledge score was 10.7 ± 2.6 (out of a maximum possible of 18) for all participants corresponding to 59 ± 14.4 % knowledge. There was no significant difference in the mean score of resident doctors (10.8 ± 2.5) compared to general practitioners (10.0 ± 2.8), (t = 2.6, p = 0.10). Over 70 % of the participants wrongly responded that uvuloplasty was an effective treatment and less than 40 % correctly answered that continuous positive airway pressure treatment was first line for severe obstructive sleep apnea. The mean score on the attitude segment was 3.4 ± 0.6 (maximum possible score of 5) for all participants and 3.4 ± 0.6 and 3.3 ± 0.5, respectively, for the residents and the general practitioners (p = 0.47). Increasing age was negatively associated with level of knowledge, while increasing number of years in medical practice and higher level of residency training was positively associated with higher knowledge scores. The knowledge of obstructive sleep apnea among resident doctors and general practitioners in Nigeria is inadequate. There is need to improve training on sleep disorders in Nigeria both at continuing medical education programs and during residency training.

Counteracting 'Not in My Backyard': The Positive Effects of Greater Occupancy within Mutual-help Recovery Homes.

PubMed

Jason, Leonard A; Groh, David R; Durocher, Megan; Alvarez, Josefina; Aase, Darrin M; Ferrari, Joseph R

2008-09-01

Group homes sometimes face significant neighborhood opposition, and municipalities frequently use maximum occupancy laws to close down these homes. This study examined how the number of residents in Oxford House recovery homes impacted residents' outcomes. Larger homes (i.e., 8 or more residents) may reduce the cost per person and offer more opportunities to exchange positive social support, thus, it was predicted that larger Oxford Houses would exhibit improved outcomes compared to smaller homes. Regression analyses using data from 643 residents from 154 U.S. Oxford Houses indicated that larger House size predicted less criminal and aggressive behavior; additionally, length of abstinence was a partial mediator in these relationships. These findings have been used in court cases to argue against closing down larger Oxford Houses. 125 words.

Evaluation of processes occurring in the bottom nepheloid layer (BNL) of an eastern Mediterranean area using 234Th/238U disequilibria.

PubMed

Evangeliou, Nikolaos; Florou, Heleny

2013-09-01

Particle-reactive radionuclide (234)Th and its ratios with the conservative (238)U were used to trace the marine processes occurring over short timescales in the bottom nepheloid layer (BNL) of seven stations in the Saronikos Gulf and the Elefsis Bay (Greece) during three seasons (summer 2008, autumn 2008 and winter 2009). Summer was considered as a steady season where low physical processes occur and stratification is well established, autumn as a commutative period and winter as period of extensive trawling and physical activities. The obtained ratio profiles showed excess of (234)Th relative to (238)U in the BNL of the sampling area during summer, caused by the dissolved fraction of (234)Th. During autumn, the situation was different with large (234)Th deficit throughout the water column leading to large export fluxes of particles from the water column. Finally, during winter the ratios showed that predominant phenomenon in the area was likely resuspension of bottom sediments. The resuspension signature was additionally evaluated by total suspended matter (TSM) inventories in the BNL. Despite the intense resuspension, small scavenging of dissolved (234)Th was recorded in the BNL resulting in high residence times of dissolved (234)Th. A 1 order of magnitude difference between dissolved and particulate (234)Th residence times was observed indicating that scavenging from dissolved to particulate (234)Th could be highly variable and, as a result, the Saronikos Gulf is a highly dynamic environment, in terms of temporal and spatial particle uptake and removal. Comparing these values to literature ones consistent results were obtained. The possibility of sediment resuspension in the BNL during winter was amplified by the bloom of phytoplankton resulting in even decreased residence times of particulate (234)Th (average values). In contrast, the respective residence times of the dissolved fraction of (234)Th in the BNL were higher showing a maximum in winter at the stations where resuspension concluded. Nevertheless, (234)Th cycling in the area is not controlled by TSM, probably due to the presence of colloids, which could play an essential role in (234)Th scavenging.

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.

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.

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...

Determination of crystal residence timescales in magma reservoirs by diffusion modeling of dendritic phosphorus zoning patterns in olivine

NASA Astrophysics Data System (ADS)

Chakraborty, S.; Potrafke, A.

2016-12-01

Deciphering the early stages of crystallization and the chronological evolution of phenocrysts in magma reservoirs is one of the main goals in volcanology. Established approaches that model the concentration evolution of fast diffusing elements like Fe/Mg carry limited information on timescales once the concentration gradients are homogenized. Elements that diffuse more slowly, such as P and Al, become useful in these cases. We present a novel modeling tool that combines high-resolution EMP mapping of slow diffusing phosphorus in olivine with 2D kinetic modeling of the diffusive relaxation of initial chemical zoning pattern of P as well as Fe/Mg. The modeling approach offers a new possibility for determining crystal residence times in magma reservoirs. P diffusion coefficients from the experimental determination of [1] and Fe/Mg diffusion coefficients from [2] were used. The method yields a time-bracket between the minimum time required to homogenize the zoning of fast-diffusing Fe/Mg and the maximum time period for which details of chemical zoning of slow-diffusing P may be retained. To illustrate the approach we have studied the compositional zoning patterns of 7 olivine crystals from Piton de la Fournaise volcano, La Réunion. All crystals show a narrow range of forsterite contents (=Fo82-84) with fully homogenized Fe/Mg distribution, whereas P-mapping reveals oscillatory to dendritic zoning patterns [3]. P concentrations scatter in the range of 0.4 wt-% to below detection limit. Revealed phosphorus zoning patterns were considered to display the initial crystal architecture, whereas Fe and Mg zoning has been wiped out due to faster diffusion. For La Réunion magmas at 1453 K, timescales between few days to weeks were determined to be the time brackets for growth and residence of the olivine crystals in the magmas. These short residence times combined with knowledge of very fast developing dendritic crystals that have recently been revealed worldwide [e.g. 3] indicate that dendritic crystal growth in such rapidly evolving dynamic environments should be considered as a widespread feature of olivine growth and evolution of many basaltic volcanic systems. [1] Watson et al., 2015, Am Min, 100, pp. 2053-2065 [2] Dohmen et al., 2007, Phys Chem Miner, 34(6), pp. 389-407 [3] Welsch et al., 2014, Geology, 42, pp. 867-870

[Chitosan-coated ophthalmic submicro emulsion for pilocarpine nitrate].

PubMed

Wei, Jun; He, Hong-Liang; Zheng, Chun-Li; Zhu, Jia-Bi

2011-08-01

The study is to design chitosan-coated pilocarpine nitrate submicro emulsion (CS-PN/SE) for the development of a novel mucoadhesive submicro emulsion, aiming to prolong the precorneal retention time and improve the ocular absorption. CS-PN/SE was fabricated in two steps: firstly, pilocarpine nitrate submicro emulsion (PN/SE) was prepared by high-speed shear with medium chain triglycerides (MCT) as oil phase and Tween 80 as the main emulsifier, and then incubated with chitosan (CS) acetic solution. The preparation process was optimized by central composite design-response surface methodology. Besides the particle size, zeta potential, entrapment efficiency and micromorphology were investigated, CS-PN/SE's precorneal residence properties and miotic effect were especially studied using New Zealand rabbits as the animal model. When CS-PN/SE was administered topically to rabbit eyes, the ocular clearance and the mean resident time (MRT) of pilocarpine nitrate were found to be dramatically improved (P < 0.05) compared with PN/SE and pilocarpine nitrate solution (PNs), since the K(CS-PN/SE) was declined to 0.006 4 +/- 0.000 3 min(-1) while MRT was prolonged up to 155.4 min. Pharmacodynamics results showed that the maximum miosis of CS-PN/SE was as high as 46.3%, while the miotic response lasted 480 min which is 255 min and 105 min longer than that of PNs and PN/SE, respectively. A larger area under the miotic percentage vs time curve (AUC) of CS-PN/SE was exhibited which is 1.6 folds and 1.2 folds as much as that of PNs and PN/SE, respectively (P < 0.05). Therefore, CS-PN/SE could enhance the duration of action and ocular bioavailability by improving the precorneal residence and ocular absorption significantly.

Amphotericin B liposomes with prolonged circulation in blood: in vitro antifungal activity, toxicity, and efficacy in systemic candidiasis in leukopenic mice.

PubMed Central

van Etten, E W; ten Kate, M T; Stearne, L E; Bakker-Woudenberg, I A

1995-01-01

Pegylated amphotericin B (AmB) liposomes (PEG-AmB-LIP) were compared with laboratory-prepared nonpegylated AmB liposomes (AmB-LIP), a formulation with a lipid composition the same as that in AmBisome, as well as with industrially prepared AmBisome regarding their in vitro antifungal activities, toxicities, blood residence times, and therapeutic efficacies. Killing of Candida albicans (> 99.9%) during short-term (6-h) incubation was observed at 0.2 mg of AmB per liter for AmB desoxycholate, 0.4 mg of AmB per liter for PEG-AmB-LIP, 0.8 mg of AmB per liter for AmB-LIP, and 12.8 mg of AmB per liter for AmBisome. The maximum tolerated doses of PEG-AmB-LIP, AmB-LIP, and AmBisome were 15, 19, and > 31 mg of AmB per kg of body weight, respectively. In contrast to AmB-LIP, the blood residence time of PEG-AmB-LIP was prolonged and dose independent. In a model of systemic candidiasis in leukopenic mice at a dose of 5 mg of AmB per kg, PEG-AmB-LIP was completely effective and AmB-LIP was partially effective, whereas AmBisome was not effective. AmB-LIP at 11 mg of AmB per kg was partially effective. AmBisome at 29 mg of AmB per kg was completely effective. In conclusion, the therapeutic efficacies of AmB liposomes can be improved by preparing AmB liposomes in which a substantial reduction in toxicity is achieved while antifungal activity is retained. In addition, therapeutic efficacy is favored by a prolonged residence time of AmB liposomes in blood. PMID:8540697

32 CFR 101.8 - Reserve training in sovereign foreign nations.

Code of Federal Regulations, 2014 CFR

2014-07-01

... training as they consider appropriate for members of the Reserve components who may be temporarily residing... the maximum extent to augment Defense Attache Offices before the continental United States-based...

32 CFR 101.8 - Reserve training in sovereign foreign nations.

Code of Federal Regulations, 2010 CFR

2010-07-01

... training as they consider appropriate for members of the Reserve components who may be temporarily residing... the maximum extent to augment Defense Attache Offices before the continental United States-based...

32 CFR 101.8 - Reserve training in sovereign foreign nations.

Code of Federal Regulations, 2011 CFR

2011-07-01

... training as they consider appropriate for members of the Reserve components who may be temporarily residing... the maximum extent to augment Defense Attache Offices before the continental United States-based...

32 CFR 101.8 - Reserve training in sovereign foreign nations.

Code of Federal Regulations, 2012 CFR

2012-07-01

... training as they consider appropriate for members of the Reserve components who may be temporarily residing... the maximum extent to augment Defense Attache Offices before the continental United States-based...

32 CFR 101.8 - Reserve training in sovereign foreign nations.

Code of Federal Regulations, 2013 CFR

2013-07-01

... training as they consider appropriate for members of the Reserve components who may be temporarily residing... the maximum extent to augment Defense Attache Offices before the continental United States-based...

Optimal system sizing in grid-connected photovoltaic applications

NASA Astrophysics Data System (ADS)

Simoens, H. M.; Baert, D. H.; de Mey, G.

A costs/benefits analysis for optimizing the combination of photovoltaic (PV) panels, batteries and an inverter for grid interconnected systems at a 500 W/day Belgian residence is presented. It is assumed that some power purchases from the grid will always be necessary, and that excess PV power can be fed into the grid. A minimal value for the cost divided by the performance is defined for economic optimization. Shortages and excesses are calculated for PV panels of 0.5-10 kWp output, with consideration given to the advantages of a battery back-up. The minimal economic value is found to increase with the magnitude of PV output, and an inverter should never be rated at more than half the array maximum output. A maximum panel size for the Belgian residence is projected to be 6 kWp.

[Development of MEDUC-PG14 survey to assess postgraduate teaching in medical specialties].

PubMed

Pizarro, Margarita; Solís, Nancy; Rojas, Viviana; Díaz, Luis Antonio; Padilla, Oslando; Letelier, Luz María; Aizman, Andrés; Sarfatis, Alberto; Olivos, Trinidad; Soza, Alejandro; Delfino, Alejandro; Latorre, Gonzalo; Ivanovic-Zuvic, Danisa; Hoyl, Trinidad; Bitran, Marcela; Arab, Juan Pablo; Riquelme, Arnoldo

2015-08-01

Feedback is one of the most important tools to improve teaching in medical education. To develop an instrument to assess the performance of clinical postgraduate teachers in medical specialties. A qualitative methodology consisting in interviews and focus-groups followed by a quantitative methodology to generate consensus, was employed. After generating the instrument, psychometric tests were performed to assess the construct validity (factor analysis) and reliability (Cronbach’s alpha). Experts in medical education, teachers and residents of a medical school participated in interviews and focus groups. With this information, 26 categories (79 items) were proposed and reduced to 14 items (Likert scale 1-5) by an expert’s Delphi panel, generating the MEDUC-PG14 survey, which was answered by 123 residents from different programs of medical specialties. Construct validity was carried out. Factor analysis showed three domains: Teaching and evaluation, respectful behavior towards patients and health care team, and providing feedback. The global score was 4.46 ± 0.94 (89% of the maximum). One teachers’ strength, as evaluated by their residents was “respectful behavior” with 4.85 ± 0.42 (97% of the maximum). “Providing feedback” obtained 4.09 ± 1.0 points (81.8% of the maximum). MEDUC-PG14 survey had a Cronbach’s alpha coefficient of 0.947. MEDUC-PG14 survey is a useful and reliable guide for teacher evaluation in medical specialty programs. Also provides feedback to improve educational skills of postgraduate clinical teachers.

Numerical and machine learning simulation of parametric distributions of groundwater residence time in streams and wells

NASA Astrophysics Data System (ADS)

Starn, J. J.; Belitz, K.; Carlson, C.

2017-12-01

Groundwater residence-time distributions (RTDs) are critical for assessing susceptibility of water resources to contamination. This novel approach for estimating regional RTDs was to first simulate groundwater flow using existing regional digital data sets in 13 intermediate size watersheds (each an average of 7,000 square kilometers) that are representative of a wide range of glacial systems. RTDs were simulated with particle tracking. We refer to these models as "general models" because they are based on regional, as opposed to site-specific, digital data. Parametric RTDs were created from particle RTDs by fitting 1- and 2-component Weibull, gamma, and inverse Gaussian distributions, thus reducing a large number of particle travel times to 3 to 7 parameters (shape, location, and scale for each component plus a mixing fraction) for each modeled area. The scale parameter of these distributions is related to the mean exponential age; the shape parameter controls departure from the ideal exponential distribution and is partly a function of interaction with bedrock and with drainage density. Given the flexible shape and mathematical similarity of these distributions, any of them are potentially a good fit to particle RTDs. The 1-component gamma distribution provided a good fit to basin-wide particle RTDs. RTDs at monitoring wells and streams often have more complicated shapes than basin-wide RTDs, caused in part by heterogeneity in the model, and generally require 2-component distributions. A machine learning model was trained on the RTD parameters using features derived from regionally available watershed characteristics such as recharge rate, material thickness, and stream density. RTDs appeared to vary systematically across the landscape in relation to watershed features. This relation was used to produce maps of useful metrics with respect to risk-based thresholds, such as the time to first exceedance, time to maximum concentration, time above the threshold (exposure time), and the time until last exceedance; thus, the parameters of groundwater residence time are measures of the intrinsic susceptibility of groundwater to contamination.

Profile, mean residence time of ACTH and cortisol responses after low and standard ACTH tests in healthy volunteers.

PubMed

Alía, P; Villabona, C; Giménez, O; Sospedra, E; Soler, J; Navarro, M A

2006-09-01

No consensus exists until now about the suitable dose of tetracosactin in the ACTH stimulation test for detecting adrenal insufficiency. Our aim was to characterize both the ACTH(1-24) and the cortisol profiles after standard high-dose test (250 microg) (HDT) and low-dose test (1 microg) (LDT) in healthy subjects in order to provide a deeper knowledge about the relationship between stimulus and response. ACTH tests were performed in 10 healthy volunteers (five men, five women) with at least 1 week of difference. Plasma ACTH(1-24) and ACTH(1-39) and serum cortisol were measured before tetracosactin i.v. injection and at 5, 15, 30, 45, 60, 75 and 90 min after stimulus. Area under the curve (AUC) of ACTH(1-24) and cortisol, as well as mean residence time (MRT) for ACTH(1-24) were calculated in both tests. Elimination of ACTH(1-24) was faster in HDT than in LDT (MRTs of 0.14 vs 0.37, respectively, P = 0.008), but plasma concentrations were higher up to 60 min cortisol production in HDT reaching a higher maximum concentration (Cmax: 1144 vs 960 nmol/l) but delayed in time (75 vs 52.5 min). No significant relationship was observed between AUC or Cmax of ACTH(1-24) and AUC, Cmax and increment of cortisol in any of the tests. However, a negative correlation of basal cortisol values was observed with relative cortisol increment (HDT: r = 0.77 P = 0.009; LDT: r = 0.94 P < 0.0001), but not so with Cmax (HDT: r = 0.22 P = 0.55; LDT: r = 0.57 P = 0.09). The elimination rate of ACTH in healthy volunteers was significantly lower in LDT than in HDT, but cortisol production rate appears to be identical in both tests, so that a maximum adrenal stimulation seems to exist. The use of LDT may be more adequate, although data from patients need studying.

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.

Timing of magma storage at the Vulcano Island during the last 1000 years

NASA Astrophysics Data System (ADS)

De Rosa, Rosanna; Donato, Paola; Gioncada, Anna; Giuffrida, Marisa; Nicotra, Eugenio; Viccaro, Marco

2016-04-01

Understanding the nature and timescales of magmatic processes is one of the primary goals of modern volcanology, and chemical zoning is an efficient tool to achieve this aim. In basic volcanic rocks, plagioclase is a common phase used for documenting magmatic processes and their timescales. This is chiefly due to its stability over a wide range of physical-chemical conditions and its sensitivity to changes in thermodynamic parameters during its growth in magma storage and transport zones. We present here textural analysis and major (SEM-EDS/WDS) and trace (LA-ICP-MS) element zoning data on plagioclase crystals from selected volcanic products of Vulcano (Aeolian Islands), emitted during the last 1000 years. The collected samples belong to the La Fossa cone (Palizzi latitic lava flow, latitic enclaves within Commenda and Pietre Cotte rhyolitic lava flows, 1888-90 spatter bombs) and Vulcanello peninsula (shoshonitic and shoshonitic-latitic lava flows at the end of Vulcanello I and Vulcanello 3 phases, respectively). Textural observations through polarizing optical microscope, high-contrast BSE images and SEM-EDS/WDS core-to-rim profiles, allowed to discriminate four different plagioclase textures, namely: 1) oscillatory-zoned crystals; 2) sieve-textured rims; 3) dissolved/resorbed cores; 4) cores with coarse sieve-textures. Plagioclase with sieve-textured rims and coarsely-sieved cores (Types 2 and 4) are the most abundant in the analyzed products. The estimates of maximum magma residence time have been obtained on crystals with exclusive oscillatory-zoned patterns (Type 1) or portions of crystals not severely affected by μm-sized glass inclusions caused by disequilibrium. We used one-step modeling of Sr diffusion considering the highest An content of each crystal and magma temperature ranging between 1075 and 1175° C. Textural observations and core-to-rim profiles on plagioclases show that dynamics of magma ascent and storage are markedly different at La Fossa and Vulcanello systems. Transfer mechanisms are however almost unchanged in each system during the considered timespan. Diffusion modelling gives residence times between 2 and 22 years. The most striking feature is that residence times are relatively low for the most evolved products (latites or latitic enclaves), especially at La Fossa eruptive system (2-19 years), with respect to the less evolved products of Vulcanello (19-21 years). It is worth to note that these timescales cannot account for the total amount of residence time of La Fossa magmas within the crust, but they can reflect the storage time of the most evolved products into the shallowest feeding system. Residence times for Vulcanello magmas could be related to longer magma storage at intermediate levels of the plumbing system followed by rapid transfer at the surface prior to the eruption.

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.

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.

Tremors from earthquakes and blasting in the Powder River basin of Wyoming and Montana

USGS Publications Warehouse

Miller, C.H.; Osterwald, F.W.

1980-01-01

We are not aware of any damage to people or to property caused by blasting in the coal surface mines even though thousands of tons of explosives are detonated each year in the basin. The maximum weight of an individual explosive charge and the time interval between blasts are regulated so that any nearby structures will not be damaged or the residents disturbed. Blasting, nevertheless, does produce seismic tremors that can be recorded over 200 kilometers away. In addition, at one mine, some very low order aftershocks were recorded relatively close to the source within 2 hours after blasting.  

The impact of reduced working hours on surgical training in Australia and New Zealand.

PubMed

Gough, Ian R

2011-01-01

There is a worldwide trend for reduced working hours for doctors, particularly in the developed western countries. This has been led by the introduction of the European Working Time Directive (EWTD) that has had a significant impact on work patterns and training. Australia currently has a more flexible working environment but this is changing. In New Zealand there is a contract for resident doctors defining a maximum 72 h of rostered work per week. Copyright © 2010 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

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.

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.

Prolonged and tunable residence time using reversible covalent kinase inhibitors

PubMed Central

Bradshaw, J. Michael; McFarland, Jesse M.; Paavilainen, Ville O.; Bisconte, Angelina; Tam, Danny; Phan, Vernon T.; Romanov, Sergei; Finkle, David; Shu, Jin; Patel, Vaishali; Ton, Tony; Li, Xiaoyan; Loughhead, David G.; Nunn, Philip A.; Karr, Dane E.; Gerritsen, Mary E.; Funk, Jens Oliver; Owens, Timothy D.; Verner, Erik; Brameld, Ken A.; Hill, Ronald J.; Goldstein, David M.; Taunton, Jack

2015-01-01

Drugs with prolonged, on-target residence time often show superior efficacy, yet general strategies for optimizing drug-target residence time are lacking. Here, we demonstrate progress toward this elusive goal by targeting a noncatalytic cysteine in Bruton's tyrosine kinase (BTK) with reversible covalent inhibitors. Utilizing an inverted orientation of the cysteine-reactive cyanoacrylamide electrophile, we identified potent and selective BTK inhibitors that demonstrate biochemical residence times spanning from minutes to 7 days. An inverted cyanoacrylamide with prolonged residence time in vivo remained bound to BTK more than 18 hours after clearance from the circulation. The inverted cyanoacrylamide strategy was further utilized to discover fibroblast growth factor receptor (FGFR) kinase inhibitors with residence times of several days, demonstrating generalizability of the approach. Targeting noncatalytic cysteines with inverted cyanoacrylamides may serve as a broadly applicable platform that facilitates “residence time by design”, the ability to modulate and improve the duration of target engagement in vivo. PMID:26006010

Comfort and experience with online learning: trends over nine years and associations with knowledge.

PubMed

Cook, David A; Thompson, Warren G

2014-07-01

Some evidence suggests that attitude toward computer-based instruction is an important determinant of success in online learning. We sought to determine how comfort using computers and perceptions of prior online learning experiences have changed over the past decade, and how these associate with learning outcomes. Each year from 2003-2011 we conducted a prospective trial of online learning. As part of each year's study, we asked medicine residents about their comfort using computers and if their previous experiences with online learning were favorable. We assessed knowledge using a multiple-choice test. We used regression to analyze associations and changes over time. 371 internal medicine and family medicine residents participated. Neither comfort with computers nor perceptions of prior online learning experiences showed a significant change across years (p > 0.61), with mean comfort rating 3.96 (maximum 5 = very comfortable) and mean experience rating 4.42 (maximum 6 = strongly agree [favorable]). Comfort showed no significant association with knowledge scores (p = 0.39) but perceptions of prior experiences did, with a 1.56% rise in knowledge score for a 1-point rise in experience score (p = 0.02). Correlations among comfort, perceptions of prior experiences, and number of prior experiences were all small and not statistically significant. Comfort with computers and perceptions of prior experience with online learning remained stable over nine years. Prior good experiences (but not comfort with computers) demonstrated a modest association with knowledge outcomes, suggesting that prior course satisfaction may influence subsequent learning.

Explaining direct care resource use of nursing home residents: findings from time studies in four states.

PubMed

Arling, Greg; Kane, Robert L; Mueller, Christine; Lewis, Teresa

2007-04-01

To explain variation in direct care resource use (RU) of nursing home residents based on the Resource Utilization Groups III (RUG-III) classification system and other resident- and unit-level explanatory variables. Primary data were collected on 5,314 nursing home residents in 156 nursing units in 105 facilities from four states (CO, IN, MN, MS) from 1998 to 2004. Study Design. Nurses and other direct care staff recorded resident-specific and other time caring for all residents on sampled nursing units. Care time was linked to resident data from the Minimum Data Set assessment instrument. Major variables were: RUG-III group (34-group), other health and functional conditions, licensed and other professional minutes per day, unlicensed minutes per day, and direct care RU (wage-weighted minutes). Resident- and unit-level relationships were examined through hierarchical linear modeling. Time study data were recorded with hand-held computers, verified for accuracy by project staff at the data collection sites and then merged into resident and unit-level data sets. Resident care time and RU varied between and within nursing units. RUG-III group was related to RU; variables such as length of stay and unit percentage of high acuity residents also were significantly related. Case-mix indices (CMIs) constructed from study data displayed much less variation across RUG-III groups than CMIs from earlier time studies. Results from earlier time studies may not be representative of care patterns of Medicaid and private pay residents. New RUG-III CMIs should be developed to better reflect the relative costs of caring for these residents.

An Analysis of Research Quality and Productivity at Six Academic Orthopaedic Residencies.

PubMed

Osborn, Patrick M; Ames, S Elizabeth; Turner, Norman S; Caird, Michelle S; Karam, Matthew D; Mormino, Matthew A; Krueger, Chad A

2018-06-06

It remains largely unknown what factors impact the research productivity of residency programs. We hypothesized that dedicated resident research time would not affect the quantity and quality of a program's peer-reviewed publication within orthopedic residencies. These findings may help programs improve structure their residency programs to maximize core competencies. Three hundred fifty-nine residents and 240 staff from six different US orthopedic residency programs were analyzed. All publications published by residents and faculty at each program from January 2007 to December 2015 were recorded. SCImago Journal Rankings (SJR) were found for each journal. There were no significant differences in publications by residents at each program (p > 0.05). Faculty with 10+ years of on staff, had significantly more publications than those with less than 10years (p < 0.01). Programs with increased resident research time did not consistently produce publications with higher SJR than those without dedicated research time. Increased dedicated resident research time did not increase resident publication rates or lead to publications with higher SJR. Copyright © 2018 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Depression recognition and capacity for self-report among ethnically diverse nursing homes residents: Evidence of disparities in screening.

PubMed

Chun, Audrey; Reinhardt, Joann P; Ramirez, Mildred; Ellis, Julie M; Silver, Stephanie; Burack, Orah; Eimicke, Joseph P; Cimarolli, Verena; Teresi, Jeanne A

2017-12-01

To examine agreement between Minimum Data Set clinician ratings and researcher assessments of depression among ethnically diverse nursing home residents using the 9-item Patient Health Questionnaire. Although depression is common among nursing homes residents, its recognition remains a challenge. Observational baseline data from a longitudinal intervention study. Sample of 155 residents from 12 long-term care units in one US facility; 50 were interviewed in Spanish. Convergence between clinician and researcher ratings was examined for (i) self-report capacity, (ii) suicidal ideation, (iii) at least moderate depression, (iv) Patient Health Questionnaire severity scores. Experiences by clinical raters using the depression assessment were analysed. The intraclass correlation coefficient was used to examine concordance and Cohen's kappa to examine agreement between clinicians and researchers. Moderate agreement (κ = 0.52) was observed in determination of capacity and poor to fair agreement in reporting suicidal ideation (κ = 0.10-0.37) across time intervals. Poor agreement was observed in classification of at least moderate depression (κ = -0.02 to 0.24), lower than the maximum kappa obtainable (0.58-0.85). Eight assessors indicated problems assessing Spanish-speaking residents. Among Spanish speakers, researchers identified 16% with Patient Health Questionnaire scores of 10 or greater, and 14% with thoughts of self-harm whilst clinicians identified 6% and 0%, respectively. This study advances the field of depression recognition in long-term care by identification of possible challenges in assessing Spanish speakers. Use of the Patient Health Questionnaire requires further investigation, particularly among non-English speakers. Depression screening for ethnically diverse nursing home residents is required, as underreporting of depression and suicidal ideation among Spanish speakers may result in lack of depression recognition and referral for evaluation and treatment. Training in depression recognition is imperative to improve the recognition, evaluation and treatment of depression in older people living in nursing homes. © 2017 John Wiley & Sons Ltd.

Transport and fate of chloride from road salt within a mixed urban and agricultural watershed in Illinois (USA): assessing the influence of chloride application rates

NASA Astrophysics Data System (ADS)

Ludwikowski, Jessica J.; Peterson, Eric W.

2018-06-01

In a typical winter season, approximately 471,000 tons of road salt are deposited along roadways in Illinois, USA. An estimated 45% of the deposited road salt will infiltrate through the soils and into shallow aquifers. Transported through shallow aquifers, chloride associated with the road salts has the potential to reside within groundwater for years based on the pathway, the geologic material, and the recharge rate of the aquifer system. Utilizing MODFLOW and MT3D, simulations employing various road-salt application rates were conducted to assess the net accumulation of chloride and the residence times of chloride in an agriculture-dominated watershed that originates in an urban area. A positive-linear relationship was observed between the application rate of chloride and both the maximum chloride concentration and total mass accumulated within the watershed. Simulated annual recharge rates along impacted surfaces ranged from 1,000 to 10,000 mg/L. After 60 years of application, simulated chloride concentrations in groundwater ranged from 197 to 1,900 mg/L. For all application rates, chloride concentrations within the groundwater rose at an annual rate of >3 mg/L. While concentrations increase throughout the system, the majority of chloride accumulation occurs near the roads and the urban areas. Model simulations reveal a positive relationship between application rate and residence time of chloride (1,123-1,288 days based on application rate). The models indicate that continued accumulation of chloride in shallow aquifers can be expected, and methods that apply less chloride effectively need to be examined.

Transport and fate of chloride from road salt within a mixed urban and agricultural watershed in Illinois (USA): assessing the influence of chloride application rates

NASA Astrophysics Data System (ADS)

Ludwikowski, Jessica J.; Peterson, Eric W.

2018-01-01

In a typical winter season, approximately 471,000 tons of road salt are deposited along roadways in Illinois, USA. An estimated 45% of the deposited road salt will infiltrate through the soils and into shallow aquifers. Transported through shallow aquifers, chloride associated with the road salts has the potential to reside within groundwater for years based on the pathway, the geologic material, and the recharge rate of the aquifer system. Utilizing MODFLOW and MT3D, simulations employing various road-salt application rates were conducted to assess the net accumulation of chloride and the residence times of chloride in an agriculture-dominated watershed that originates in an urban area. A positive-linear relationship was observed between the application rate of chloride and both the maximum chloride concentration and total mass accumulated within the watershed. Simulated annual recharge rates along impacted surfaces ranged from 1,000 to 10,000 mg/L. After 60 years of application, simulated chloride concentrations in groundwater ranged from 197 to 1,900 mg/L. For all application rates, chloride concentrations within the groundwater rose at an annual rate of >3 mg/L. While concentrations increase throughout the system, the majority of chloride accumulation occurs near the roads and the urban areas. Model simulations reveal a positive relationship between application rate and residence time of chloride (1,123-1,288 days based on application rate). The models indicate that continued accumulation of chloride in shallow aquifers can be expected, and methods that apply less chloride effectively need to be examined.

Explaining Direct Care Resource Use of Nursing Home Residents: Findings from Time Studies in Four States

PubMed Central

Arling, Greg; Kane, Robert L; Mueller, Christine; Lewis, Teresa

2007-01-01

Objective To explain variation in direct care resource use (RU) of nursing home residents based on the Resource Utilization Groups III (RUG-III) classification system and other resident- and unit-level explanatory variables. Data Sources/Study Setting Primary data were collected on 5,314 nursing home residents in 156 nursing units in 105 facilities from four states (CO, IN, MN, MS) from 1998 to 2004. Study Design Nurses and other direct care staff recorded resident-specific and other time caring for all residents on sampled nursing units. Care time was linked to resident data from the Minimum Data Set assessment instrument. Major variables were: RUG-III group (34-group), other health and functional conditions, licensed and other professional minutes per day, unlicensed minutes per day, and direct care RU (wage-weighted minutes). Resident- and unit-level relationships were examined through hierarchical linear modeling. Data Collection/Extraction Methods Time study data were recorded with hand-held computers, verified for accuracy by project staff at the data collection sites and then merged into resident and unit-level data sets. Principal Findings Resident care time and RU varied between and within nursing units. RUG-III group was related to RU; variables such as length of stay and unit percentage of high acuity residents also were significantly related. Case-mix indices (CMIs) constructed from study data displayed much less variation across RUG-III groups than CMIs from earlier time studies. Conclusions Results from earlier time studies may not be representative of care patterns of Medicaid and private pay residents. New RUG-III CMIs should be developed to better reflect the relative costs of caring for these residents. PMID:17362220

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.

RESIDENCE TIME DISTRIBUTION OF FLUIDS IN STIRRED ANNULAR PHOTOREACTORS

EPA Science Inventory

When gases flow through an annular photoreactor at constant rate, some of the gas spends more or less than the average residence time in the reactor. This spread of residence time can have an important effect on the performance of the reactor. this study tested how the residence...

C-A4-01: Computerized Clinical Decision Support During Drug Ordering for Long-term Care Residents With Renal Insufficiency

PubMed Central

Field, Terry S; Rochon, Paula; Lee, Monica; Gavendo, Linda; Baril, Joann L; Gurwitz, Jerry H

2010-01-01

Objective: To determine whether a computerized clinical decision support system (CDSS) providing patient specific recommendations in real- time improves the quality of prescribing for long-term care residents with renal insufficiency. Design: A randomized trial within the long-stay units of a large long-term care facility. Randomization was within blocks by unit type. Alerts related to medication prescribing for residents with renal insufficiency were displayed to prescribers in the intervention units and hidden but tracked in control units. Measurement: The proportions of final drug orders that were appropriate were compared between intervention and control units within alert categories: recommended medication doses; recommended administration frequencies; recommendations to avoid the drug; 4) warnings of missing information. Results: The rates of alerts were nearly equal in the intervention and control units: 2.5 per 1000 resident days in the intervention units and 2.4 in the control units. The proportions of dose alerts for which the final drug orders were appropriate were similar between the intervention and control units (relative risk 0.95, 95% confidence interval 0.83, 1.1). For the remaining alert categories significantly higher proportions of final drug orders were appropriate in the intervention units: relative risk 2.4 for maximum frequency (1.4, 4.4); 2.6 for drugs that should be avoided (1.4, 5.0); and 1.8 for alerts to acquire missing information (1.1, 3.4). Overall, final drug orders were appropriate significantly more often than a relative risk 1.2 (1.0, 1.4). By tracking personnel time and expenditures, we estimated the cost of developing the CDSS as $48,668.57. Drug costs saved during the 12 months of the trial are estimated at $2,137. Conclusion: Clinical decision support for physicians prescribing medications for long-term care residents with renal insufficiency can improve the quality of prescribing decisions. However, patient well-being and quality of care rather than the business case related to cost savings are likely to be the key drivers for adoption of this HIT application.

Radiocarbon constraints on the glacial ocean circulation and its impact on atmospheric CO2

NASA Astrophysics Data System (ADS)

Skinner, L. C.; Primeau, F.; Freeman, E.; de La Fuente, M.; Goodwin, P. A.; Gottschalk, J.; Huang, E.; McCave, I. N.; Noble, T. L.; Scrivner, A. E.

2017-07-01

While the ocean's large-scale overturning circulation is thought to have been significantly different under the climatic conditions of the Last Glacial Maximum (LGM), the exact nature of the glacial circulation and its implications for global carbon cycling continue to be debated. Here we use a global array of ocean-atmosphere radiocarbon disequilibrium estimates to demonstrate a ~689+/-53 14C-yr increase in the average residence time of carbon in the deep ocean at the LGM. A predominantly southern-sourced abyssal overturning limb that was more isolated from its shallower northern counterparts is interpreted to have extended from the Southern Ocean, producing a widespread radiocarbon age maximum at mid-depths and depriving the deep ocean of a fast escape route for accumulating respired carbon. While the exact magnitude of the resulting carbon cycle impacts remains to be confirmed, the radiocarbon data suggest an increase in the efficiency of the biological carbon pump that could have accounted for as much as half of the glacial-interglacial CO2 change.

Kinetics of anaerobic treatment of landfill leachates combined with urban wastewaters.

PubMed

Fueyo, Gema; Gutiérrez, Antonio; Berrueta, José

2003-04-01

The anaerobic degradation of landfill leachates mixed with domestic wastewater has been studied in a pilot-scale Upflow Anaerobic Sludge Blanket (UASB) reactor. A previous work in laboratory-scale had shown that a fraction (5%) of the refractory organic matter could be additionally degraded when these two substrates were treated in conjunction, but this synergistic effect in the Chemical Oxygen Demand (COD) removal was not reproduced. However, the mass loading rate for which the maximum degradation was obtained was higher for the mixtures (0.5 kg COD/kg SSV x d) than for the separated components (0.18 and 0.19), allowing an increase in the treatment capacity of the leachates. The methane productivity (304 L/kg COD) was close to the theoretical maximum and independent of the proportion of the mixture components. The experimental data were fitted to a modification of Haldane's kinetic model, in which the parameters depend on the hydraulic residence time and the biomass concentration.

Positive affect among nursing home residents with Alzheimer's dementia: the effect of recreational activity.

PubMed

Schreiner, A S; Yamamoto, E; Shiotani, H

2005-03-01

The experience of positive emotions is an integral component of quality of life. Research suggests that cognitive deficits in persons with dementia may impede their ability to generate pleasurable moments and hence decrease their positive affect. Therefore, structured recreation activities may have the potential to significantly improve resident affect. However, differences in affect between ordinary time and recreation time are not well known. The present study used previously published structured-observation instruments to measure affect and behaviour among 35 dementia residents at two nursing homes in Japan during ordinary time and during recreation time. A total of 3,854 one-minute observations were coded. Dementia residents expressed happiness over seven times more often during recreation time than during ordinary time. Over 60% of ordinary time was solitary, with 65.72% of all observed affect being 'Null Affect'. A total of 43.75% of residents expressed happiness only during recreation time. In addition 48.9% of all behaviour during 'Ordinary Time' was coded as 'Null Behaviour', which indicated that the resident was sitting and doing nothing. Findings indicate that recreation time is significantly higher in positive affect than ordinary time and that virtually all residents benefited from recreation.

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.

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.

Evaluation of American Board of Orthodontics certification protocols in postgraduate orthodontic programs in the United States and Canada.

PubMed

Park, Jae Hyun; Putrus, Raphael R; Pruzansky, Dawn P; Grubb, John

2017-03-01

The objective of this study was to identify the board certification protocols that hospital and university-based postgraduate orthodontic programs have in place to prepare residents for the American Board of Orthodontics (ABO) certification examination. An electronic survey was sent to the program directors of each of the 72 postgraduate orthodontic programs in the United States and Canada. The survey consisted of 49 questions about demographics, resident case assignment protocols, and ABO examination preparation methods. The response rate was 81%. Most programs were 30 to 36 months in length (72.7%). Many residents had a case load of 51 to 75 during their first year (50.9%), with an average maximum case load of 70 to 109. There was a positive correlation with both the number of cases that first-year residents start and the length of the program (Spearman correlation coefficient = 0.379; P <0.01) when compared with maximum case load. Approximately 72% of the programs do not offer a written mock board examination; however, 72% reported offering a clinical mock board examination. ABO cases are identified within the first 6 months of most programs. About 88% of respondents believe that residents take advantage of the banking system, and that over the past 5 years ABO Initial Certification Examination applications have increased. Most program directors (89.1%) believe that their program length is sufficient for board preparation. Subjects tested in the written examination are integrated into the didactic curriculum and strengthened with ongoing literature reviews, with a passing rate over 90%. Clinical examination preparation varies, with most programs requiring a mock board examination for graduation. Total participation in both the Initial Certification Examination and banking has increased since 2010; better follow-up protocols are needed to track residents after graduation. Copyright © 2017 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

Trait differences between naturalized and invasive plant species independent of residence time and phylogeny.

PubMed

Gallagher, R V; Randall, R P; Leishman, M R

2015-04-01

The ability to predict which alien plants will transition from naturalized to invasive prior to their introduction to novel regions is a key goal for conservation and has the potential to increase the efficacy of weed risk assessment (WRA). However, multiple factors contribute to plant invasion success (e.g., functional traits, range characteristics, residence time, phylogeny), and they all must be taken into account simultaneously in order to identify meaningful correlates of invasion success. We compiled 146 pairs of phylogenetically paired (congeneric) naturalized and invasive plant species in Australia with similar minimum residence times (i.e., time since introduction in years). These pairs were used to test for differences in 5 functional traits (flowering duration, leaf size, maximum height, specific leaf area [SLA], seed mass) and 3 characteristics of species' native ranges (biome occupancy, mean annual temperature, and rainfall breadth) between naturalized and invasive species. Invasive species, on average, had larger SLA, longer flowering periods, and were taller than their congeneric naturalized relatives. Invaders also exhibited greater tolerance for different environmental conditions in the native range, where they occupied more biomes and a wider breadth of rainfall and temperature conditions than naturalized congeners. However, neither seed mass nor leaf size differed between pairs of naturalized and invasive species. A key finding was the role of SLA in distinguishing between naturalized and invasive pairs. Species with high SLA values were typically associated with faster growth rates, more rapid turnover of leaf material, and shorter lifespans than those species with low SLA. This suite of characteristics may contribute to the ability of a species to transition from naturalized to invasive across a wide range of environmental contexts and disturbance regimes. Our findings will help in the refinement of WRA protocols, and we advocate the inclusion of quantitative traits, in particular SLA, into the WRA schemes. © 2014 The Authors. Conservation Biology published by Wiley Periodicals, Inc. on behalf of Society for Conservation Biology.

Emotional intelligence in orthopedic surgery residents.

PubMed

Chan, Kevin; Petrisor, Brad; Bhandari, Mohit

2014-04-01

Emotional intelligence (EI) is the ability to understand and manage emotions in oneself and others. It was originally popularized in the business literature as a key attribute for success that was distinct from cognitive intelligence. Increasing focus is being placed on EI in medicine to improve clinical and academic performance. Despite the proposed benefits, to our knowledge, there have been no previous studies on the role of EI in orthopedic surgery. We evaluated baseline data on EI in a cohort of orthopedic surgery residents. We asked all orthopedic surgery residents at a single institution to complete an electronic version of the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT). We used completed questionnaires to calculate total EI scores and 4 branch scores. Data were analyzed according to a priori cutoff values to determine the proportion of residents who were considered competent on the test. Data were also analyzed for possible associations with age, sex, race and level of training. Thirty-nine residents (100%) completed the MSCEIT. The mean total EI score was 86 (maximum score 145). Only 4 (10%) respondents demonstrated competence in EI. Junior residents (p = 0.026), Caucasian residents (p = 0.009) and those younger than 30 years (p = 0.008) had significantly higher EI scores. Our findings suggest that orthopedic residents score low on EI based on the MSCEIT. Optimizing resident competency in noncognitive skills may be enhanced by dedicated EI education, training and testing.

Do mentors matter in graduating pediatrics residents' career choices?

PubMed

Umoren, Rachel A; Frintner, Mary Pat

2014-01-01

Little is known about the association between mentorship and career choice during residency in pediatrics. This study examines graduating residents with mentors who provide career advice and the relationship between having a mentor who is a subspecialist and having a subspecialty practice goal. National, random samples of 1000 graduating pediatrics residents were surveyed each year from 2006 to 2012; 4197 (61%) responded. Responses were pooled across years to examine mentor specialty and career goal at time of residency graduation. Multivariable logistic regression was used to examine relationships between mentor specialty and career goal at the time of graduation. Most (87%) residents reported having a mentor who provided career advice during residency; the proportion linearly increased from 83% in 2006 to 87% in 2012; P < .05. Forty-five percent of those with mentors had a mentor who was a subspecialist; 55% had a generalist as a mentor. Overall, 45% of residents had a subspecialty career goal at time of graduation. After controlling for career goal at the start of residency and resident characteristics, residents with a subspecialist mentor were more likely to have a subspecialty career goal at time of graduation (adjusted odds ratio = 5.25; 95% confidence interval, 4.41-6.25). Residents who were male, without children, without debt, not married, not minority, and from larger residency programs were also more likely to have a subspecialty career goal at the time of graduation from residency. Almost 9 in 10 pediatric residents have a mentor who provides career advice. Although multiple factors shape decisions about careers, mentor specialty is one factor that might encourage residents to pursue fellowship training. Copyright © 2014 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Effects of resident water and non-equilibrium adsorption on the primary and enhanced coalbed methane gas recovery

NASA Astrophysics Data System (ADS)

Jahediesfanjani, Hossein

The major part of the gas in coalbed methane and shale gas reservoirs is stored as the adsorbed gas in the coal and organic materials of the black shale internal surfaces. The sorption sites in both reservoirs are composed of several macropores that contain very small pore sizes. Therefore, the adsorption/desorption is very slow process and follows a non-equilibrium trend. The time-dependency of the sorption process is further affected by the reservoir resident water. Water can diffuse into the matrix and adsorption sites, plug the pores and affect the reservoir gas production. This study presents an experimental and theoretical procedure to investigate the effects of the resident water and time-dependency of the sorption process on coalbed and shale gas primary and enhanced recovery by simultaneous CO 2/N2 injection. Series of the experiments are conducted to construct both equilibrium and non-equilibrium single and multi-component isotherms with the presence of water. A novel and rapid data interpretation technique is developed based on the nonequilibrium adsorption/desorption thermodynamics, mass conservation law, and volume filling adsorption theory. The developed technique is implemented to construct both equilibrium and non-equilibrium multi-component multi-phase isotherms from the early time experimental measurements. The non-equilibrium isotherms are incorporated in the coalbed methane/shale gas reservoir simulations to account for the time-dependency of the sorption process. The experimental results indicate that the presence of water in the sorption system reduces both carbon dioxide and nitrogen adsorption rates. Reduction in the adsorption rate for carbon dioxide is more than nitrogen. The results also indicate that the resident water reduces the adsorption ability of low rank coals more than high rank ones. The results of the multi-component sorption tests indicate that increasing the initial mole fraction of the nitrogen gas in the injected CO2/N2 mixture will increase the net carbon dioxide sequestration rate on coals in the presence of water. The optimum CO2/N2 ratio that can result in the maximum carbon dioxide sequestration rate can be obtained by conducting the experiments for various CO2/N2 ratios. The results of applying the developed non-equilibrium interpretation technique for several literature and in-house data indicate that both the equilibrium and non-equilibrium isotherms can be constructed in shorter time period (around 70 times less than the time required with the equilibrium techniques) and with higher accuracy using this method. (Abstract shortened by UMI.)

Establishing a community pharmacy residency at an independent pharmacy: Time allocation and valuation.

PubMed

Shugart, Katherine; Bryant, Jason; Kress, Dean; Ziegler, Bryan; Connelly, Lynn; Brittain, Kristy

2015-12-01

The value of a first-year community pharmacy residency program (CPRP) at an independent pharmacy was estimated based on time allocation for resident responsibilities. Predefined time allocation categories for the pharmacy resident were used to consistently classify and document time completing residency activities. Benefit-to-cost ratio was determined by tabulating total costs and total benefits of the residency program. A retrospective-prospective comparison of overall change in revenue, operating expense, and prescription volume was performed between the preresident time period (July 2012 to June 2013) and the postresident time period (July 2013 to June 2014). This comparison accounted for resident activities that did not directly generate revenue. Time allocations for the resident out of 2,221 total hours logged were dispensing (40%), clinical setup (16%), research (8%), professional meetings (7%), clinical activities (5%), resident education (5%), site precepting (4%), residency meetings (4%), didactic teaching (3%), miscellaneous (3%), marketing (2%), training (2%), and public health promotion (1%). Total costs were $77,422, and total benefits were $118,410. The benefit-to-cost ratio was 1.53. The postresident time interval had $172,451 more revenue and $6,622 more in operating expenses than the preresident time interval, and prescription volume decreased by 2,000 prescriptions compared to the previous year. The benefit-to-cost analysis indicated a $1.53 return for every $1.00 invested into a CPRP. An increase in revenue and operating expenses for the pharmacy was observed after implementation of the CPRP compared to the previous year. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Health Risks to Children and Adults Residing in Riverine Environments where Surficial Sediments Contain Metals Generated by Active Gold Mining in Ghana

PubMed Central

Armah, Frederick Ato; Gyeabour, Elvis Kyere

2013-01-01

The purpose of this study was to investigate the current status of metal pollution in the sediment from rivers, lakes, and streams in active gold mining districts in Ghana. Two hundred and fifty surface sediment samples from 99 locations were collected and analyzed for concentrations of As, Hg, Cr, Co, Cu, Fe, Zn, Pb, Cd, Ni, and Mn using inductively coupled plasma-mass spectroscopy (ICP-MS). Metal concentrations were then used to assess the human health risks to resident children and adults in central tendency exposure (CTE) and reasonable maximum exposure (RME) scenarios. The concentrations of Pb, Cd, and As were almost twice the threshold values established by the Hong Kong Interim Sediment Quality Guidelines (ISQG). Hg, Cu, and Cr concentrations in sediment were 14, 20, and 26 times higher than the Canadian Freshwater Sediment Guidelines for these elements. Also, the concentrations of Pb, Cu, Cr, and Hg were 3, 11, 12, and 16 times more than the Australian and New Zealand Environment and Conservation Council (ANZECC) sediment guideline values. The results of the human health risk assessment indicate that for ingestion of sediment under the central tendency exposure (CTE) scenario, the cancer risks for child and adult residents from exposure to As were 4.18 × 10−6 and 1.84 × 10−7, respectively. This suggests that up to 4 children out of one million equally exposed children would contract cancer if exposed continuously to As over 70 years (the assumed lifetime). The hazard index for child residents following exposure to Cr(VI) in the RME scenario was 4.2. This is greater than the United States Environmental Protection Agency (USEPA) threshold of 1, indicating that adverse health effects to children from exposure to Cr(VI) are possible. This study demonstrates the urgent need to control industrial emissions and the severe heavy metal pollution in gold mining environments. PMID:24278631

Pediatric dermatology training survey of United States dermatology residency programs.

PubMed

Nijhawan, Rajiv I; Mazza, Joni M; Silverberg, Nanette B

2014-01-01

Variability exists in pediatric dermatology education for dermatology residents. We sought to formally assess the pediatric dermatology curriculum and experience in a dermatology residency program. Three unique surveys were developed for dermatology residents, residency program directors, and pediatric dermatology fellowship program directors. The surveys consisted of questions pertaining to residency program characteristics. Sixty-three graduating third-year residents, 51 residency program directors, and 18 pediatric dermatology fellowship program directors responded. Residents in programs with one or more full-time pediatric dermatologist were more likely to feel very competent treating children and were more likely to be somewhat or extremely satisfied with their pediatric curriculums than residents in programs with no full-time pediatric dermatologist (50.0% vs 5.9%, p = 0.002, and 85.3% vs 52.9%, p < 0.001, respectively). Residents in programs with no full-time pediatric dermatologist were the only residents who were somewhat or extremely dissatisfied with their pediatric training. Residency program directors were more satisfied with their curriculums when there was one or more pediatric dermatologist on staff (p < 0.01). Residents in programs with pediatric dermatology fellowships were much more likely to report being extremely satisfied than residents in programs without a pediatric dermatology fellowship (83.3% vs 21.2%; p < 0.001). The results of this survey support the need for dermatology residency programs to continue to strengthen their pediatric dermatology curriculums, especially through the recruitment of full-time pediatric dermatologists. © 2013 Wiley Periodicals, Inc.

Low NOx Heavy Fuel Combustor Concept Program

NASA Technical Reports Server (NTRS)

Novick, A. S.; Troth, D. L.

1981-01-01

The development of the technology required to operate an industrial gas turbine combustion system on minimally processed, heavy petroleum or residual fuels having high levels of fuel-bound nitrogen (FBN) while producing acceptable levels of exhaust emissions is discussed. Three combustor concepts were designed and fabricated. Three fuels were supplied for the combustor test demonstrations: a typical middle distillate fuel, a heavy residual fuel, and a synthetic coal-derived fuel. The primary concept was an air staged, variable-geometry combustor designed to produce low emissions from fuels having high levels of FBN. This combustor used a long residence time, fuel-rich primary combustion zone followed by a quick-quench air mixer to rapidly dilute the fuel rich products for the fuel-lean final burnout of the fuel. This combustor, called the rich quench lean (RQL) combustor, was extensively tested using each fuel over the entire power range of the model 570 K engine. Also, a series of parameteric tests was conducted to determine the combustor's sensitivity to rich-zone equivalence ratio, lean-zone equivalence ratio, rich-zone residence time, and overall system pressure drop. Minimum nitrogen oxide emissions were measured at 50 to 55 ppmv at maximum continuous power for all three fuels. Smoke was less than a 10 SAE smoke number.

Decoding the Role of Water Dynamics in Ligand-Protein Unbinding: CRF1R as a Test Case.

PubMed

Bortolato, Andrea; Deflorian, Francesca; Weiss, Dahlia R; Mason, Jonathan S

2015-09-28

The residence time of a ligand-protein complex is a crucial aspect in determining biological effect in vivo. Despite its importance, the prediction of ligand koff still remains challenging for modern computational chemistry. We have developed aMetaD, a fast and generally applicable computational protocol to predict ligand-protein unbinding events using a molecular dynamics (MD) method based on adiabatic-bias MD and metadynamics. This physics-based, fully flexible, and pose-dependent ligand scoring function evaluates the maximum energy (RTscore) required to move the ligand from the bound-state energy basin to the next. Unbinding trajectories are automatically analyzed and translated into atomic solvation factor (SF) values representing the water dynamics during the unbinding event. This novel computational protocol was initially tested on two M3 muscarinic receptor and two adenosine A2A receptor antagonists and then evaluated on a test set of 12 CRF1R ligands. The resulting RTscores were used successfully to classify ligands with different residence times. Additionally, the SF analysis was used to detect key differences in the degree of accessibility to water molecules during the predicted ligand unbinding events. The protocol provides actionable working hypotheses that are applicable in a drug discovery program for the rational optimization of ligand binding kinetics.

NANEX: Process design and optimization.

PubMed

Baumgartner, Ramona; Matić, Josip; Schrank, Simone; Laske, Stephan; Khinast, Johannes; Roblegg, Eva

2016-06-15

Previously, we introduced a one-step nano-extrusion (NANEX) process for transferring aqueous nano-suspensions into solid formulations directly in the liquid phase. Nano-suspensions were fed into molten polymers via a side-feeding device and excess water was eliminated via devolatilization. However, the drug content in nano-suspensions is restricted to 30 % (w/w), and obtaining sufficiently high drug loadings in the final formulation requires the processing of high water amounts and thus a fundamental process understanding. To this end, we investigated four polymers with different physicochemical characteristics (Kollidon(®) VA64, Eudragit(®) E PO, HPMCAS and PEG 20000) in terms of their maximum water uptake/removal capacity. Process parameters as throughput and screw speed were adapted and their effect on the mean residence time and filling degree was studied. Additionally, one-dimensional discretization modeling was performed to examine the complex interactions between the screw geometry and the process parameters during water addition/removal. It was established that polymers with a certain water miscibility/solubility can be manufactured via NANEX. Long residence times of the molten polymer in the extruder and low filling degrees in the degassing zone favored the addition/removal of significant amounts of water. The residual moisture content in the final extrudates was comparable to that of extrudates manufactured without water. Copyright © 2016 Elsevier B.V. All rights reserved.

41 CFR 302-11.5 - To be reimbursed for expenses incurred in my residence transactions, must I occupy the residence...

Code of Federal Regulations, 2010 CFR

2010-07-01

... residence transactions, must I occupy the residence at the time I am notified of my transfer? Yes, to be... expenses incurred in my residence transactions, must I occupy the residence at the time I am notified of my transfer? 302-11.5 Section 302-11.5 Public Contracts and Property Management Federal Travel Regulation...

41 CFR 302-11.5 - To be reimbursed for expenses incurred in my residence transactions, must I occupy the residence...

Code of Federal Regulations, 2013 CFR

2013-07-01

... residence transactions, must I occupy the residence at the time I am notified of my transfer? Yes, to be... expenses incurred in my residence transactions, must I occupy the residence at the time I am notified of my transfer? 302-11.5 Section 302-11.5 Public Contracts and Property Management Federal Travel Regulation...

41 CFR 302-11.5 - To be reimbursed for expenses incurred in my residence transactions, must I occupy the residence...

Code of Federal Regulations, 2014 CFR

2014-07-01

... residence transactions, must I occupy the residence at the time I am notified of my transfer? Yes, to be... expenses incurred in my residence transactions, must I occupy the residence at the time I am notified of my transfer? 302-11.5 Section 302-11.5 Public Contracts and Property Management Federal Travel Regulation...

41 CFR 302-11.5 - To be reimbursed for expenses incurred in my residence transactions, must I occupy the residence...

Code of Federal Regulations, 2012 CFR

2012-07-01

... residence transactions, must I occupy the residence at the time I am notified of my transfer? Yes, to be... expenses incurred in my residence transactions, must I occupy the residence at the time I am notified of my transfer? 302-11.5 Section 302-11.5 Public Contracts and Property Management Federal Travel Regulation...

41 CFR 302-11.5 - To be reimbursed for expenses incurred in my residence transactions, must I occupy the residence...

Code of Federal Regulations, 2011 CFR

2011-07-01

... residence transactions, must I occupy the residence at the time I am notified of my transfer? Yes, to be... expenses incurred in my residence transactions, must I occupy the residence at the time I am notified of my transfer? 302-11.5 Section 302-11.5 Public Contracts and Property Management Federal Travel Regulation...

Resident duty hours in Canada: a survey and national statement

PubMed Central

2014-01-01

Physicians in general, and residents in particular, are adapting to duty schedules in which they have fewer continuous work hours; however, there are no Canadian guidelines on duty hours restrictions. To better inform resident duty hour policy in Canada, we set out to prepare a set of recommendations that would draw upon evidence reported in the literature and reflect the experiences of resident members of the Canadian Association of Internes and Residents (CAIR). A survey was prepared and distributed electronically to all resident members of CAIR. A total of 1796 eligible residents participated in the survey. Of those who responded, 38% (601) reported that they felt they could safely provide care for up to 16 continuous hours, and 20% (315) said that 12 continuous hours was the maximum period during which they could safely provide care (n = 1592). Eighty-two percent (1316) reported their perception that the quality of care they had provided suffered because of the number of consecutive hours worked (n = 1598). Only 52% (830) had received training in handover (n = 1594); those who had received such training reported that it was commonly provided through informal modelling. On the basis of these data and the existing literature, CAIR recommends that resident duty hours be managed in a way that does not endanger the health of residents or patients; does not impair education; is flexible; and does not violate ethical or legal standards. Further, residents should be formally trained in handover skills and alternative duty hour models. PMID:25559388

Resident duty hours in Canada: a survey and national statement.

PubMed

Masterson, Mark F; Shrichand, Pankaj; Maniate, Jerry M

2014-01-01

Physicians in general, and residents in particular, are adapting to duty schedules in which they have fewer continuous work hours; however, there are no Canadian guidelines on duty hours restrictions. To better inform resident duty hour policy in Canada, we set out to prepare a set of recommendations that would draw upon evidence reported in the literature and reflect the experiences of resident members of the Canadian Association of Internes and Residents (CAIR). A survey was prepared and distributed electronically to all resident members of CAIR. A total of 1796 eligible residents participated in the survey. Of those who responded, 38% (601) reported that they felt they could safely provide care for up to 16 continuous hours, and 20% (315) said that 12 continuous hours was the maximum period during which they could safely provide care (n=1592). Eighty-two percent (1316) reported their perception that the quality of care they had provided suffered because of the number of consecutive hours worked (n=1598). Only 52% (830) had received training in handover (n=1594); those who had received such training reported that it was commonly provided through informal modelling. On the basis of these data and the existing literature, CAIR recommends that resident duty hours be managed in a way that does not endanger the health of residents or patients; does not impair education; is flexible; and does not violate ethical or legal standards. Further, residents should be formally trained in handover skills and alternative duty hour models.

Reconstructing the Paleo-Limnologic Evolution of Lake Bonney, Antarctica using Dissolved Noble Gases

NASA Astrophysics Data System (ADS)

Warrier, R. B.; Castro, M.; Hall, C. M.; Kenig, F. P.; Doran, P. T.

2013-12-01

The McMurdo Dry Valleys, situated on the western coast of the Ross Sea are the largest ice-free region in Antarctica. Lake Bonney (LB), located in western Taylor valley, one of the main east-west dry valleys, has two lobes, East Lake Bonney (ELB) and West Lake Bonney (WLB), which are separated by a narrow straight with a ~13 m deep sill. Because the evolution of LB is ultimately controlled by climate and because there are no reliable millennial-scale continental records of climate other than the Taylor Dome ice core in this region of Antarctica, a number of studies have reconstructed the paleolimnologic history of LB using diverse tools to try to reconstruct the history of the lake, and thus, the climate evolution in this area. However, many open questions remain with respect to the paleo-limnologic evolution of LB. To further place constraints on the evolution of LB, we analyzed 23 lake samples collected between 5 and ~40 m depth from both ELB and WLB for He and Ar concentrations as well as isotopic ratios. Preliminary results show that samples present He excesses up to two and three orders of magnitude with respect to air saturated water (ASW) in ELB and WLB, respectively. While He excesses generally increase with depth in WLB suggesting accumulation of 4He over time, a similar correlation with depth is not observed for ELB samples, indicating a more complex evolutionary history in this lobe. Measured R/Ra He isotopic ratios, where Ra is the atmospheric 3He/4He ratio, vary between 0.20-0.61 and 0.16-0.22 for ELB and WLB respectively, and indicate that observed He excesses are predominantly crustal in origin, with a small (<~5%) mantle contribution. In contrast, measured 40Ar/36Ar ratios indicate that Ar concentrations at all depths in ELB are atmospheric in origin while WLB samples below the sill indicate addition of excess 40Ar, likely of radiogenic origin. Preliminary estimates of water residence times based on measured He excesses and crustal production ratios from basement rocks point to maximum water ages of ~5 kyrs and ~500 kyrs for the deep waters of ELB and WLB, respectively. Similarly, a maximum residence time of ~500 kyrs was obtained for bottom waters of WLB assuming a crustal origin for the observed excess 40Ar. These preliminary age results are maximum estimations and assume that all He and Ar excesses are entirely of crustal origin. Our preliminary results indicate that the WLB waters have been isolated from the atmosphere for a much longer period of time than ELB waters and point to a very different evolution of both lobes. In addition, these maximum WLB ages obtained are much younger than previously thought (~1-5 Ma).

Residence time control on hot moments of net nitrate production and uptake in the hyporheic zone

USGS Publications Warehouse

Briggs, Martin A.; Lautz, Laura K.; Hare, Danielle K.

2014-01-01

moments of net production and uptake, enhancing NO3- production as residence times approach the anaerobic threshold, and changing zones of net NO3- production to uptake as residence times increase past the net sink threshold. The anaerobic and net sink thresholds for beaver-influenced streambed morphology occur at much shorter residence times (1.3 h and 2.3 h, respectively) compared to other documented hyporheic systems, and the net sink threshold compares favorably to the lower boundary of the anaerobic threshold determined for this system with the new oxygen Damkohler number. The consistency of the residence time threshold values of NO3- cycling in this study, despite environmental variability and disparate morphology, indicates that NO3- hot moment dynamics are primarily driven by changes in physical hydrology and associated residence times.

The Residence Time of Water in the Atmosphere Revisited

NASA Astrophysics Data System (ADS)

van der Ent, Ruud; Tuinenburg, Obbe

2017-04-01

This paper revisits the knowledge on the residence time of water in the atmosphere. Based on state-of-the-art data of the hydrological cycle we derive a global average residence time of 8.9±0.4 days (uncertainty given as one standard deviation). We use two different atmospheric moisture tracking models (WAM-2layers and 3D-Trajectories) to obtain atmospheric residence time characteristics in time and space. The tracking models estimate the global average residence time to be around 8.5 days based on ERA-Interim data. We conclude that the statement of a recent study that the global average residence time of water in the atmosphere is 4-5 days, is not correct. We derive spatial maps of residence time, attributed to evaporation and precipitation, and age of atmospheric water, showing that there are different ways of looking at temporal characteristics of atmospheric water. Longer evaporation residence times often indicate larger distances towards areas of high precipitation. From our analysis we find that the residence time over the ocean is about 2 days lower than over land. It can be seen that in winter, the age of atmospheric moisture tends to be much lower than in summer. On the Northern Hemisphere, due to the contrast in ocean-to-land temperature and associated evaporation rates, the age of atmospheric moisture increases following atmospheric moisture flow inland in winter, and decreases in summer. Looking at the probability density functions of atmospheric residence time for precipitation and evaporation we find long-tailed distributions with the median around 5 days. Overall, our research confirms the 8-10 days traditional estimate for the global mean residence time of atmospheric water, and our research contributes to a more complete view on the characteristics of the turnover of water in the atmosphere in time and space. In the light of this session, our results show that the turnover of water is relatively fast, but water travels quite far, which explains why it is so hard to make both weather and hydrological predictions on time spans longer than a week.

Data Validation Package May 2016 Groundwater Sampling at the Lakeview, Oregon, Processing Site August 2016

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

Linard, Joshua; Hall, Steve

2016-08-01

This biennial event includes sampling five groundwater locations (four monitoring wells and one domestic well) at the Lakeview, Oregon, Processing Site. For this event, the domestic well (location 0543) could not be sampled because no one was in residence during the sampling event (Note: notification was provided to the resident prior to the event). Per Appendix A of the Groundwater Compliance Action Plan, sampling is conducted to monitor groundwater quality on a voluntary basis. Sampling and analyses were conducted as specified in the Sampling and Analysis Plan for U.S. Department of Energy Office of Legacy Management Sites (LMS/PRO/S04351, continually updated).more » One duplicate sample was collected from location 0505. Water levels were measured at each sampled monitoring well. The constituents monitored at the Lakeview site are manganese and sulfate. Monitoring locations that exceeded the U.S. Environmental Protection Agency (EPA) Secondary Maximum Contaminant Levels for these constituents are listed in Table 1. Review of time-concentration graphs included in this report indicate that manganese and sulfate concentrations are consistent with historical measurements.« less

A pilot study of human response to general aviation aircraft noise

NASA Technical Reports Server (NTRS)

Stearns, J.; Brown, R.; Neiswander, P.

1983-01-01

A pilot study, conducted to evaluate procedures for measuring the noise impact and community response to general aviation aircraft around Torrance Municipal Airport, a typical large GA airport, employed Torrance Airport's computer-based aircraft noise monitoring system, which includes nine permanent monitor stations surrounding the airport. Some 18 residences near these monitor stations were equipped with digital noise level recorders to measure indoor noise levels. Residents were instructed to fill out annoyance diaries for periods of 5-6 days, logging the time of each annoying aircraft overflight noise event and judging its degree of annoyance on a seven-point scale. Among the noise metrics studied, the differential between outdoor maximum A-weighted noise level of the aircraft and the outdoor background level showed the best correlation with annoyance; this correlation was clearly seen at only high noise levels, And was only slightly better than that using outdoor aircraft noise level alone. The results indicate that, on a national basis, a telephone survey coupled with outdoor noise measurements would provide an efficient and practical means of assessing the noise impact of general aviation aircraft.

Estimation of southern resident killer whale exposure to exhaust emissions from whale-watching vessels and potential adverse health effects and toxicity thresholds.

PubMed

Lachmuth, Cara L; Barrett-Lennard, Lance G; Steyn, D Q; Milsom, William K

2011-04-01

Southern resident killer whales in British Columbia and Washington are exposed to heavy vessel traffic. This study investigates their exposure to exhaust gases from whale-watching vessels by using a simple dispersion model incorporating data on whale and vessel behavior, atmospheric conditions, and output of airborne pollutants from the whale-watching fleet based on emissions data from regulatory agencies. Our findings suggest that current whale-watching guidelines are usually effective in limiting pollutant exposure to levels at or just below those at which measurable adverse health effects would be expected in killer whales. However, safe pollutant levels are exceeded under worst-case conditions and certain average-case conditions. To reduce killer whale exposure to exhaust we recommend: vessels position on the downwind side of whales, a maximum of 20 whale-watching vessels should be within 800 m at any given time, viewing periods should be limited, and current whale-watch guidelines and laws should be enforced. Copyright © 2011. Published by Elsevier Ltd.

Effects of zebra mussels on food webs: Interactions with juvenile bluegill and water residence time

USGS Publications Warehouse

Richardson, W.B.; Bartsch, L.A.

1997-01-01

We evaluated how water residence time mediated the impact of zebra mussels Dreissena polymorpha and bluegill sunfish Lepomis macrochirus on experimental food webs established in 1100-1 outdoor mesocosms. Water residence time was manipulated as a surrogate for seston resupply - a critical variable affecting growth and survival of suspension-feeding invertebrates. We used a 2 x 2 x 2 factorial experimental design with eight treatment combinations (3 replicates/treatment) including the presence or absence of Dreissena (2000 per m2), juvenile bluegill (40 per mesocosm), and short (1100 1 per d) or long (220 1 per d) water residence time. Measures of seston concentration (chlorophyll a, turbidity and suspended solids) were greater in the short- compared to long water-residence mesocosms, but intermediate in short water-residence mesocosms containing Dreissena. Abundance of rotifers (Keratella and Polyarthra) was reduced in Dreissena mesocosms and elevated in short residence time mesocosms. Cladocera abundance, in general, was unaffected by the presence of Dreissena; densities were higher in short-residence time mesocosms, and reduced in the presence of Lepomis. The growth of juvenile Lepomis were unaffected by Dreissena because of abundant benthic food. The final total mass of Dreissena was significantly greater in short- than long-residence mesocosms. Impacts of Dreissena on planktonic food webs may not only depend on the density of zebra mussels but also on the residence time of the surrounding water and the resupply of seston. ?? 1997 Kluwer Academic Publishers.

Staged fluidized bed

DOEpatents

Mallon, Richard G.

1984-01-01

Method and apparatus for narrowing the distribution of residence times of any size particle and equalizing the residence times of large and small particles in fluidized beds. Particles are moved up one fluidized column and down a second fluidized column with the relative heights selected to equalize residence times of large and small particles. Additional pairs of columns are staged to narrow the distribution of residence times and provide complete processing of the material.

DNA residence time is a regulatory factor of transcription repression

PubMed Central

Clauß, Karen; Popp, Achim P.; Schulze, Lena; Hettich, Johannes; Reisser, Matthias; Escoter Torres, Laura; Uhlenhaut, N. Henriette

2017-01-01

Abstract Transcription comprises a highly regulated sequence of intrinsically stochastic processes, resulting in bursts of transcription intermitted by quiescence. In transcription activation or repression, a transcription factor binds dynamically to DNA, with a residence time unique to each factor. Whether the DNA residence time is important in the transcription process is unclear. Here, we designed a series of transcription repressors differing in their DNA residence time by utilizing the modular DNA binding domain of transcription activator-like effectors (TALEs) and varying the number of nucleotide-recognizing repeat domains. We characterized the DNA residence times of our repressors in living cells using single molecule tracking. The residence times depended non-linearly on the number of repeat domains and differed by more than a factor of six. The factors provoked a residence time-dependent decrease in transcript level of the glucocorticoid receptor-activated gene SGK1. Down regulation of transcription was due to a lower burst frequency in the presence of long binding repressors and is in accordance with a model of competitive inhibition of endogenous activator binding. Our single molecule experiments reveal transcription factor DNA residence time as a regulatory factor controlling transcription repression and establish TALE-DNA binding domains as tools for the temporal dissection of transcription regulation. PMID:28977492

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.

Flood of September 12-13, 1982 in Gibson, Carroll, and Madison Counties, western Tennessee

USGS Publications Warehouse

Robbins, Clarence H.; Gamble, Charles R.; Bingham, Roy H.

1986-01-01

Intense rainfall on September 12-13, 1982, caused severe local flooding along many streams in Gibson County in western Tennessee. The rainfall resulted from remnants of Hurricane Chris combining with a cool front moving across the western half of the State. A maximum 1-hr rainfall intensity of 3.3 in was recorded at Humboldt. Peak discharge exceeded the 100-yr flood on many small streams. The floods caused three deaths and about 15.3 million dollars damage to crops, roads and bridges, businesses, and residential areas. Long-time residents of Gibson County reported that stream stages have not been as high since at least 1922. (USGS)

The antimicrobial peptides lactoferricin B and magainin 2 cross over the bacterial cytoplasmic membrane and reside in the cytoplasm.

PubMed

Haukland, H H; Ulvatne, H; Sandvik, K; Vorland, L H

2001-11-23

The localization of immunolabelled antimicrobial peptides was studied using transmission electron microscopy. Staphylococcus aureus and Escherichia coli were exposed to lactoferricin B (17-41), lactoferricin B (17-31) and D-lactoferricin B (17-31). E. coli was also exposed to cecropin P1 and magainin 2. The lactoferricins were found in the cytoplasm of both bacteria. In S. aureus the amount of cytoplasmic lactoferricin B (17-41) was time- and concentration-dependent, reaching a maximum within 30 min. Cecropin P1 was confined to the cell wall, while magainin 2 was found in the cytoplasm of E. coli. The finding of intracellularly localized magainin is not reported previously.

Using soil residence time to delineate spatial and temporal patterns of transient landscape response

NASA Astrophysics Data System (ADS)

Almond, Peter; Roering, Josh; Hales, T. C.

2007-09-01

On hillslopes the balance between soil transport and production determines local soil thickness and the age distribution of particles that comprise the soil (where age refers to the time elapsed since detachment from bedrock). The mean of this age distribution is defined as the residence time, and in a landscape with time-invariant topography (i.e., morphologic steady state), the spatial uniformity of soil production ensures that the residence time of soils is spatially invariant. Thus, given constant soil-forming factors, spatial variation of soil properties reflects differences in residence time driven by nonuniform soil production. Spatially extensive soil databases, which are often freely available in electronic form, provide a cheap and accessible means of analyzing patterns of soil residence time and quantifying landscape dynamics. Here we use a soil chronosequence to calibrate a chronofunction describing the reddening of soils in the Oregon Coast Range, which is then used to quantify the spatial distribution of soil residence time. In contrast to the popular conception that the Oregon Coast Range experiences uniform erosion, we observe systematic variations in soil residence time driven by stream capture, deep-seated landsliding, and lateral channel migration. Large, contiguous areas with short residence time soils (hue 10YR) occur west of the Siuslaw River-Long Tom Creek drainage divide, whereas soil patches with redder hues of 7.5YR or 5YR indicate longer residence times and transient landscape conditions. These zones of red soils (5YR) occur east of the Siuslaw-Long Tom divide, coinciding with low-gradient ridge and valley topography and deeply alluviated valleys resulting from drainage reversal in the Quaternary. Patches of red soils are also associated with deep-seated landslides at various locations in our study area. Our calculated soil residence times appear subject to overestimation resulting from limitations of the simple weathering index used here and chronofunction calibration uncertainties. Nonetheless, our soil residence time estimates appear accurate to within an order of magnitude and provide a useful constraint on landscape dynamics over geomorphic timescales.

5 CFR 534.203 - Maximum stipends.

Code of Federal Regulations, 2010 CFR

2010-01-01

... (minus 3 steps). L-9 First year postgraduate (Ph. D.) GS-11-1 (minus 3 steps). L-9 First year medical or dental residency GS-11-1 (minus 3 steps). L-10 Second year postdoctoral (Ph. D.) GS-12-1 (minus 3 steps...

Environmental Influences on Patterns of Vertical Movement and Site Fidelity of Grey Reef Sharks (Carcharhinus amblyrhynchos) at Aggregation Sites

PubMed Central

Vianna, Gabriel M. S.; Meekan, Mark G.; Meeuwig, Jessica J.; Speed, Conrad W.

2013-01-01

We used acoustic telemetry to describe the patterns of vertical movement, site fidelity and residency of grey reef sharks (Carcharhinus amblyrhynchos) on the outer slope of coral reefs in Palau, Micronesia, over a period of two years and nine months. We tagged 39 sharks (mostly adult females) of which 31 were detected regularly throughout the study. Sharks displayed strong inter-annual residency with greater attendance at monitored sites during summer than winter months. More individuals were detected during the day than at night. Mean depths of tagged sharks increased from 35 m in winter to 60 m in spring following an increase in water temperature at 60 m, with maximum mean depths attained when water temperatures at 60 m stabilised around 29°C. Sharks descended to greater depths and used a wider range of depths around the time of the full moon. There were also crepuscular cycles in mean depth, with sharks moving into shallower waters at dawn and dusk each day. We suggest that daily, lunar and seasonal cycles in vertical movement and residency are strategies for optimising both energetic budgets and foraging behaviour. Cyclical patterns of movement in response to environmental variables might affect the susceptibility of reef sharks to fishing, a consideration that should be taken into account in the implementation of conservation strategies. PMID:23593193

Environmental influences on patterns of vertical movement and site fidelity of grey reef sharks (Carcharhinus amblyrhynchos) at aggregation sites.

PubMed

Vianna, Gabriel M S; Meekan, Mark G; Meeuwig, Jessica J; Speed, Conrad W

2013-01-01

We used acoustic telemetry to describe the patterns of vertical movement, site fidelity and residency of grey reef sharks (Carcharhinus amblyrhynchos) on the outer slope of coral reefs in Palau, Micronesia, over a period of two years and nine months. We tagged 39 sharks (mostly adult females) of which 31 were detected regularly throughout the study. Sharks displayed strong inter-annual residency with greater attendance at monitored sites during summer than winter months. More individuals were detected during the day than at night. Mean depths of tagged sharks increased from 35 m in winter to 60 m in spring following an increase in water temperature at 60 m, with maximum mean depths attained when water temperatures at 60 m stabilised around 29°C. Sharks descended to greater depths and used a wider range of depths around the time of the full moon. There were also crepuscular cycles in mean depth, with sharks moving into shallower waters at dawn and dusk each day. We suggest that daily, lunar and seasonal cycles in vertical movement and residency are strategies for optimising both energetic budgets and foraging behaviour. Cyclical patterns of movement in response to environmental variables might affect the susceptibility of reef sharks to fishing, a consideration that should be taken into account in the implementation of conservation strategies.

General surgery training without laparoscopic surgery fellows: the impact on residents and patients.

PubMed

Linn, John G; Hungness, Eric S; Clark, Sara; Nagle, Alexander P; Wang, Edward; Soper, Nathaniel J

2011-10-01

To evaluate resident case volume after discontinuation of a laparoscopic surgery fellowship, and to examine disparities in patient care over the same time period. Resident case logs were compared for a 2-year period before and 1 year after discontinuing the fellowship, using a 2-sample t test. Databases for bariatric and esophageal surgery were reviewed to compare operative time, length of stay (LOS), and complication rate by resident or fellow over the same time period using a 2-sample t test. Increases were seen in senior resident advanced laparoscopic (Mean Fellow Year = 21 operations vs Non Fellow Year = 61, P < 0.01), esophageal (1 vs 11, P < .01) and bariatric volume (9 vs 36, P < .01). Junior resident laparoscopic volume increased (P < 0.05). No difference in LOS or complication rate was seen with resident vs fellow assistant. Operative time was greater for gastric bypass with resident assistant (152 ± 51 minutes vs 138 ± 53, P < .05). Discontinuing a laparoscopic fellowship significantly increases resident case volume in laparoscopic surgery. Operative time for complex operations may increase in the absence of a fellow. Other patient outcomes are not affected by this change. Copyright © 2011 Mosby, Inc. All rights reserved.

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

Kaplan, C.R.; Shaddix, C.R.; Smyth, K.C.

This paper presents time-dependent numerical simulations of both steady and time-varying CH{sub 4}/air diffusion flames to examine the differences in combustion conditions which lead to the observed enhancement in soot production in the flickering flames. The numerical model solves the two-dimensional, time-dependent, reactive-flow Navier-Stokes equations coupled with submodels for soot formation and radiation transport. Qualitative comparisons between the experimental and computed steady flame show good agreement for the soot burnout height and overall flame shape except near the burner lip. Quantitative comparisons between experimental and computed radial profiles of temperature and soot volume fraction for the steady flame show goodmore » to excellent agreement at mid-flame heights, but some discrepancies near the burner lip and at high flame heights. For the time-varying CH{sub 4}/air flame, the simulations successfully predict that the maximum soot concentration increases by over four times compared to the steady flame with the same mean fuel and air velocities. By numerically tracking fluid parcels in the flowfield, the temperature and stoichiometry history were followed along their convective pathlines. Results for the pathline which passes through the maximum sooting region show that flickering flames exhibit much longer residence times during which the local temperatures and stoichiometries are favorable for soot production. The simulations also suggest that soot inception occurs later in flickering flames, and at slightly higher temperatures and under somewhat leaner conditions compared to the steady flame. The integrated soot model of Syed et al., which was developed from a steady CH{sub 4}/air flame, successfully predicts soot production in the time-varying CH{sub 4}/air flames.« less

Missing links in oral health care for frail elderly people.

PubMed

MacEntee, Michael I

2006-06-01

A national interdisciplinary strategy is needed to address the comprehensive oral health care needs of frail elderly people residing in long-term care facilities. Reasonable care within the social and personal context of frailty encompasses active prevention of disease augmented by necessary restorative treatment, provided with sensitivity to a person"s propensity to seek care. Typically, dental emergencies are managed quite well in longterm care facilities, either by treating the resident on site or by transporting the resident to a local clinician. In addition, facility administrators are usually well aware of their legal responsibilities to provide diagnostic services to residents before disease or dysfunction causes irreparable damage. Consequently, many facilities have arrangements with dental hygienists, dentists or denturists for periodic clinical assessment of all residents, or they seek help at the first sign of trouble. On the other hand, effective, widely accepted strategies for assisting frail residents with daily oral hygiene are lacking, and in many regions across the country it is overly difficult for frail residents with severe oral impairment or dysfunction to receive appropriate care and treatment. A cooperative effort from many disciplines will be needed to provide these missing links in Canadian health services and to realize the principle of providing maximum benefit to the least advantaged in society.

Maintaining social cohesion is a more important determinant of patch residence time than maximizing food intake rate in a group-living primate, Japanese macaque (Macaca fuscata).

PubMed

Kazahari, Nobuko

2014-04-01

Animals have been assumed to employ an optimal foraging strategy (e.g., rate-maximizing strategy). In patchy food environments, intake rate within patches is positively correlated with patch quality, and declines as patches are depleted through consumption. This causes patch-leaving and determines patch residence time. In group-foraging situations, patch residence times are also affected by patch sharing. Optimal patch models for groups predict that patch residence times decrease as the number of co-feeding animals increases because of accelerated patch depletion. However, group members often depart patches without patch depletion, and their patch residence time deviates from patch models. It has been pointed out that patch residence time is also influenced by maintaining social proximity with others among group-living animals. In this study, the effects of maintaining social cohesion and that of rate-maximizing strategy on patch residence time were examined in Japanese macaques (Macaca fuscata). I hypothesized that foragers give up patches to remain in the proximity of their troop members. On the other hand, foragers may stay for a relatively long period when they do not have to abandon patches to follow the troop. In this study, intake rate and foraging effort (i.e., movement) did not change during patch residency. Macaques maintained their intake rate with only a little foraging effort. Therefore, the patches were assumed to be undepleted during patch residency. Further, patch residence time was affected by patch-leaving to maintain social proximity, but not by the intake rate. Macaques tended to stay in patches for short periods when they needed to give up patches for social proximity, and remained for long periods when they did not need to leave to keep social proximity. Patch-leaving and patch residence time that prioritize the maintenance of social cohesion may be a behavioral pattern in group-living primates.

A METHOD TO INCORPORATE ECOLOGY INTO RESIDENCE TIME OF CHEMICALS IN EMBAYMENTS: LOCAL EFFECT TIME

EPA Science Inventory

Residence times are classically defined by the physical and chemical aspects of water bodies rather than by their ecological implications. Therefore, a more clear and direct connection between the residence times and ecological effects is necessary to quantitatively relate these ...

Fully integrated sub 100ps photon counting platform

NASA Astrophysics Data System (ADS)

Buckley, S. J.; Bellis, S. J.; Rosinger, P.; Jackson, J. C.

2007-02-01

Current state of the art high resolution counting modules, specifically designed for high timing resolution applications, are largely based on a computer card format. This has tended to result in a costly solution that is restricted to the computer it resides in. We describe a four channel timing module that interfaces to a computer via a USB port and operates with a resolution of less than 100 picoseconds. The core design of the system is an advanced field programmable gate array (FPGA) interfacing to a precision time interval measurement module, mass memory block and a high speed USB 2.0 serial data port. The FPGA design allows the module to operate in a number of modes allowing both continuous recording of photon events (time-tagging) and repetitive time binning. In time-tag mode the system reports, for each photon event, the high resolution time along with the chronological time (macro time) and the channel ID. The time-tags are uploaded in real time to a host computer via a high speed USB port allowing continuous storage to computer memory of up to 4 millions photons per second. In time-bin mode, binning is carried out with count rates up to 10 million photons per second. Each curve resides in a block of 128,000 time-bins each with a resolution programmable down to less than 100 picoseconds. Each bin has a limit of 65535 hits allowing autonomous curve recording until a bin reaches the maximum count or the system is commanded to halt. Due to the large memory storage, several curves/experiments can be stored in the system prior to uploading to the host computer for analysis. This makes this module ideal for integration into high timing resolution specific applications such as laser ranging and fluorescence lifetime imaging using techniques such as time correlated single photon counting (TCSPC).

Comfort and experience with online learning: trends over nine years and associations with knowledge

PubMed Central

2014-01-01

Background Some evidence suggests that attitude toward computer-based instruction is an important determinant of success in online learning. We sought to determine how comfort using computers and perceptions of prior online learning experiences have changed over the past decade, and how these associate with learning outcomes. Methods Each year from 2003–2011 we conducted a prospective trial of online learning. As part of each year’s study, we asked medicine residents about their comfort using computers and if their previous experiences with online learning were favorable. We assessed knowledge using a multiple-choice test. We used regression to analyze associations and changes over time. Results 371 internal medicine and family medicine residents participated. Neither comfort with computers nor perceptions of prior online learning experiences showed a significant change across years (p > 0.61), with mean comfort rating 3.96 (maximum 5 = very comfortable) and mean experience rating 4.42 (maximum 6 = strongly agree [favorable]). Comfort showed no significant association with knowledge scores (p = 0.39) but perceptions of prior experiences did, with a 1.56% rise in knowledge score for a 1-point rise in experience score (p = 0.02). Correlations among comfort, perceptions of prior experiences, and number of prior experiences were all small and not statistically significant. Conclusions Comfort with computers and perceptions of prior experience with online learning remained stable over nine years. Prior good experiences (but not comfort with computers) demonstrated a modest association with knowledge outcomes, suggesting that prior course satisfaction may influence subsequent learning. PMID:24985690

Graduates-of-foreign-dermatology residencies and military dermatology residencies and women in academic dermatology.

PubMed

Wu, Jashin J; Davis, Kristy F; Ramirez, Claudia C; Alonso, Carol A; Berman, Brian; Tyring, Stephen K

2009-05-15

It is well known that there is a growing shortage of academic dermatologists in the U.S. The number of graduates of foreign dermatology residencies (GFDR) and graduates of military dermatology residencies (GMDR) who take full-time academic dermatology positions are currently unknown. It is likely that a higher proportion of GFDRs and GMDRs are more likely to enter academics and practice medical dermatology. The percentage of women in academic dermatology has not been reported since 1994. To determine the total number of GFDRs, GMDRs, and women who are full-time faculty members at U.S. dermatology residency programs. The educational background of all full-time faculty members of the 107 U.S. dermatology residency programs that were active as of December 2004 were determined through extensive Internet searches, telephone, and email correspondences with residency coordinators and faculty members. Pure PhDs, physicians who did not complete a dermatology residency program at an allopathic school, PharmDs, DDSs, and FNPs were excluded. The University of Puerto Rico was not considered a foreign residency program. As of December 2004, there were 988 full-time dermatology faculty members in the US, 813 of which met our inclusion criteria. There were 30 GFDRs, accounting for 3.7 percent of full-time academic dermatologists. There were 29 GMDRs, accounting for 3.6 percent of all full-time academic dermatologists. Women accounted for 44.42 percent of academic dermatologists and 15.9 percent (14/107) of dermatology chairs/chiefs. GFDRs, GMDRs, and women comprise important proportions of full-time faculty members at U.S. dermatology residency programs.

Comparable operative times with and without surgery resident participation.

PubMed

Uecker, John; Luftman, Kevin; Ali, Sadia; Brown, Carlos

2013-01-01

Both physicians and patients may perceive that having surgical residents participate in operative procedures may prolong operations and worsen outcomes. We hypothesized that resident participation would prolong operative times and potentially adversely affect postoperative outcomes. To evaluate the effect of general surgery resident participation in surgical procedures on operative times and postoperative patient outcomes. Retrospective study of general surgery procedures performed during two 1-year time periods, 2007 without residents and 2011 with residents. Procedures included laparoscopic appendectomy and cholecystectomy, thyroidectomy, breast procedure, hernia repair, lower extremity amputation, tunneled venous catheter, and percutaneous endoscopic gastrostomy. The primary outcome was operative time and secondary outcomes included length of stay (LOS) and mortality. Academic general surgery residency program. There were 2280 operative procedures performed during the 2 periods: 1150 with resident involvement (RES group) and 1130 without residents (NORES group). The RES and NORES groups were similar for patient age (42 vs 41, p = 0.14) and male gender (46% vs 45%, p = 0.68), and there was no difference in overall operative time (68min vs 66min, p = 0.58). More specifically there was no difference in operative time (minutes) for specific procedures including laparoscopic appendectomy (67 vs 71, p = 0.8), thyroidectomy (125 vs 109, p = 0.16), breast procedure (38 vs 26, p = 0.79), hernia repair (61 vs 60, p = 0.74), lower extremity amputation (65 vs 77, p = 0.16), tunneled venous catheter (49 vs 47, p = 0.75), and percutaneous endoscopic gastrostomy (49 vs 46, p = 0.76). However, laparoscopic cholecystectomy took slightly longer in the RES group (71 vs 66, p = 0.02). LOS was shorter during the year with resident involvement (2.6 days vs 3.7 days, p = 0.0004) and there was no difference in mortality (0.17% vs 0.35%, p = 0.45). There is no difference in operative time for common general surgery procedures with or without resident involvement. In addition, resident involvement is associated with a decrease in LOS. This information should be used to change physician and patient negative perceptions regarding resident involvement while performing surgical procedures. © 2013 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

The threat of funding cuts for graduate medical education: survey of decision makers.

PubMed

Kozak, R J; Kazzi, A A; Langdorf, M I; Martinez, C T

1997-07-01

To assess the potential actions of medical school deans, graduate medical education (GME) committee chairs, and hospital chief executive officers (CEOs) regarding future funding reductions for residency training. Specifically, institutions with emergency medicine (EM) residencies were surveyed to see whether EM training was disproportionally at risk for reductions. An anonymous 2-page survey was used. Ninety-eight EM residency programs were identified using the American Medical Association Graduate Medical Education Directory 1994-95. Seventy deans, 102 GME chairs, and 97 hospital CEOs were identified. The survey posed a hypothetical 25% forced reduction in residency positions and asked the decision makers for their responses. Options included: 1) proportional reductions of training positions from all residencies, 2) proportional reductions in either primary care or specialty residency positions, or 3) reduction or elimination of specific training programs. The survey asked for a first and second choice of residencies to be reduced or eliminated from an alphabetical list of 17. The survey elicited explanations for each program reduction. 200 (74%) of 269 surveys were returned. Eighty-four responders selected specific residencies to be reduced or eliminated. EM was selected 8 times, making EM the seventh most vulnerable residency to be targeted for reductions. The decision makers who selected proportional reductions chose to reduce across all residencies 32 times, among only the specialty residencies 129 times, and among only the primary care residencies 3 times. In the setting of anticipated residency cuts, favored proportional reductions in specialty residencies would likely affect EM training. However, most GME decision makers with an existing EM residency program do not consider the EM residency a top choice to be reduced or eliminated.

Scheduling in the context of resident duty hour reform

PubMed Central

2014-01-01

Fuelled by concerns about resident health and patient safety, there is a general trend in many jurisdictions toward limiting the maximum duration of consecutive work to between 14 and 16 hours. The goal of this article is to assist institutions and residency programs to make a smooth transition from the previous 24- to 36-hour call system to this new model. We will first give an overview of the main types of coverage systems and their relative merits when considering various aspects of patient care and resident pedagogy. We will then suggest a practical step-by-step approach to designing, implementing, and monitoring a scheduling system centred on clinical and educational needs in the context of resident duty hour reform. The importance of understanding the impetus for change and of assessing the need for overall workflow restructuring will be explored throughout this process. Finally, as a practical example, we will describe a large, university-based teaching hospital network’s transition from a traditional call-based system to a novel schedule that incorporates the new 16-hour duty limit. PMID:25561221

Rosuvastatin pharmacokinetics and pharmacogenetics in Caucasian and Asian subjects residing in the United States.

PubMed

Birmingham, Bruce K; Bujac, Sarah R; Elsby, Robert; Azumaya, Connie T; Zalikowski, Julie; Chen, Yusong; Kim, Kenneth; Ambrose, Helen J

2015-03-01

Systemic exposure to rosuvastatin in Asian subjects living in Japan or Singapore is approximately twice that observed in Caucasian subjects in Western countries or in Singapore. This study was conducted to determine whether pharmacokinetic differences exist among the most populous Asian subgroups and Caucasian subjects in the USA. Rosuvastatin pharmacokinetics was studied in Chinese, Filipino, Asian-Indian, Korean, Vietnamese, Japanese and Caucasian subjects residing in California. Plasma concentrations of rosuvastatin and metabolites after a single 20-mg dose were determined by mass spectrometric detection. The influence of polymorphisms in SLCO1B1 (T521>C [Val174Ala] and A388>G [Asn130Asp]) and in ABCG2 (C421>A [Gln141Lys]) on exposure to rosuvastatin was also assessed. The average rosuvastatin area under the curve from time zero to time of last quantifiable concentration was between 64 and 84 % higher, and maximum drug concentration was between 70 and 98 % higher in East Asian subgroups compared with Caucasians. Data for Asian-Indians was intermediate to these two ethnic groups at 26 and 29 %, respectively. Similar increases in exposure to N-desmethyl rosuvastatin and rosuvastatin lactone were observed. Rosuvastatin exposure was higher in subjects carrying the SLCO1B1 521C allele compared with that in non-carriers of this allele. Similarly, exposure was higher in subjects carrying the ABCG2 421A allele compared with that in non-carriers. Plasma exposure to rosuvastatin and its metabolites was significantly higher in Asian populations residing in the USA compared with Caucasian subjects living in the same environment. This study suggests that polymorphisms in the SLCO1B1 and ABCG2 genes contribute to the variability in rosuvastatin exposure.

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.

Implementation of a "Flipped Classroom" for Neurosurgery Resident Education.

PubMed

Girgis, Fady; Miller, Jonathan P

2018-01-01

Engaging residents across a multiyear training spectrum is challenging given the heterogeneity of experience and limited time available for educational activities. A "flipped classroom" model, in which residents prepare ahead of time for mentored topic discussions, has potential advantages. We implemented a curriculum consisting of topics distributed across the specialty. Weekly, each resident was randomly assigned to research a specific aspect of an assigned topic appropriate to his or her level of experience: junior residents about what characterizes each clinical entity, midlevel residents about when to intervene, and chief residents about how to administer treatment. Residents completed an anonymous survey 6 months after implementation. Board examination performance was assessed before and after implementation. A total of 12 residents participated in the program. Weekly, 1.75±0.40 hours were spent in preparation, with senior residents reporting less time than junior residents. All residents indicated that the accumulation of experience across 7 years of residency was a major advantage of this program, and all preferred it to lectures. Performance on the board examination significantly increased after implementation (from 316±36 to 468±45, p<0.05). The flipped classroom is a viable approach to resident education and is associated with increased engagement and improved performance using validated knowledge-assessment tools.

Land processes lead to surprising patterns in atmospheric residence time

NASA Astrophysics Data System (ADS)

van der Ent, R.; Tuinenburg, O.

2017-12-01

Our research using atmospheric moisture tracking methods shows that the global average atmospheric residence time of evaporation is 8-10 days. This residence time appears to be Gamma distributed with a higher probability of shorter than average residence times and a long tail. As a consequence the median of this residence time is around 5 days. In some places in the world the first few hours/days after evaporation there seems to be a little chance for a moisture particle to precipitate again, which is reflected by a Gamma distribution having a shape parameter below 1. In this study we present global maps of this parameter using different datasets (GLDAS and ERA-Interim). The shape parameter is as such also a measure for the land-atmospheric coupling strength along the path of the atmospheric water particle. We also find that different evaporation components: canopy interception, soil evaporation and transpiration appear to have different residence time distributions. We find a daily cycle in the residence time distribution over land, which is not present over the oceans. In this paper we will show which of the evaporation components is mainly responsible for this daily pattern and thus exhibits the largest daily cycle of land-atmosphere coupling strength.

The Application of Margin in Life Theory in Regard to Attrition and Remediation among Emergency Medicine Residents

ERIC Educational Resources Information Center

Kalynych, Colleen J.

2010-01-01

Medical residency is a time of high stress, long hours, high case loads, fatigue, and lack of free time. Burnout rates among residents have been reported to be between 25-76%. Scant literature exists in regard to resident stress and its impact on learning and attrition during residency. The theory of margin posits that a healthy margin is…

Moving Out: Transition to Non-Residence among Resident Fathers in the United States, 1968-1997

ERIC Educational Resources Information Center

Gupta, Sanjiv; Smock, Pamela J.; Manning, Wendy D.

2004-01-01

This article provides the first individual-level estimates of the change over time in the probability of non-residence for initially resident fathers in the United States. Drawing on the 1968-1997 waves of the Panel Study of Income Dynamics, we used discrete-time event history models to compute the probabilities of non-residence for six 5-year…

Modeling nitrate-nitrogen removal process in first-flush reactor for stormwater treatment.

PubMed

Deng, Zhiqiang; Sun, Shaowei; Gang, Daniel Dianchen

2012-08-01

Stormwater runoff is one of the most common non-point sources of water pollution to rivers, lakes, estuaries, and coastal beaches. While most pollutants and nutrients, including nitrate-nitrogen, in stormwater are discharged into receiving waters during the first-flush period, no existing best management practices (BMPs) are specifically designed to capture and treat the first-flush portion of urban stormwater runoff. This paper presents a novel BMP device for highway and urban stormwater treatment with emphasis on numerical modeling of the new BMP, called first-flush reactor (FFR). A new model, called VART-DN model, for simulation of denitrification process in the designed first-flush reactor was developed using the variable residence time (VART) model. The VART-DN model is capable of simulating various processes and mechanisms responsible for denitrification in the FFR. Based on sensitivity analysis results of model parameters, the denitrification process is sensitive to the temperature correction factor (b), maximum nitrate-nitrogen decay rate (K (max)), actual varying residence time (T (v)), the constant decay rate of denitrifiying bacteria (v (dec)), temperature (T), biomass inhibition constant (K (b)), maximum growth rate of denitrifiying bacteria (v (max)), denitrifying bacteria concentration (X), longitudinal dispersion coefficient (K (s)), and half-saturation constant of dissolved carbon for biomass (K (Car-X)); a 10% increase in the model parameter values causes a change in model root mean square error (RMSE) of -28.02, -16.16, -12.35, 11.44, -9.68, 10.61, -16.30, -9.27, 6.58 and 3.89%, respectively. The VART-DN model was tested using the data from laboratory experiments conducted using highway stormwater and secondary wastewater. Model results for the denitrification process of highway stormwater showed a good agreement with observed data and the simulation error was less than 9.0%. The RMSE and the coefficient of determination for simulating denitrification process of wastewater were 0.5167 and 0.6912, respectively, demonstrating the efficacy of the VART-DN model.

Mercury accumulation and attenuation at a rapidly forming delta with a point source of mining waste

PubMed Central

Johnson, Bryce E.; Esser, Bradley K.; Whyte, Dyan C.; Ganguli, Priya M.; Austin, Carrie M.; Hunt, James R.

2009-01-01

The Walker Creek intertidal delta of Tomales Bay, California is impacted by a former mercury mine within the watershed. Eleven short sediment cores (10 cm length) collected from the delta found monomethylmercury (MMHg) concentrations ranging from 0.3 to 11.4 ng/g (dry wt.), with lower concentrations occurring at the vegetated marsh and upstream channel locations. Algal mats common to the delta’s sediment surface had MMHg concentrations ranging from 7.5 to 31.5 ng/g, and the top 1 cm of sediment directly under the mats had two times greater MMHg concentrations compared to adjacent locations without algal covering. Spatial trends in resident biota reflect enhanced MMHg uptake at the delta compared to other bay locations. Eighteen sediment cores, 1 to 2 meters deep, collected from the 1.2 km2 delta provide an estimate of a total mercury (Hg) inventory of 2500 ± 500 kg. Sediment Hg concentrations ranged from pre-mining background conditions of approximately 0.1 μg/g to a post-mining maximum of 5 μg/g. Sediment accumulation rates were determined from three sediment cores using measured differences of 137Cs activity. We estimate a pre-mining Hg accumulation of less than 20 kg/yr, and a period of maximum Hg accumulation in the 1970s and 1980s with loading rates greater than 50 kg/yr, corresponding to the failure of a tailings dam at the mine site. At the time of sampling (2003) over 40 kg/yr of Hg was still accumulating at the delta, indicating limited recovery. We attribute observed spatial evolution of elevated Hg levels to ongoing inputs and sediment re-working, and estimate the inventory of the anthropogenic fraction of total Hg to be at least 1500 ± 300 kg. We suggest ongoing sediment inputs and methylation at the deltaic surface support enhanced mercury levels for resident biota and transfer to higher trophic levels throughout the Bay. PMID:19539980

In vitro and in vivo evaluation of gastro-retentive carvedilol loaded chitosan beads using Gastroplus™.

PubMed

Praveen, Radhakrishnan; Prasad Verma, Priya Ranjan; Venkatesan, Jayachandran; Yoon, Dong-Han; Kim, Se-Kwon; Singh, Sandeep Kumar

2017-09-01

The objective of present investigation was to develop gastro-retentive controlled release system of carvedilol using biological macromolecule, chitosan. 3 2 full factorial design was adopted for optimization of tripolyphosphate (X 1 ) and curing time (X 2 ). Bead stability in 0.1N HCl, buoyancy duration, density, drug loading, dissolution efficiency and cumulative percentage release at 8th hour were evaluated as dependent variables. The levels of X 1 and X 2 of optimized formulation having maximum desirability was found to 2.0% w/v and 62.66min, respectively. The in silico predicted responses and observed response were found to be in good agreement (percent bias error: -13.295 to +13.269). SEM images showed numerous pores in the cross sectional image that renders buoyancy. AUC 0-∞ of optimized formulation was 1.47 times higher as compared to suspension corroborating enhanced extent of absorption. T max and mean residence time were significantly higher from optimized formulation vis a vis suspension. In silico study indicated maximum regional absorption from the duodenum (94.1%) followed by jejunum (5.6%). Wagner-Nelson and Loo-Reigelman method were the preferred deconvolution approach over numerical deconvolution to establish IVIVC. In conclusion, the study showed that gastro-retentive controlled release system prepared using chitosan could be a potential drug carrier of carvedilol with improved bioavailability. Copyright © 2017 Elsevier B.V. All rights reserved.

Does intentional support of degree programs in general surgery residency affect research productivity or pursuit of academic surgery?

PubMed

Joshua Smith, Jesse; Patel, Ravi K; Chen, Xi; Tarpley, Margaret J; Terhune, Kyla P

2014-01-01

Many residents supplement general surgery training with years of dedicated research, and an increasing number at our institution pursue additional degrees. We sought to determine whether it was worth the financial cost for residency programs to support degrees. We reviewed graduating chief residents (n = 69) in general surgery at Vanderbilt University from 2001 to 2010 and collected the data including research time and additional degrees obtained. We then compared this information with the following parameters: (1) total papers, (2) first-author papers, (3) Journal Citation Reports impact factors of journals in which papers were published, and (4) first job after residency or fellowship training. The general surgery resident training program at Vanderbilt University is an academic program, approved to finish training 7 chief residents yearly during the time period studied. Chief residents in general surgery at Vanderbilt who finished their training 2001 through 2010. We found that completion of a degree during residency was significantly associated with more total and first-author publications as compared with those by residents with only dedicated research time (p = 0.001 and p = 0.017). Residents completing a degree also produced publications of a higher caliber and level of authorship as determined by an adjusted resident impact factor score as compared with those by residents with laboratory research time only (p = 0.005). Degree completion also was significantly correlated with a first job in academia if compared to those with dedicated research time only (p = 0.046). Our data support the utility of degree completion when economically feasible and use of dedicated research time as an effective way to significantly increase research productivity and retain graduates in academic surgery. Aggregating data from other academic surgery programs would allow us to further determine association of funding of additional degrees as a means to encourage academic productivity and retention. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

The effect of the 16-hour intern workday restriction on surgical residents' in-hospital activities.

PubMed

Dennis, Bradley M; Long, Eric L; Zamperini, Katherine M; Nakayama, Don K

2013-01-01

To observe the effects of the 2011 Accreditation Council on Graduate Medical Education 16-hour intern workday restrictions on surgical residents' clinical and educational activities. All the residents recorded the following weekly in-hospital activities during February and March 2011 (year before intern work restrictions) and 2012 (first year under new requirements): operating room (OR) and clinic; bedside procedures; rounds and ward work; on-call duties in hospital; communication (e.g., checkouts and family and patient discussions); education (conferences and study); and personal (rest and meals). Descriptive statistics were calculated in 3 resident groups (interns, first postgraduate year [PGY1]; junior, PGY2 and 3; and senior, PGY4 and 5). The unpaired t test was used to compare data between 2011 and 2012; significance was set at p< 0.05. Medical school affiliated hospital. Categorical resident trainees in surgery, PGY1-5, 4 residents per level, with all 20 residents participating in the study. From 2011 to 2012, time spent in the hospital by the intern did not change (all results in h/wk, mean±standard deviation: 68.5±13.8 to 72.8±15.8, respectively) but the time devoted to specific activities changed significantly. In-hospital personal time decreased by 50% (5.3±4.6 to 2.6±2.0, p = 0.004). Interns spent less time placing central lines (2.1±2.2 to 0.9±1.2, p = 0.006) and more on rounds (8.8±8.8 to 14.2±9.8, p = 0.027), which included supervision with upper level residents. There was no change in the total time spent in the OR, the clinic, performing bedside procedures, and educational activities. Changes in intern work did not affect the time junior and senior residents spent on bedside procedures, time spent in the clinic, and total time spent in the hospital. In 2012, junior residents spent less time in educational activities (11.4±8.5 to 7.0±4.5, p = 0.0007) and the seniors spent more time in the OR (13.7±7.5 to 20.6±10.7, p = 0.0002). The 16-hour restriction preserved interns' educational activities and time spent in the OR and clinic, but changed resident work activities at all levels. The time spent on rounds increased, time spent by the juniors on conferences decreased, and time spent by senior residents in the OR increased. Duty restrictions in general and intern supervision requirements demand ongoing adjustments in resident work schedules. Copyright © 2013 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Teachers' Perceptions of Difficulties in Teaching Ethics in Residencies.

ERIC Educational Resources Information Center

Strong, Carson; And Others

1992-01-01

Analysis of responses of 63 medical faculty involved in formal ethics teaching programs for medical residents indicated such perceived problems as time constraints resulting from residents' heavy schedules; attitudes of residents; logistical problems; time demands on faculty; lack of reinforcement for teaching ethics; and deficiencies in faculty…

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.

Allocation of Internal Medicine Resident Time in a Swiss Hospital: A Time and Motion Study of Day and Evening Shifts.

PubMed

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

2017-04-18

Little current evidence documents how internal medicine residents spend their time at work, particularly with regard to the proportions of time spent in direct patient care versus using computers. To describe how residents allocate their time during day and evening hospital shifts. Time and motion study. Internal medicine residency at a university hospital in Switzerland, May to July 2015. 36 internal medicine residents with an average of 29 months of postgraduate training. Trained observers recorded the residents' activities using a tablet-based application. Twenty-two activities were categorized as directly related to patients, indirectly related to patients, communication, academic, nonmedical tasks, and transition. In addition, the presence of a patient or colleague and use of a computer or telephone during each activity was recorded. Residents were observed for a total of 696.7 hours. Day shifts lasted 11.6 hours (1.6 hours more than scheduled). During these shifts, activities indirectly related to patients accounted for 52.4% of the time, and activities directly related to patients accounted for 28.0%. Residents spent an average of 1.7 hours with patients, 5.2 hours using computers, and 13 minutes doing both. Time spent using a computer was scattered throughout the day, with the heaviest use after 6:00 p.m. The study involved a small sample from 1 institution. At this Swiss teaching hospital, internal medicine residents spent more time at work than scheduled. Activities indirectly related to patients predominated, and about half the workday was spent using a computer. Information Technology Department and Department of Internal Medicine of Lausanne University Hospital.

A novel modeling approach to the mixing process in twin-screw extruders

NASA Astrophysics Data System (ADS)

Kennedy, Amedu Osaighe; Penlington, Roger; Busawon, Krishna; Morgan, Andy

2014-05-01

In this paper, a theoretical model for the mixing process in a self-wiping co-rotating twin screw extruder by combination of statistical techniques and mechanistic modelling has been proposed. The approach was to examine the mixing process in the local zones via residence time distribution and the flow dynamics, from which predictive models of the mean residence time and mean time delay were determined. Increase in feed rate at constant screw speed was found to narrow the shape of the residence time distribution curve, reduction in the mean residence time and time delay and increase in the degree of fill. Increase in screw speed at constant feed rate was found to narrow the shape of the residence time distribution curve, decrease in the degree of fill in the extruder and thus an increase in the time delay. Experimental investigation was also done to validate the modeling approach.

Using just-in-time teaching and peer instruction in a residency program's core curriculum: enhancing satisfaction, engagement, and retention.

PubMed

Schuller, Mary C; DaRosa, Debra A; Crandall, Marie L

2015-03-01

To assess use of the combined just-in-time teaching (JiTT) and peer instruction (PI) instructional strategy in a residency program's core curriculum. In 2010-2011, JiTT/PI was piloted in 31 core curriculum sessions taught by 22 faculty in the Northwestern University Feinberg School of Medicine's general surgery residency program. JiTT/PI required preliminary and categorical residents (n=31) to complete Web-based study questions before weekly specialty topic sessions. Responses were examined by faculty members "just in time" to tailor session content to residents' learning needs. In the sessions, residents answered multiple-choice questions (MCQs) using clickers and engaged in PI. Participants completed surveys assessing their perceptions of JiTT/PI. Videos were coded to assess resident engagement time in JiTT/PI sessions versus prior lecture-based sessions. Responses to topic session MCQs repeated in review sessions were evaluated to study retention. More than 70% of resident survey respondents indicated that JiTT/PI aided in the learning of key points. At least 90% of faculty survey respondents reported positive perceptions of aspects of the JiTT/PI strategy. Resident engagement time for JiTT/PI sessions was significantly greater than for prior lecture-based sessions (z=-2.4, P=.016). Significantly more review session MCQ responses were correct for residents who had attended corresponding JiTT/PI sessions than for residents who had not (chi-square=13.7; df=1; P<.001). JiTT/PI increased learner participation, learner retention, and the amount of learner-centered time. JiTT/PI represents an effective approach for meaningful and active learning in core curriculum sessions.

Implementing the 2009 Institute of Medicine recommendations on resident physician work hours, supervision, and safety.

PubMed

Blum, Alexander B; Shea, Sandra; Czeisler, Charles A; Landrigan, Christopher P; Leape, Lucian

2011-01-01

Long working hours and sleep deprivation have been a facet of physician training in the US since the advent of the modern residency system. However, the scientific evidence linking fatigue with deficits in human performance, accidents and errors in industries from aeronautics to medicine, nuclear power, and transportation has mounted over the last 40 years. This evidence has also spawned regulations to help ensure public safety across safety-sensitive industries, with the notable exception of medicine. In late 2007, at the behest of the US Congress, the Institute of Medicine embarked on a year-long examination of the scientific evidence linking resident physician sleep deprivation with clinical performance deficits and medical errors. The Institute of Medicine's report, entitled "Resident duty hours: Enhancing sleep, supervision and safety", published in January 2009, recommended new limits on resident physician work hours and workload, increased supervision, a heightened focus on resident physician safety, training in structured handovers and quality improvement, more rigorous external oversight of work hours and other aspects of residency training, and the identification of expanded funding sources necessary to implement the recommended reforms successfully and protect the public and resident physicians themselves from preventable harm. Given that resident physicians comprise almost a quarter of all physicians who work in hospitals, and that taxpayers, through Medicare and Medicaid, fund graduate medical education, the public has a deep investment in physician training. Patients expect to receive safe, high-quality care in the nation's teaching hospitals. Because it is their safety that is at issue, their voices should be central in policy decisions affecting patient safety. It is likewise important to integrate the perspectives of resident physicians, policy makers, and other constituencies in designing new policies. However, since its release, discussion of the Institute of Medicine report has been largely confined to the medical education community, led by the Accreditation Council for Graduate Medical Education (ACGME). To begin gathering these perspectives and developing a plan to implement safer work hours for resident physicians, a conference entitled "Enhancing sleep, supervision and safety: What will it take to implement the Institute of Medicine recommendations?" was held at Harvard Medical School on June 17-18, 2010. This White Paper is a product of a diverse group of 26 representative stakeholders bringing relevant new information and innovative practices to bear on a critical patient safety problem. Given that our conference included experts from across disciplines with diverse perspectives and interests, not every recommendation was endorsed by each invited conference participant. However, every recommendation made here was endorsed by the majority of the group, and many were endorsed unanimously. Conference members participated in the process, reviewed the final product, and provided input before publication. Participants provided their individual perspectives, which do not necessarily represent the formal views of any organization. In September 2010 the ACGME issued new rules to go into effect on July 1, 2011. Unfortunately, they stop considerably short of the Institute of Medicine's recommendations and those endorsed by this conference. In particular, the ACGME only applied the limitation of 16 hours to first-year resident physicans. Thus, it is clear that policymakers, hospital administrators, and residency program directors who wish to implement safer health care systems must go far beyond what the ACGME will require. We hope this White Paper will serve as a guide and provide encouragement for that effort. RESIDENT PHYSICIAN WORKLOAD AND SUPERVISION: By the end of training, a resident physician should be able to practice independently. Yet much of resident physicians' time is dominated by tasks with little educational value. The caseload can be so great that inadequate reflective time is left for learning based on clinical experiences. In addition, supervision is often vaguely defined and discontinuous. Medical malpractice data indicate that resident physicians are frequently named in lawsuits, most often for lack of supervision. The recommendations are: The ACGME should adjust resident physicians workload requirements to optimize educational value. Resident physicians as well as faculty should be involved in work redesign that eliminates nonessential and noneducational activity from resident physician dutiesMechanisms should be developed for identifying in real time when a resident physician's workload is excessive, and processes developed to activate additional providersTeamwork should be actively encouraged in delivery of patient care. Historically, much of medical training has focused on individual knowledge, skills, and responsibility. As health care delivery has become more complex, it will be essential to train resident and attending physicians in effective teamwork that emphasizes collective responsibility for patient care and recognizes the signs, both individual and systemic, of a schedule and working conditions that are too demanding to be safeHospitals should embrace the opportunities that resident physician training redesign offers. Hospitals should recognize and act on the potential benefits of work redesign, eg, increased efficiency, reduced costs, improved quality of care, and resident physician and attending job satisfactionAttending physicians should supervise all hospital admissions. Resident physicians should directly discuss all admissions with attending physicians. Attending physicians should be both cognizant of and have input into the care patients are to receive upon admission to the hospitalInhouse supervision should be required for all critical care services, including emergency rooms, intensive care units, and trauma services. Resident physicians should not be left unsupervised to care for critically ill patients. In settings in which the acuity is high, physicians who have completed residency should provide direct supervision for resident physicians. Supervising physicians should always be physically in the hospital for supervision of resident physicians who care for critically ill patientsThe ACGME should explicitly define "good" supervision by specialty and by year of training. Explicit requirements for intensity and level of training for supervision of specific clinical scenarios should be providedCenters for Medicare and Medicaid Services (CMS) should use graduate medical education funding to provide incentives to programs with proven, effective levels of supervision. Although this action would require federal legislation, reimbursement rules would help to ensure that hospitals pay attention to the importance of good supervision and require it from their training programs. RESIDENT PHYSICIAN WORK HOURS: Although the IOM "Sleep, supervision and safety" report provides a comprehensive review and discussion of all aspects of graduate medical education training, the report's focal point is its recommendations regarding the hours that resident physicians are currently required to work. A considerable body of scientific evidence, much of it cited by the Institute of Medicine report, describes deteriorating performance in fatigued humans, as well as specific studies on resident physician fatigue and preventable medical errors. The question before this conference was what work redesign and cultural changes are needed to reform work hours as recommended by the Institute of Medicine's evidence-based report? Extensive scientific data demonstrate that shifts exceeding 12-16 hours without sleep are unsafe. Several principles should be followed in efforts to reduce consecutive hours below this level and achieve safer work schedules. The recommendations are: Limit resident physician work hours to 12-16 hour maximum shiftsA minimum of 10 hours off duty should be scheduled between shiftsResident physician input into work redesign should be actively solicitedSchedules should be designed that adhere to principles of sleep and circadian science; this includes careful consideration of the effects of multiple consecutive night shifts, and provision of adequate time off after night work, as specified in the IOM reportResident physicians should not be scheduled up to the maximum permissible limits; emergencies frequently occur that require resident physicians to stay longer than their scheduled shifts, and this should be anticipated in scheduling resident physicians' work shiftsHospitals should anticipate the need for iterative improvement as new schedules are initiated; be prepared to learn from the initial phase-in, and change the plan as neededAs resident physician work hours are redesigned, attending physicians should also be considered; a potential consequence of resident physician work hour reduction and increased supervisory requirements may be an increase in work for attending physicians; this should be carefully monitored, and adjustments to attending physician work schedules made as needed to prevent unsafe work hours or working conditions for this group"Home call" should be brought under the overall limits of working hours; work load and hours should be monitored in each residency program to ensure that resident physicians and fellows on home call are getting sufficient sleepMedicare funding for graduate medical education in each hospital should be linked with adherence to the Institute of Medicine limits on resident physician work hours. MOONLIGHTING BY RESIDENT PHYSICIANS: The Institute of Medicine report recommended including external as well as internal moonlighting in working hour limits. The recommendation is: All moonlighting work hours should be included in the ACGME working hour limits and actively monitored. (ABSTRACT TRUNCATED)

Evaluation of Residence Time on Nitrogen Oxides Removal in Non-Thermal Plasma Reactor

PubMed Central

Talebizadeh, Pouyan; Rahimzadeh, Hassan; Babaie, Meisam; Javadi Anaghizi, Saeed; Ghomi, Hamidreza; Ahmadi, Goodarz; Brown, Richard

2015-01-01

Non-thermal plasma (NTP) has been introduced over the last few years as a promising after- treatment system for nitrogen oxides and particulate matter removal from diesel exhaust. NTP technology has not been commercialised as yet, due to its high rate of energy consumption. Therefore, it is important to seek out new methods to improve NTP performance. Residence time is a crucial parameter in engine exhaust emissions treatment. In this paper, different electrode shapes are analysed and the corresponding residence time and NOx removal efficiency are studied. An axisymmetric laminar model is used for obtaining residence time distribution numerically using FLUENT software. If the mean residence time in a NTP plasma reactor increases, there will be a corresponding increase in the reaction time and consequently the pollutant removal efficiency increases. Three different screw thread electrodes and a rod electrode are examined. The results show the advantage of screw thread electrodes in comparison with the rod electrode. Furthermore, between the screw thread electrodes, the electrode with the thread width of 1 mm has the highest NOx removal due to higher residence time and a greater number of micro-discharges. The results show that the residence time of the screw thread electrode with a thread width of 1 mm is 21% more than for the rod electrode. PMID:26496630

Formation and spreading of Red Sea Outflow Water in the Red Sea

NASA Astrophysics Data System (ADS)

Zhai, Ping; Bower, Amy S.; Smethie, William M.; Pratt, Larry J.

2015-09-01

Hydrographic data, chlorofluorocarbon-12 (CFC-12) and sulfur hexafluoride (SF6) measurements collected in March 2010 and September-October 2011 in the Red Sea, as well as an idealized numerical experiment are used to study the formation and spreading of Red Sea Outflow Water (RSOW) in the Red Sea. Analysis of inert tracers, potential vorticity distributions, and model results confirm that RSOW is formed through mixed-layer deepening caused by sea surface buoyancy loss in winter in the northern Red Sea and reveal more details on RSOW spreading rates, pathways, and vertical structure. The southward spreading of RSOW after its formation is identified as a layer with minimum potential vorticity and maximum CFC-12 and SF6. Ventilation ages of seawater within the RSOW layer, calculated from the partial pressure of SF6 (pSF6), range from 2 years in the northern Red Sea to 15 years at 17°N. The distribution of the tracer ages is in agreement with the model circulation field which shows a rapid transport of RSOW from its formation region to the southern Red Sea where there are longer circulation pathways and hence longer residence time due to basin wide eddies. The mean residence time of RSOW within the Red Sea estimated from the pSF6 age is 4.7 years. This time scale is very close to the mean transit time (4.8 years) for particles from the RSOW formation region to reach the exit at the Strait of Bab el Mandeb in the numerical experiment.

Residents as teachers: psychiatry and family medicine residents' self-assessment of teaching knowledge, skills, and attitudes.

PubMed

Brand, Michael W; Ekambaram, Vijayabharathi; Tucker, Phebe; Aggarwal, Ruchi

2013-09-01

Residents are one of the prime sources of information and education for medical students. As an initial step in supporting residents as teachers, a baseline self-assessment of residents' knowledge, skills, attitudes, and values related to teaching was conducted among psychiatry and family medicine residents to compare and improve their confidence and skills as teachers. Psychiatry residents (N=12) and family medicine residents (N=23) completed self-assessments of their knowledge, skills, attitudes, and values related to teaching. Residents also were asked to list steps used in the One-Minute Preceptor process and estimate the time each spent in teaching. Descriptive summary statistics were used for four main areas related to teaching; t-test and chi-square analyses were conducted to ascertain whether there was a significant difference in resident groups. In the current study, the perceived amount of time spent for teaching patients was significantly higher among family practice residents, whereas no group differences were found for time teaching medical students, peers, community members, non-physicians, or others. However, family medicine residents rated themselves higher than psychiatry residents in their understanding of their roles in teaching medical students and teaching patients. Also, family medicine residents' self-reported teaching skills were more advanced (82.4%) than psychiatry residents' (54.2%). They most likely applied at least two different teaching methods in inpatient and outpatient settings, as compared with psychiatry residents. No significant group differences were found in the other 15 items assessing teaching knowledge, skills, attitudes, and values. Results indicate that residents' knowledge, skills, attitudes, and values regarding teaching varies across institutions and training programs. The psychiatry residents in this study do not clearly understand their role as educators with patients and medical students; they have a less clear understanding of teaching techniques, and report spending less time educating patients than do family medicine residents. The differences might be due to different patient populations and treatment settings. The study suggests that psychiatry residents may have difficulty adapting the One-Minute Preceptor technique in psychiatric settings. Results serve as a benchmarking study in a performance-improvement program to enhance psychiatry residents' teaching skills.

Obstetrics and gynaecology chief resident attitudes toward teaching junior residents under normal working conditions.

PubMed

Gil, Karen M; Savitski, Jennifer L; Bazan, Sara; Patterson, Laurene R; Kirven, Melissa

2009-09-01

This study aimed to identify factors that chief residents believe impact the teaching of junior residents under normal working conditions and the areas in which they believe education on the role of resident as teacher would be beneficial. Obstetrics and gynaecology (O&G) chief residents were asked to rate the importance of teaching various skills, how often conflict situations arose, and to identify training that would be helpful through a national web-based survey. An e-mail was sent to coordinators of the Residency Review Committee (RRC) O&G residency programmes with a request that they forward the link to their chief residents three times from January through March 2006. Responses were received from 204 postgraduate Year 4 (PGY4) residents (18% of all PGY4 residents) from 133 programmes (54% of all residency programmes) and 33 states. Teaching junior residents how to prioritise patient care and obtain critical information in an emergent situation was considered very to extremely important by 97%. Conflict situations with junior residents were reported to occur between one and five times by 41-58%; an additional 26-28% reported that these situations occurred six or more times. Residents felt it would be helpful to extremely helpful to have training in resolving conflicts that involved patient care (48-59%), as well as in resolving conflict among junior residents, communicating effectively with them and becoming an effective leader (65-78%). The skills that chief residents considered most important to teach junior residents involved direct patient care. Chief residents would like training in how to resolve conflict with, and among, junior residents, and in how to become an effective leader.

Parental leave for residents and pediatric training programs.

PubMed

2013-02-01

The American Academy of Pediatrics (AAP) is committed to the development of rational, equitable, and effective parental leave policies that are sensitive to the needs of pediatric residents, families, and developing infants and that enable parents to spend adequate and good-quality time with their young children. It is important for each residency program to have a policy for parental leave that is written, that is accessible to residents, and that clearly delineates program practices regarding parental leave. At a minimum, a parental leave policy for residents and fellows should conform legally with the Family Medical Leave Act as well as with respective state laws and should meet institutional requirements of the Accreditation Council for Graduate Medical Education for accredited programs. Policies should be well formulated and communicated in a culturally sensitive manner. The AAP advocates for extension of benefits consistent with the Family Medical Leave Act to all residents and interns beginning at the time that pediatric residency training begins. The AAP recommends that regardless of gender, residents who become parents should be guaranteed 6 to 8 weeks, at a minimum, of parental leave with pay after the infant's birth. In addition, in conformance with federal law, the resident should be allowed to extend the leave time when necessary by using paid vacation time or leave without pay. Coparenting, adopting, or fostering of a child should entitle the resident, regardless of gender, to the same amount of paid leave (6-8 weeks) as a person who takes maternity/paternity leave. Flexibility, creativity, and advanced planning are necessary to arrange schedules that optimize resident education and experience, cultivate equity in sharing workloads, and protect pregnant residents from overly strenuous work experiences at critical times of their pregnancies.

Effect of protected research time on ABSITE scores during general surgery residency.

PubMed

Orkin, Bruce A; Poirier, Jennifer; Kowal-Vern, Areta; Chan, Edie; Ohara, Karen; Mendoza, Brian

2018-02-01

Objective - To determine whether residents with one or more years of dedicated research time (Research Residents, RR) improved their ABSITE scores compared to those without (Non-Research Residents, N-RR). A retrospective review of general surgery residents' ABSITE scores from 1995 to 2016 was performed. RR were compared to N-RR. Additional analysis of At Risk (AR) v Not At Risk residents (NAR) (35th percentile as PGY1-2) was also performed. Cohort - 147 residents (34 RR and 113 N-RR). There were no differences in initial ABSITE scores (p = 0.47). By definition, the AR group had lower scores than NAR. Overall, post-research RR v PGY-4 N-RR scores did not differ (p = 0.84). Only the AR residents improved their scores (p = 0.0009 v NAR p = 0.42), regardless of research group (p = 0.70). Protected research time did not improve residents' ABSITE scores, regardless of initial scores. At Risk residents improved regardless of research group status. Copyright © 2017 Elsevier Inc. All rights reserved.

Nurses' personal statements about factors that influence their decisions about the time they spend with residents with long-term mental illness living in psychiatric group dwellings.

PubMed

Hellzén, Ove

2004-09-01

One seldom-discussed issue is the factors that influence nurses' decisions about the time they spend with residents in psychiatric care. This study uses a qualitative naturalistic approach and consists of an analysis of focus-group interviews with nurses, which aimed to identify factors affecting nurses' decisions about being with or being nonattendant in their relationship with their residents. Two series of focus-group interviews were conducted, interpreted and analysed through content analysis. The study included all the staff (n=32) at two municipal psychiatric group dwellings housing residents mainly with a diagnosis of long-term schizophrenia. This study revealed that the main factor that determined nurses' nurse/resident time together or nonattendance time was whether they liked or disliked the individual resident. One possible explanation is the carers' change from a perspective in which the nursing care was given on the basis of each resident's needs and rights, based on the individual nurse's professional judgement, to a consumer perspective, which leads to a change in responsibility from themselves to the individual residents.

3D thermal model of laser surface glazing for H13 tool steel

NASA Astrophysics Data System (ADS)

Kabir, I. R.; Yin, D.; Naher, S.

2017-10-01

In this work a three dimensional (3D) finite element model of laser surface glazing (LSG) process has been developed. The purpose of the 3D thermal model of LSG was to achieve maximum accuracy towards the predicted outcome for optimizing the process. A cylindrical geometry of 10mm diameter and 1mm length was used in ANSYS 15 software. Temperature distribution, depth of modified zone and cooling rates were analysed from the thermal model. Parametric study was carried out varying the laser power from 200W-300W with constant beam diameter and residence time which were 0.2mm and 0.15ms respectively. The maximum surface temperature 2554°K was obtained for power 300W and minimum surface temperature 1668°K for power 200W. Heating and cooling rates increased with increasing laser power. The depth of the laser modified zone attained for 300W power was 37.5µm and for 200W power was 30µm. No molten zone was observed at 200W power. Maximum surface temperatures obtained from 3D model increased 4% than 2D model presented in author's previous work. In order to verify simulation results an analytical solution of temperature distribution for laser surface modification was used. The surface temperature after heating was calculated for similar laser parameters which is 1689°K. The difference in maximum surface temperature is around 20.7°K between analytical and numerical analysis of LSG for power 200W.

Number needed to eat: pizza and resident conference attendance.

PubMed

Cosimini, Michael J; Mackintosh, Liza; Chang, Todd P

2016-12-01

The didactic conference is a common part of the resident education curriculum. Given the demands of clinical responsibilities and restrictions on duty hours, maximising education is a challenge faced by all residency programmes. To date, little research exists with respect to how the provision of complimentary food affects physician and resident conference attendance. The objective of this study was to determine whether complimentary food improves resident arrival times and attendance at educational conferences and, furthermore, to test whether this provision is a potentially cost-effective tool for improving education. A retrospective review of 36 resident educational Friday noon conferences, including 1043 resident arrivals, was performed. Data were analysed for total attendance, arrival times, number needed to eat (NNE) and the percentage of residents arriving on time, and compared between days on which food was and was not provided. Median attendance was 3.7% higher (p = 0.04) on days on which food was provided, at a cost of US$46 for each additional resident in attendance. Arrival times were also statistically significantly improved when food was provided, with a median improvement of 0.7 minutes (p = 0.02) and an 11.0% increase in on-time arrivals (p < 0.001). The NNE was 10.6. Complimentary food improves both attendance and arrival times by a small, but statistically significant, degree. The provision of complimentary food can be considered as an incentive for attendance and on-time arrival at didactic educational sessions, although more cost-effective modalities may exist. © 2016 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Changes in Resident Well-Being at One Institution Across a Decade of Progressive Work Hours Limitations.

PubMed

Krug, Michael F; Golob, Anna L; Wander, Pandora L; Wipf, Joyce E

2017-10-01

To measure changes in markers of resident well-being over time as progressive work hours limitations (WHLs) were enforced, and to investigate resident perceptions of the 2011 WHLs. A survey study of internal medicine residents was conducted at the University of Washington's multihospital residency program in 2012. The survey included validated well-being questions: the Maslach Burnout Inventory, the two-question PRIME-MD depression screen, and career satisfaction questions. Chi-square tests were used to compare 2012 well-being questionnaire responses against nearly identical surveys conducted in 2001 and 2004 at the same institution. In addition, residents were asked to rate the impact of WHLs on resident well-being and education as well as patient care, and to state preferences for future WHLs. Significantly different proportions of residents met burnout criteria across time, with fewer meeting criteria in 2012 than in 2001 (2001: 76% [87/115]; 2004: 64% [75/118]; 2012: 61% [68/112]; P = .039). Depression screening results also differed across time, with fewer screening positive in 2012 than in 2004 (2001: 45% [52/115]; 2004: 55% [65/118]; 2012 [35/112]: 31%; P = .001). Residents, especially seniors, reported perceived negative impacts of WHLs on their well-being, education, and patient care. Most senior residents favored reverting to the pre-July 2011 system of WHLs. Interns were more divided. Validated measures of resident well-being changed across the three time points measured. Residents had the lowest rates of burnout and depression in 2012. Resident perceptions of the 2011 WHLs, however, were generally negative.

Residence time of symmetric random walkers in a strip with large reflective obstacles

NASA Astrophysics Data System (ADS)

Ciallella, Alessandro; Cirillo, Emilio N. M.; Sohier, Julien

2018-05-01

We study the effect of a large obstacle on the so-called residence time, i.e., the time that a particle performing a symmetric random walk in a rectangular (two-dimensional, 2D) domain needs to cross the strip. We observe complex behavior: We find out that the residence time does not depend monotonically on the geometric properties of the obstacle, such as its width, length, and position. In some cases, due to the presence of the obstacle, the mean residence time is shorter with respect to the one measured for the obstacle-free strip. We explain the residence time behavior by developing a one-dimensional (1D) analog of the 2D model where the role of the obstacle is played by two defect sites having smaller probability to be crossed with respect to all the other regular sites. The 1D and 2D models behave similarly, but in the 1D case we are able to compute exactly the residence time, finding a perfect match with the Monte Carlo simulations.

Impacts of Industrial Wind Turbine Noise on Sleep Quality: Results From a Field Study of Rural Residents in Ontario, Canada.

PubMed

Lane, James D; Bigelow, Philip L; Majowicz, Shannon E; McColl, R Stephen

2016-07-01

The objectives of this study were to determine whether grid-connected industrial wind turbines (IWTs) are a risk factor for poor sleep quality, and if IWT noise is associated with sleep parameters in rural Ontarians. A daily sleep diary and actigraphy-derived measures of sleep were obtained from 12 participants from an IWT community and 10 participants from a comparison community with no wind power installations. The equivalent and maximum sound pressure levels within the bedroom were also assessed. No statistically significant differences were observed between IWT residents and non-IWT residents for any of the parameters measured in this study. Actigraphy and sleep diaries are feasible tools to understand the impact of IWTs on the quality of sleep for nearby residents. Further studies with larger sample sizes should be conducted to determine whether the lack of statistical significance observed here is a result of sample size, or reflects a true lack of association.

Pediatricians Working Part-Time Has Plateaued.

PubMed

Cull, William L; Frintner, Mary Pat; O'Connor, Karen G; Olson, Lynn M

2016-04-01

To examine trends in pediatricians working part-time and residents seeking part-time work and to examine associated characteristics. The American Academy of Pediatrics (AAP) Periodic Survey of Fellows and the AAP Annual Survey of Graduating Residents were used to examine part-time employment. Fourteen periodic surveys were combined with an overall response rate of 57%. Part-time percentages were compared for surveys conducted from 2006-2009 and 2010-2013. The AAP Annual Surveys of Graduating Residents (combined response rate = 60%) from 2006-2009 were compared with 2010-2013 surveys for residents seeking and obtaining part-time positions following training. Multivariable logistic regression models identified characteristics associated with part-time work. Comparable percentages of pediatricians worked part-time in 2006-2009 (23%) and 2010-2013 (23%). There was similarly no statistically significant difference in residents seeking part-time work (30%-28%), and there was a slight decline in residents accepting part-time work (16%-13%, aOR .75, 95% CI .56-.96). Increases in working part-time were not found for any subgroups examined. Women consistently were more likely than men to work part-time (35% vs 9%), but they showed different patterns of part-time work across age. Women in their 40s (40%) were more likely than other women (33%) and men in their 60s (20%) were more likely than other men (5%) to work part-time. There has been a levelling off in the number of pediatricians working part-time and residents seeking part-time work. Overall, women remain more likely to work part-time, although 1 in 5 men over 60 work part-time. Copyright © 2016 Elsevier Inc. All rights reserved.

Anesthesia preparation time is not affected by the experience level of the resident involved during his/her first month of adult cardiac surgery.

PubMed

Broussard, David M; Couch, Michael C

2011-10-01

This study was designed to answer the question of whether the experience level of the resident on his/her first month of adult cardiothoracic anesthesiology has an impact on operating room efficiency in a large academic medical center. Traditionally, the resident's 1st month of cardiac anesthesia had been reserved for the clinical anesthesia (CA)-2 year of training. This study analyzed the impact on operating room efficiency of moving the 1st month of cardiac anesthesia into the CA-1 year. The authors hypothesized that there would be no difference in anesthesia preparation times (defined as the interval between "in-room" and "anesthesia-ready" times) between CA-1 and CA-2 residents on their 1st month of cardiac anesthesia. This study was retrospective and used an electronic anesthesia information management system database. This study was conducted on care provided at a single 450-bed academic medical center. This study included 12 residents in their 1st month of cardiac anesthesia. The anesthesia preparation time (defined as the interval between "in-room" and "anesthesia-ready" times) was measured for cases involving residents on their first month of cardiac anesthesia. Anesthesia preparation times for 6 CA-1 resident months and 6 CA-2 resident months (100 adult cardiac procedures in total) were analyzed (49 for the CA-1 residents and 51 for the CA-2s). There were no differences in preparation time between CA-1 and CA-2 residents as a group (p = 0.8169). The CA-1 residents had an unadjusted mean (±standard error) of 51.1 ± 3.18 minutes, whereas the CA-2 residents' unadjusted mean was 50.2 ± 2.41 minutes. Adjusting for case mix (valves v coronary artery bypass graft surgery), the CA-1 mean was 49.1 ± 5.22 minutes, whereas the CA-2 mean was 49.1 ± 4.54 minutes. These findings suggest that operating room efficiency as measured by the anesthesia preparation time may not be affected by the level of the resident on his/her 1st month of adult cardiac anesthesia. Copyright © 2011 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.

Development of the Seeding System Used for Laser Velocimeter Surveys of the NASA Low-Speed Centrifugal Compressor Flow Field

NASA Technical Reports Server (NTRS)

Wasserbauer, C. A.; Hathaway, M. D.

1994-01-01

Consideration is given to an atomizer-based system for distributing high-volume rates of polystyrene latex (PSL) seed material developed to support laser velocimeter investigations of the NASA Low-Speed Compressor flow field. Complete evaporation of the liquid carrier before the flow entering the compressor was of primary concern for the seeder system design. It is argued that the seed nozzle should incorporate a needle valve that can mechanically dislodge accumulated PSL seed material when the nozzle is turned off. Water is less expensive as the liquid carrier and should be used whenever adequate residence times are available to ensure complete evaporation. PSL agglomerates over time and needs to be mixed or blended before use. Arrangement of the spray nozzles needs to be adjustable to provide maximum seeding at the laser probe volume.

Staged fluidized bed

DOEpatents

Mallon, R.G.

1983-05-13

The invention relates to oil shale retorting and more particularly to staged fluidized bed oil shale retorting. Method and apparatus are disclosed for narrowing the distribution of residence times of any size particle and equalizing the residence times of large and small particles in fluidized beds. Particles are moved up one fluidized column and down a second fluidized column with the relative heights selected to equalize residence times of large and small particles. Additional pairs of columns are staged to narrow the distribution of residence times and provide complete processing of the material.

Association of Resident Duty Hour Restrictions, Level of Trainee, and Number of Available Residents with Mortality in the Neonatal Intensive Care Unit.

PubMed

Beltempo, Marc; Clement, Karin; Lacroix, Guy; Bélanger, Sylvie; Julien, Anne-Sophie; Piedboeuf, Bruno

2018-02-08

 This article assesses the effect of reducing consecutive hours worked by residents from 24 to 16 hours on yearly total hours worked per resident in the neonatal intensive care unit (NICU) and evaluates the association of resident duty hour reform, level of trainee, and the number of residents present at admission with mortality in the NICU.  This is a 6-year retrospective cohort study including all pediatric residents working in a Level 3 NICU ( N  = 185) and infants admitted to the NICU ( N  = 8,159). Adjusted odds ratios (aOR) were estimated for mortality with respect to Epoch (2008-2011 [24-hour shifts] versus 2011-2014 [16-hour shifts]), level of trainee, and the number of residents present at admission.  The reduction in maximum consecutive hours worked was associated with a significant reduction of the median yearly total hours worked per resident in the NICU (381 hour vs. 276 hour, p  < 0.01). Early mortality rate was 1.2% (50/4,107) before the resident duty hour reform and 0.8% (33/4,052) after the reform (aOR, 0.57; 95% confidence interval [CI], 0.33-0.98). Neither level of trainee (aOR, 1.22; 95% CI, 0.71-2.10; junior vs. senior) nor the number of residents present at admission (aOR, 2.08; 95% CI, 0.43-10.02, 5-8 residents vs. 0-2 residents) were associated with early mortality. Resident duty hour reform was not associated with hospital mortality (aOR, 0.73; 95% CI, 0.50-1.07; after vs. before resident duty hour reform).  Resident duty hour restrictions were associated with a reduction in the number of yearly hours worked by residents in the NICU as well as a significant decrease in adjusted odds of early mortality but not of hospital mortality in admitted neonates. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Comparison of the effectiveness of some common animal data scaling techniques in estimating human radiation dose

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

Sparks, R.B.; Aydogan, B.

In the development of new radiopharmaceuticals, animal studies are typically performed to get a first approximation of the expected radiation dose in humans. This study evaluates the performance of some commonly used data extrapolation techniques to predict residence times in humans using data collected from animals. Residence times were calculated using animal and human data, and distributions of ratios of the animal results to human results were constructed for each extrapolation method. Four methods using animal data to predict human residence times were examined: (1) using no extrapolation, (2) using relative organ mass extrapolation, (3) using physiological time extrapolation, andmore » (4) using a combination of the mass and time methods. The residence time ratios were found to be log normally distributed for the nonextrapolated and extrapolated data sets. The use of relative organ mass extrapolation yielded no statistically significant change in the geometric mean or variance of the residence time ratios as compared to using no extrapolation. Physiologic time extrapolation yielded a statistically significant improvement (p < 0.01, paired t test) in the geometric mean of the residence time ratio from 0.5 to 0.8. Combining mass and time methods did not significantly improve the results of using time extrapolation alone. 63 refs., 4 figs., 3 tabs.« less

Health promotion program: a resident well-being study.

PubMed

Watson, David T; Long, William J; Yen, David; Pichora, David R

2009-01-01

Surgical training places unique stresses on residents that can lead to decreased levels of presenteeism. We hypothesized that presenteeism levels could be positively influenced by improving workplace hygiene. a cohort of surgical residents was asked to complete the Stanford Presenteeism Scale: Health Status and Employee Productivity (SPS-6) questionnaire before, and one year after the implementation of a workplace health promotion program. Twenty-six of thirty-three residents responded to the initial survey and reported a mean SPS-6 score of 17.3 +/- 4.5, well below population normative value of 24 +/- 3 (p < 0.0001). At one-year post intervention 25 of 32 residents responded, reporting a mean SPS-6 score of 18.3+/- 4.6. The mean SPS-6 score improved by 1.2+/- 3.8 (p = 0.35). Subgroup analysis showed a trend toward improved SPS-6 in those who participated in the health promotion program (p = 0.15) and a significant difference when junior residents were compared to seniors (p = 0.034). Overall, results were limited by our small sample size. Presenteeism scores for surgical residents at our institution are well below population values. Use of validated tools such as the SPS-6 may allow for more objective analysis and decision making when planning for resident education and workload. PRESENTEEISM: the ability while on the job to produce quality work at maximum productivity. DECREASED PRESENTEEISM: a state of decreased productivity and below-normal work quality related to health/workplace distracters.

50 CFR 92.11 - Regional management areas.

Code of Federal Regulations, 2012 CFR

2012-10-01

..., numbers of subsistence users, and other management data and traditional knowledge for the benefit of the... 50 Wildlife and Fisheries 9 2012-10-01 2012-10-01 false Regional management areas. 92.11 Section... Regional management areas. (a) Regions identified. To allow for maximum participation by residents of...

50 CFR 92.11 - Regional management areas.

Code of Federal Regulations, 2014 CFR

2014-10-01

..., numbers of subsistence users, and other management data and traditional knowledge for the benefit of the... 50 Wildlife and Fisheries 9 2014-10-01 2014-10-01 false Regional management areas. 92.11 Section... Regional management areas. (a) Regions identified. To allow for maximum participation by residents of...

50 CFR 92.11 - Regional management areas.

Code of Federal Regulations, 2013 CFR

2013-10-01

..., numbers of subsistence users, and other management data and traditional knowledge for the benefit of the... 50 Wildlife and Fisheries 9 2013-10-01 2013-10-01 false Regional management areas. 92.11 Section... Regional management areas. (a) Regions identified. To allow for maximum participation by residents of...

Vibration Responses of Test Structure No. 2 During the Edward Air Force Base Phase of the National Sonic Boom Program

NASA Technical Reports Server (NTRS)

Findley, D. S.; Huckel, V.; Hubbard, H. H.

1975-01-01

In order to evaluate reaction of people to sonic booms of varying overpressures and time durations, a series of closely controlled and systematic flight tests/studies were conducted from June 3 to June 23, 1966. The dynamic responses of several building structures were measured, with emphasis on a two-story residence structure. Sample acceleration and strain recordings from F-104, B-58, and XB-70 sonic boom exposures are included, along with tabulations of the maximum acceleration and strain values measured for each one of about 140 flight tests. These data are compared with similar measurements for engine noise exposures of the building during simulated landing approaches and takeoffs of KC-135 aircraft.

Structure and dynamics of water inside endohedrally functionalized carbon nanotubes.

PubMed

Paul, Sanjib; Abi, T G; Taraphder, Srabani

2014-05-14

We have carried out classical molecular dynamics simulations on the formation of extended water chains inside single-walled carbon nanotubes (SWCNTs) in water in the presence of selected functional groups covalently attached to the inner wall of the tube. Analogues of polar amino acid sidechains have been chosen to carry out the endohedral functionalization of SWCNTs. Our results show a spontaneous and asymmetric filling of the nanotube with dynamical water chains in all the cases studied. The presence of Asp- and Glu-like sidechains is found to result in the formation of well-ordered water chains across the tube having the maximum number of water molecules being retained within the core with the largest residence times. The presence of methyl or methylene groups along the suspended chain is observed to disrupt the formation of water chains with higher length and/or longer residence times. The importance of hydrogen bonding in forming these water chains is assessed in terms of the relaxations of different hydrogen bond correlation functions. For a given dimension of the hydrophobic nanopore, we thus obtain a scale comparing the ability of carboxylic, alcohol, and imidazole groups in controlling the structure and dynamics of water in it. Our results also suggest that SWCNTs of varying lengths, endohedrally functionalized with Asp- and Glu-like sidechains, may be used as design templates in CNT-based water storage devices.

Respiratory function impairment and cardiopulmonary consequences in long-time residents of the Canadian Arctic.

PubMed Central

Schaefer, O; Eaton, R D; Timmermans, F J; Hildes, J A

1980-01-01

Spirometry, roentgenography and electrocardiography were performed during community health surveys in 1976-78 in 176 Inuit and other long-time residents of the northeastern (Arctic Bay) and western (Inuvik) Canadian Arctic, and the results were related to age, ethnic origin, occupation and history of climatic exposure, smoking and hospitalization for tuberculosis. In Arctic Bay the young men showed excellent respiratory function, normal-sized pulmonary arteries and normal electrocardiograms, but abnormalities of all three types were increasingly frequent and severe after age 25. The forced mid-expiratory flow (FMF) fell to less than 50% of the norm by age 40, and dilatation of the pulmonary artery, hypertrophy of the right ventricle, right bundle branch block and a pseudoinfarction pattern on the ECG were frequently associated. In contrast, the men in Inuvik, an urbanized centre, maintained above normal respiratory function until age 40, and the FMF and pulmonary artery diameter remained normal in the older men except for Inuit and white trappers over 60 years old who had run fox trap lines along the Arctic coast in the 1920s and 30s. These data suggest that inhalation of extremely cold air at maximum ventilation may be a prime factor in the chronic obstructive lung disease of Inuit hunters, whereas smoking has only a minor role and hospitalization for tuberculosis appears to protect from rather than contribute to this disorder. PMID:7448675

Respiratory function impairment and cardiopulmonary consequences in long-time residents of the Canadian Arctic.

PubMed

Schaefer, O; Eaton, R D; Timmermans, F J; Hildes, J A

1980-11-22

Spirometry, roentgenography and electrocardiography were performed during community health surveys in 1976-78 in 176 Inuit and other long-time residents of the northeastern (Arctic Bay) and western (Inuvik) Canadian Arctic, and the results were related to age, ethnic origin, occupation and history of climatic exposure, smoking and hospitalization for tuberculosis. In Arctic Bay the young men showed excellent respiratory function, normal-sized pulmonary arteries and normal electrocardiograms, but abnormalities of all three types were increasingly frequent and severe after age 25. The forced mid-expiratory flow (FMF) fell to less than 50% of the norm by age 40, and dilatation of the pulmonary artery, hypertrophy of the right ventricle, right bundle branch block and a pseudoinfarction pattern on the ECG were frequently associated. In contrast, the men in Inuvik, an urbanized centre, maintained above normal respiratory function until age 40, and the FMF and pulmonary artery diameter remained normal in the older men except for Inuit and white trappers over 60 years old who had run fox trap lines along the Arctic coast in the 1920s and 30s. These data suggest that inhalation of extremely cold air at maximum ventilation may be a prime factor in the chronic obstructive lung disease of Inuit hunters, whereas smoking has only a minor role and hospitalization for tuberculosis appears to protect from rather than contribute to this disorder.

Pharmacokinetics of fluralaner in dogs following a single oral or intravenous administration.

PubMed

Kilp, Susanne; Ramirez, Diana; Allan, Mark J; Roepke, Rainer K A; Nuernberger, Martin C

2014-03-07

Fluralaner is a novel systemic insecticide and acaricide. The purpose of these studies was to investigate the pharmacokinetic properties of fluralaner in Beagle dogs following single oral or intravenous (i.v.) administration. Following the oral administration of 12.5, 25 or 50 mg fluralaner/kg body weight (BW), formulated as chewable tablets or i.v. administration of 12.5 mg fluralaner/kg BW, formulated as i.v. solution to 24 Beagles, plasma samples were collected until 112 days after treatment. Plasma concentrations of fluralaner were measured using HPLC-MS/MS. Pharmacokinetic parameters were calculated by non-compartmental methods. After oral administration, maximum plasma concentrations (C(max)) were reached within 1 day on average. Fluralaner was quantifiable in plasma for up to 112 days after single oral and i.v. treatment. The apparent half-life of fluralaner was 12-15 days and the mean residence time was 15-20 days. The apparent volume of distribution of fluralaner was 3.1 L/kg, and clearance was 0.14 L/kg/day. Fluralaner is readily absorbed after single-dose oral administration, and has a long elimination half-life, long mean residence time, relatively high apparent volume of distribution, and low clearance. These pharmacokinetic characteristics help to explain the prolonged activity of fluralaner against fleas and ticks on dogs after a single oral dose.

The Annual Glaciohydrology Cycle in the Ablation Zone of the Greenland Ice Sheet: Part 1. Hydrology Model

NASA Technical Reports Server (NTRS)

Colgan, William; Rajaram, Harihar; Anderson, Robert; Steffen. Konrad; Phillips, Thomas; Zwally, H. Jay; Abdalati, Waleed

2012-01-01

We apply a novel one-dimensional glacier hydrology model that calculates hydraulic head to the tidewater-terminating Sermeq Avannarleq flowline of the Greenland ice sheet. Within a plausible parameter space, the model achieves a quasi-steady-state annual cycle in which hydraulic head oscillates close to flotation throughout the ablation zone. Flotation is briefly achieved during the summer melt season along a approx.17 km stretch of the approx.50 km of flowline within the ablation zone. Beneath the majority of the flowline, subglacial conduit storage closes (i.e. obtains minimum radius) during the winter and opens (i.e. obtains maximum radius) during the summer. Along certain stretches of the flowline, the model predicts that subglacial conduit storage remains open throughout the year. A calculated mean glacier water residence time of approx.2.2 years implies that significant amounts of water are stored in the glacier throughout the year. We interpret this residence time as being indicative of the timescale over which the glacier hydrologic system is capable of adjusting to external surface meltwater forcings. Based on in situ ice velocity observations, we suggest that the summer speed-up event generally corresponds to conditions of increasing hydraulic head during inefficient subglacial drainage. Conversely, the slowdown during fall generally corresponds to conditions of decreasing hydraulic head during efficient subglacial drainage.

Conversion Characteristics and Production Evaluation of Styrene/o-Xylene Mixtures Removed by DBD Pretreatment

PubMed Central

Jiang, Liying; Zhu, Runye; Mao, Yubo; Chen, Jianmeng; Zhang, Liang

2015-01-01

The combination of chemical oxidation methods with biotechnology to removal recalcitrant VOCs is a promising technology. In this paper, the aim was to identify the role of key process parameters and biodegradability of the degradation products using a dielectric barrier discharge (DBD) reactor, which provided the fundamental data to evaluate the possibilities of the combined system. Effects of various technologic parameters like initial concentration of mixtures, residence time and relative humidity on the decomposition and the degradation products were examined and discussed. It was found that the removal efficiency of mixed VOCs decreased with increasing initial concentration. The removal efficiency reached the maximum value as relative humidity was approximately 40%–60%. Increasing the residence time resulted in increasing the removal efficiency and the order of destruction efficiency of VOCs followed the order styrene > o-xylene. Compared with the single compounds, the removal efficiency of styrene and o-xylene in the mixtures of VOCs decreased significantly and o-xylene decreased more rapidly. The degradation products were analyzed by gas chromatography and gas chromatography-mass spectrometry, and the main compounds detected were O3, COx and benzene ring derivatives. The biodegradability of mixed VOCs was improved and the products had positive effect on biomass during plasma application, and furthermore typical results indicated that the biodegradability and biotoxicity of gaseous pollutant were quite depending on the specific input energy (SIE). PMID:25629961

Radiocarbon constraints on the glacial ocean circulation and its impact on atmospheric CO2

PubMed Central

Skinner, L. C.; Primeau, F.; Freeman, E.; de la Fuente, M.; Goodwin, P. A.; Gottschalk, J.; Huang, E.; McCave, I. N.; Noble, T. L.; Scrivner, A. E.

2017-01-01

While the ocean’s large-scale overturning circulation is thought to have been significantly different under the climatic conditions of the Last Glacial Maximum (LGM), the exact nature of the glacial circulation and its implications for global carbon cycling continue to be debated. Here we use a global array of ocean–atmosphere radiocarbon disequilibrium estimates to demonstrate a ∼689±53 14C-yr increase in the average residence time of carbon in the deep ocean at the LGM. A predominantly southern-sourced abyssal overturning limb that was more isolated from its shallower northern counterparts is interpreted to have extended from the Southern Ocean, producing a widespread radiocarbon age maximum at mid-depths and depriving the deep ocean of a fast escape route for accumulating respired carbon. While the exact magnitude of the resulting carbon cycle impacts remains to be confirmed, the radiocarbon data suggest an increase in the efficiency of the biological carbon pump that could have accounted for as much as half of the glacial–interglacial CO2 change. PMID:28703126

High-fidelity simulation of lung isolation with double-lumen endotracheal tubes and bronchial blockers in anesthesiology resident training.

PubMed

Failor, Erin; Bowdle, Andrew; Jelacic, Srdjan; Togashi, Kei

2014-08-01

Demonstrate the feasibility of using the AirSim Bronchi airway simulator to teach residents how to manage lung isolation with double-lumen endotracheal tubes and bronchial blockers and evaluate their performance with a detailed checklist. Prospective observational study. University anesthesiology residency training program. Anesthesiology residents taking a cardiothoracic anesthesiology rotation. Residents were instructed in 7 tasks using the AirSim Bronchi: The use of the fiberoptic bronchoscope, methods for placing left and right double-lumen endotracheal tubes and 3 bronchial blockers (Univent, Arndt, and Cohen), and application of continuous positive airway pressure (CPAP) to the unventilated lung. Two to 3 weeks later, checklists and a detailed scoring system were used to assess performance. Residents rated the curriculum and their own confidence in performing the tasks using a 5-point Likert scale. Thirteen residents completed the curriculum. Their median Likert scale ratings of the curriculum based on a questionnaire with 6 items ranged from 4 to 5 of 5. Resident confidence scores for each lung isolation technique improved after the simulation training, with the median gain ranging from 0.5 to 1.5 Likert levels depending on the task. The largest improvement occurred with the bronchial blockers (p<0.05). The median performance score for the 7 tasks combined was 88% of the maximum possible points. The authors used the AirSim Bronchi simulator in a novel simulation curriculum to teach lung-isolation techniques to anesthesiology residents and evaluated performance using a detailed checklist scoring system. This curriculum is a promising educational tool. Copyright © 2014 Elsevier Inc. All rights reserved.

Impact of duty-hour restriction on resident inpatient teaching.

PubMed

Mazotti, Lindsay A; Vidyarthi, Arpana R; Wachter, Robert M; Auerbach, Andrew D; Katz, Patricia P

2009-10-01

Education and patient care are essential to academic hospitalists, and residents are key partners in these goals. The Accreditation Council for Graduate Medical Education (ACGME) duty-hour restrictions (DHR) likely impacted aspects of resident teaching, well-being, and patient care practices that affect the duties of academic hospitalists. To determine the impact of DHR on resident teaching time and the factors associated with, and impacts of, time spent teaching. Cross-sectional survey. SETTING AND MEASUREMENTS: A total of 164 internal medicine residents at University of California, San Francisco (UCSF), San Francisco, CA were queried regarding their time spent teaching, completion of administrative tasks, number of hours worked, frequency of emotional exhaustion, and satisfaction with quality of patient care provided after DHR. Regression analyses identified factors associated with decreased teaching time and determined that there were associations between time spent teaching, emotional exhaustion, and satisfaction with quality of patient care. A total of 125 residents (76%) responded; 24% reported spending less time teaching. Less time teaching was associated with being a postgraduate year (PGY)-2 (odds ratio [OR], 7.14; 95% confidence interval [CI], 1.56-32.79) or PGY-3 (OR, 8.23; 95% CI, 1.44-47.09), reporting working <80 hours/week (OR, 5.99; 95% CI, 1.11-32.48) and spending a greater percentage of time on administrative tasks (OR, 1.03; 95% CI, 1.00-1.06). Those residents who spent less time teaching also reported less frequent emotional exhaustion (P = 0.003) and more satisfaction with quality of care (P = 0.006). DHR has decreased teaching time for some residents, and those residents are more likely to be less emotionally exhausted and deliver self-perceived higher quality of care. Academic hospitalists should consider these impacts of DHR and make adjustments such as educational and work-life innovations to account for these shifts. Copyright 2009 Society of Hospital Medicine

Time-motion studies of internal medicine residents' duty hours: a systematic review and meta-analysis.

PubMed

Leafloor, Cameron W; Lochnan, Heather A; Code, Catherine; Keely, Erin J; Rothwell, Deanna M; Forster, Alan J; Huang, Allen R

2015-01-01

Since the mid-1980s, medical residents' long duty hours have been under scrutiny as a factor affecting patient safety and the work environment for the residents. After several mandated changes in duty hours, it is important to understand how residents spend their time before proposing and implementing future changes. Time-motion methodology may provide reliable information on what residents do while on duty. The purpose of this study is to review all available literature pertaining to time-motion studies of internal medicine residents while on a medicine service and to understand how much of their time is apportioned to various categories of tasks, and also to determine the effects of the Accreditation Council for Graduate Medical Education (ACGME)-mandated duty hour changes on resident workflow in North America. Electronic bibliographic databases were searched for articles in English between 1941 and April 2013 reporting time-motion studies of internal medicine residents rotating through a general medicine service. Eight articles were included. Residents spent 41.8% of time in patient care activities, 18.1% communicating, 13.8% in educational activities, 19.7% in personal/other, and 6.6% in transit. North American data showed the following changes after the implementation of the ACGME 2003 duty hours standard: patient care activities from 41.8% to 40.8%, communication activities from 19.0% to 22.3%, educational activities from 17.7% to 11.6%, and personal/other activities from 21.5% to 17.1%. There was a paucity of time-motion data. There was great variability in the operational definitions of task categories reported in the studies. Implementation of the ACGME duty hour standards did not have a significant effect on the percentage of time spent in particular tasks. There are conflicting reports on how duty hour changes have affected patient safety. A low proportion of time spent in educational activities deserves further study and may point to a review of the educational models used.

Should radiology residents be taught evidence-based radiology? An experiment with "the EBR Journal Club".

PubMed

Heilbrun, Marta E

2009-12-01

Introduce radiology residents to evidence-based radiology (EBR) using a journal club format based on the Radiology Alliance for Health Services Research/American Alliance of Academic Chief Residents in Radiology (RAHSR/A3CR2) Critical Thinking Skills sessions and EBR series of articles published in Radiology in 2007. The club began with a presentation outlining the process that would occur in an alternating format, with topics and articles chosen by residents. In session A, questions were rephrased in a Patient/Population, Intervention, Comparison, Outcome format, and a literature search was performed. Articles were discussed in session B, with residents assigned by year to the tasks of article summary, technology assessment, and comparison to checklists (Standards for Reporting of Diagnostic Accuracy, Consolidated Standards of Reporting Trials, or Quality of Reporting of Meta-analysis). The residents collectively assigned a level of evidence to each article, and a scribe provided a summary. Twenty-two residents participated, with 12/22 (55%) of residents submitting any question, 6/22 (27.3%) submitting more than one question, and 4 residents submitting questions in more than one session. Topics included radiation risk, emergency radiology, screening examinations, modality comparisons, and technology assessment. Of the 31 articles submitted for review, 15 were in radiology journals and 5 were published before 2000. For 2/9 topics searched, no single article that the residents selected was available through our library's subscription service. The maximum level of evidence assigned by residents was level III, "limited evidence." In each session, the residents concluded that they became less confident in the "right answer." They proposed that future reading recommendations come from attendings rather than literature searches. A journal club format is an effective tool to teach radiology residents EBR principles. Resistance comes from the difficulty in accessing good literature for review and in constructing good review questions.

Result Summary for the Area 5 Radioactive Waste Management Site Performance Assessment Model Version 4.110

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

NSTec Environmental Management

2011-07-20

Results for Version 4.110 of the Area 5 Radioactive Waste Management Site (RWMS) performance assessment (PA) model are summarized. Version 4.110 includes the fiscal year (FY) 2010 inventory estimate, including a future inventory estimate. Version 4.110 was implemented in GoldSim 10.11(SP4). The following changes have been implemented since the last baseline model, Version 4.105: (1) Updated the inventory and disposal unit configurations with data through the end of FY 2010. (1) Implemented Federal Guidance Report 13 Supplemental CD dose conversion factors (U.S. Environmental Protection Agency, 1999). Version 4.110 PA results comply with air pathway and all-pathways annual total effective dosemore » (TED) performance objectives (Tables 2 and 3, Figures 1 and 2). Air pathways results decrease moderately for all scenarios. The time of the maximum for the air pathway open rangeland scenario shifts from 1,000 to 100 years (y). All-pathways annual TED increases for all scenarios except the resident scenario. The maximum member of public all-pathways dose occurs at 1,000 y for the resident farmer scenario. The resident farmer dose was predominantly due to technetium-99 (Tc-99) (82 percent) and lead-210 (Pb-210) (13 percent). Pb-210 present at 1,000 y is produced predominantly by radioactive decay of uranium-234 (U-234) present at the time of disposal. All results for the postdrilling and intruder-agriculture scenarios comply with the performance objectives (Tables 4 and 5, Figures 3 and 4). The postdrilling intruder results are similar to Version 4.105 results. The intruder-agriculture results are similar to Version 4.105, except for the Pit 6 Radium Disposal Unit (RaDU). The intruder-agriculture result for the Shallow Land Burial (SLB) disposal units is a significant fraction of the performance objective and exceeds the performance objective at the 95th percentile. The intruder-agriculture dose is due predominantly to Tc-99 (75 percent) and U-238 (9.5 percent). The acute intruder scenario results comply with all performance objectives (Tables 6 and 7, Figures 5 and 6). The acute construction result for the SLB disposal units decreases significantly with this version. The maximum acute intruder dose occurs at 1,000 y for the SLB disposal units under the acute construction scenario. The acute intruder dose is caused by multiple radionuclides including U-238 (31 percent), Th-229 (28 percent), plutonium-239 (8.6 percent), U-233 (7.8 percent), and U-234 (6.7 percent). All results for radon-222 (Rn-222) flux density comply with the performance objective (Table 8, Figure 7). The mean Pit 13 RaDU flux density is close to the 0.74 Bq m{sup -2} s{sup -1} limit.« less

Energy and electrode consumption analysis of electrocoagulation for the removal of arsenic from underground water.

PubMed

Martínez-Villafañe, J F; Montero-Ocampo, C; García-Lara, A M

2009-12-30

A systematic study of the effect of design and operation conditions of an electrochemical reactor on the treatment time for arsenic (As) electro-removal from underground water (GW) was carried out to analyse the energy and electrode consumption. The effects of four factors--current density, interelectrode distance, electrode area-volume ratio, and liquid motion driving mode--were evaluated. The response variables were the energy and the electrode consumption and the treatment time to reduce the GW residual As concentration to 10 microg L(-1), which is the maximum contaminant level (MCL) established by the World Health Organization (WHO) in drinking water. The results obtained in this study showed that the factor that had the greatest effect on most of the response variables was the liquid motion driving mode. The best residence time was 20s, which favoured low energy consumption (58.78 Wh m(-3)) and low electrode material loss (9.59 g m(-3)).

Association of Time to Attrition in Surgical Residency With Individual Resident and Programmatic Factors.

PubMed

Yeo, Heather L; Abelson, Jonathan S; Symer, Matthew M; Mao, Jialin; Michelassi, Fabrizio; Bell, Richard; Sedrakyan, Art; Sosa, Julie A

2018-02-21

Attrition in general surgery residency remains high, and attrition that occurs in the later years is the most worrisome. Although several studies have retrospectively investigated the timing of attrition, no study to date has prospectively evaluated a national cohort of residents to understand which residents are at risk for attrition and at what point during residency. To prospectively evaluate individual resident and programmatic factors associated with the timing of attrition during general surgery residency. This longitudinal, national cohort study administered a survey to all categorical general surgery interns from the class of 2007-2008 during their first 30 days of residency and linked the data with 9-year follow-up data assessing program completion. Data were collected from June 1, 2007, through June 30, 2016. Kaplan-Meier curves evaluating time to attrition during the 9 years after the start of residency. Among our sample of 836 residents (306 women [36.6%] and 528 men [63.2%]; gender unknown in 2), cumulative survival analysis demonstrated overall attrition for the cohort of 20.8% (n = 164). Attrition was highest in the first postgraduate year (67.6% [n = 111]; absolute rate, 13.3%) but continued during the next 6 years, albeit at a lower rate. Beginning in the first year, survival analysis demonstrated higher attrition among Hispanic compared with non-Hispanic residents (21.1% vs 12.4%; P = .04) and at military programs compared with academic or community programs after year 1 (32.3% vs 11.0% or 13.5%; P = .01). Beginning in year 4 of residency, higher attrition was encountered among women compared with men (23.3% vs 17.4%; P = .05); at year 5, at large compared with small programs (26.0% vs 18.4%; P = .04). Race and program location were not associated with attrition. Although attrition was highest during the internship year, late attrition persists, particularly among women and among residents in large programs. These results provide a framework for timing of interventions in graduate surgical training that target residents most at risk for late attrition.

A new time-space accounting scheme to predict stream water residence time and hydrograph source components at the watershed scale

Treesearch

Takahiro Sayama; Jeffrey J. McDonnell

2009-01-01

Hydrograph source components and stream water residence time are fundamental behavioral descriptors of watersheds but, as yet, are poorly represented in most rainfall-runoff models. We present a new time-space accounting scheme (T-SAS) to simulate the pre-event and event water fractions, mean residence time, and spatial source of streamflow at the watershed scale. We...

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.

Water Residence Time estimation by 1D deconvolution in the form of a l2 -regularized inverse problem with smoothness, positivity and causality constraints

NASA Astrophysics Data System (ADS)

Meresescu, Alina G.; Kowalski, Matthieu; Schmidt, Frédéric; Landais, François

2018-06-01

The Water Residence Time distribution is the equivalent of the impulse response of a linear system allowing the propagation of water through a medium, e.g. the propagation of rain water from the top of the mountain towards the aquifers. We consider the output aquifer levels as the convolution between the input rain levels and the Water Residence Time, starting with an initial aquifer base level. The estimation of Water Residence Time is important for a better understanding of hydro-bio-geochemical processes and mixing properties of wetlands used as filters in ecological applications, as well as protecting fresh water sources for wells from pollutants. Common methods of estimating the Water Residence Time focus on cross-correlation, parameter fitting and non-parametric deconvolution methods. Here we propose a 1D full-deconvolution, regularized, non-parametric inverse problem algorithm that enforces smoothness and uses constraints of causality and positivity to estimate the Water Residence Time curve. Compared to Bayesian non-parametric deconvolution approaches, it has a fast runtime per test case; compared to the popular and fast cross-correlation method, it produces a more precise Water Residence Time curve even in the case of noisy measurements. The algorithm needs only one regularization parameter to balance between smoothness of the Water Residence Time and accuracy of the reconstruction. We propose an approach on how to automatically find a suitable value of the regularization parameter from the input data only. Tests on real data illustrate the potential of this method to analyze hydrological datasets.

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.

[Work satisfaction, quality of life and leisure time of residents at the Soroka University Medical Center, Beer Sheba, Israel].

PubMed

Acker, Asaf; Perry, Zvi; Reuveni, Haim; Toker, Asaf

2009-02-01

Work dissatisfaction among physicians worldwide continues to rise over the last few decades, mainly due to declining professional prestige, tack of self fulfillment, time pressure and tack of leisure time. Physicians' burnout is a major result of dissatisfaction, causing doctors to leave the medical profession, and to provide lower quality of care. To examine the work satisfaction, quality of life and leisure time of residents in the Soroka University Medical Center. A validated questionnaire was delivered during the second half of 2004 to 252 residents in the Soroka University Medical Center The data was analyzed using the SPSS 12 for windows program. Descriptive analysis, parametric Students' T Test [where p<0.05 was set to be considered valid) and a-parametric Mann Whitney and x2 tests were conducted. A total of 137 residents responded to the questionnaire (response rate of 54.36%]. The residents' satisfaction level was low, mainly due to dissatisfaction with their quality of life. There was no difference in satisfaction between male and female residents. Residents in the early stage of their internship were more satisfied than residents who had completed the first stage in regard to their income (p=0.005). Surgical residents were less satisfied than non-surgical residents (p=0.003), mainly from the work relations with their superiors (p=0.015). The residents at the Soroka University Medical Center were satisfied with their work environment but not with their quality of life and leisure time. Further attention must be given to these matters--a step which will eventually improve patient care, and delay, to some extent, the burnout of physicians.

Finding Value in Surgical Didactics: Longitudinal Resident Feedback From Case-Based and Traditional Lectures in an Orthopaedic Residency.

PubMed

Barnwell, Jonathan C; Halvorson, Jason J; Teasdall, Robert D; Carroll, Eben A

To evaluate orthopedic resident perceptions of a didactic curriculum presented in traditional and case-based formats. Prospective cohort study using anonymous web-based survey after each conference evaluating resident perceptions of faculty participation, didactic delivery, content, and overall conference value. Conferences were structured as primarily case-based or traditional lecture. Logistic analysis was performed to determine factors predictive of rating a conference as valuable time spent. Orthopedic residency training program at single institution over an academic year. Orthopedic residents in postgraduate training year 1 to 5 attending mandatory didactic conference. Cased-based conferences received higher Likert ratings on residents' perception of faculty participation, instructor delivery, and improvement in topic understanding when compared to traditional lecture-based conferences (p < 0.0001 for each factor). Residents also were more likely to rate case-based conferences as valuable time spent (p < 0.0001). In our logistic model, factors associated with a negative likelihood of rating a conference as valuable were lecture format (odds ratio [OR] = 0.155, 95% CI: 0.115-0.208), PGY-2 level presenter (OR = 0.288, 95% CI: 0.169-0.490), and PGY-3 level presenter (OR = 0.433, 95% CI: 0.269-0.696). Timing in the year, surgical subspeciality, and conference identity were not significant predictors of conference value rating. Longitudinal resident feedback demonstrates highly favorable resident perceptions toward case-based formats in didactic sessions. Junior levels residents are not perceived as effective as senior residents and faculty in presenting material in either format. These methods allow for a dynamic approach to identifying strengths and weaknesses in a resident curriculum as a well as a means for more focused and real-time improvements. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Effect of modest pay-for-performance financial incentive on time-to-discharge summary dictation among medical residents.

PubMed

Wolk, Adam; Wang, Erwin; Horak, Bernard; Cloonan, Patricia; Adams, Michael; Moore, Eileen; Jaipaul, Chitra Komal; Brown, Gabrielle; Dasgupta, Dabanjan; Deluca, Danielle; Grossman, Mila

2013-01-01

Evaluate the effect of a modest financial incentive on time-to-discharge summary dictation among medicine residents. Pay-for-performance incentives are used in a number of health care settings. Studies are lacking on their use with medical residents and other trainees. Timely completion of discharge summaries is necessary for effective follow-up after hospitalization, and residents perform the majority of discharge summary dictations in academic medical centers. Medicine residents with the lowest average discharge-to-dictation time during their 1-month inpatient medicine ward rotation were rewarded with a $50 gift card. Discharge data were captured using an autopopulating electronic database. The average discharge-to-dictation time was reduced from 7.44 to 1.84 days, representing a 75.3% decrease. Almost 90% of discharge summary dictations were performed on the day of discharge. A modest financial incentive resulted in a marked improvement in the time-to-discharge summary dictation by medicine residents. Pay-for-performance programs may be an effective strategy for improving the quality and efficiency of patient care in academic medical centers.

Online residence time distribution measurement of thermochemical biomass pretreatment reactors

DOE PAGES

Sievers, David A.; Kuhn, Erik M.; Stickel, Jonathan J.; ...

2015-11-03

Residence time is a critical parameter that strongly affects the product profile and overall yield achieved from thermochemical pretreatment of lignocellulosic biomass during production of liquid transportation fuels. The residence time distribution (RTD) is one important measure of reactor performance and provides a metric to use when evaluating changes in reactor design and operating parameters. An inexpensive and rapid RTD measurement technique was developed to measure the residence time characteristics in biomass pretreatment reactors and similar equipment processing wet-granular slurries. Sodium chloride was pulsed into the feed entering a 600 kg/d pilot-scale reactor operated at various conditions, and aqueous saltmore » concentration was measured in the discharge using specially fabricated electrical conductivity instrumentation. This online conductivity method was superior in both measurement accuracy and resource requirements compared to offline analysis. Experimentally measured mean residence time values were longer than estimated by simple calculation and screw speed and throughput rate were investigated as contributing factors. In conclusion, a semi-empirical model was developed to predict the mean residence time as a function of operating parameters and enabled improved agreement.« less

Innovative dementia care: functional status over time of persons with Alzheimer disease in a residential care centre compared to special care units.

PubMed

Warren, S; Janzen, W; Andiel-Hett, C; Liu, L; McKim, H R; Schalm, C

2001-01-01

Residential care centres (RCCs) for persons with Alzheimer disease are increasing worldwide, but there are few studies that compare the functional outcomes of RCC residents to residents of other types of continuing care settings. This study compared residents of the first Canadian RCC on physical, cognitive, behavioural and emotional functioning 6, 12 and 18 months after admission to residents of special care units (SCUs) operated by the same continuing care provider. SCU residents were initially functioning lower than RCC residents on most outcome measures and these differences persisted over time. Resident functioning declined over time regardless of care setting and, when the initial status was controlled for, the rates of decline were similar. However, RCC residents experienced greater independence/freedom of choice, fewer physical or psychotropic medication restraints and were more active, which may have enhanced their quality of life. Copyright 2001 S. Karger AG, Basel

An Exploratory Study of Skin Problems Experienced by UK Nursing Home Residents Using Different Pad Designs.

PubMed

Clarke-OʼNeill, Sinead; Farbrot, Anne; Lagerstedt, Marie-Louise; Cottenden, Alan; Fader, Mandy

2015-01-01

The primary aim of this study was to determine whether the severity of incontinence-associated dermatitis (IAD) among nursing home-based incontinence pad users varies between pad designs. A second aim was to examine the utility of a simple method for reporting skin health problems in which healthcare assistants were asked to record basic observational data at each pad change. Randomized, multiple crossover, observational, exploratory. Twenty-one men and 57 women using absorbent continence products to contain urinary and/or fecal incontinence were recruited from 10 nursing homes in London and the south of England. A day-time variant and a night-time variant of each of the 4 main disposable pad designs on the market for moderate/heavy incontinence were tested: (1) insert pads with stretch pants; (2) 1-piece all-in-one diapers; (3) pull-up pants; and (4) belted/T-shape diapers. All pad variants for day-time use had an absorption capacity of 1900 mL ± 20% (measured using ISO 11948-1 International Standards Organization) while the capacity of night-time variants was 2400 mL ± 20%. Each resident used each of the 4 pad designs (day-time and night-time variants) for 2 weeks and the order of testing was randomized by nursing home. Skin health data were collected using 2 methods in parallel. Method 1 comprised visual observation by researchers (1 observation per pad design; 4 observations in total over 8 weeks). In method 2, healthcare assistants logged observational data on skin health at every pad change for the 8 weeks. The primary outcome variable was severity of the most severe skin problem noted by the researcher for each resident, and for each pad design (method 1). Descriptive data on skin care methods used in the nursing homes were also collected using short questionnaires and researcher observation. No significant differences in the severity or incidence of skin problems were found between observations using the 4 pad designs. However, a wide range of skin conditions was recorded that made classification difficult; the skin was often marked with creases from absorbent products, temporary marks, and pink/purple discoloration. We observed few cases of the severe erythema, rashes, and vesicles that are commonly used descriptors in previous skin tools. Nevertheless, the collected data reflect an abundance of skin problems that were difficult to categorize neatly. Researcher observations (method 1) showed that nearly all the residents (96%) had at least 1 IAD skin problem recorded over the 8-week period and 64% of residents had at least 1 problem that was rated as maximum severity. Healthcare assistants logged skin problems on 6.1% of pad changes. The discrepancy between researcher and healthcare assistant data appears to be largely due to healthcare assistants sometimes discounting low-grade IAD as normal for that population. Incontinence-associated dermatitis is common among nursing home residents who use incontinence pads, and it is often severe. No evidence was found that any design of pad was more likely than any others to be associated with skin problems. The method devised to enable healthcare assistants to record basic observational data on skin health in the diaper area at each pad change (Method 2) proved simple to use but still resulted in substantial underreporting of IAD, suggesting that further work is needed to develop a tool that more successfully encourages them to log and treat IAD problems.

Reproductive patterns in demersal crustaceans from the upper boundary of the OMZ off north-central Chile

NASA Astrophysics Data System (ADS)

Gallardo, María de los Ángeles; González López, Andrés E.; Ramos, Marcel; Mujica, Armando; Muñoz, Praxedes; Sellanes, Javier; Yannicelli, Beatriz

2017-06-01

Pleuroncodes monodon (Crustacea: Munididae) supports one of the main trawling fisheries over the continental shelf off Chile between 25°S and 37°S within the upper boundary of the oxygen minimum zone (OMZ). Although the reproductive cycle of P. monodon has been described, the relationship between this key biological process and the variability of the OMZ has not been comprehensibly addressed neither for P. monodon nor for other OMZ resident species. In this study a set of 14 quasi-monthly oceanographic cruises carried out between June 2010 and November 2011 were conducted over the continental shelf off Coquimbo (30°S) to investigate the temporal variability of: i) dissolved oxygen concentration, temperature and chlorophyll-a at relevant depths ii) the presence and proportion of occurrence of P. monodon ovigerous females and juveniles from benthic trawls; iii) the presence of different stage larvae in the plankton, and iv) similar biological data for other species from the OMZ and shallower depths crustaceans. During summer months oxygen levels and bottom temperature were lower than in winter, while chlorophyll-a concentration was maximum in summer coinciding with an active (but not maximum) upwelling season. P. monodon maximum egg carrying occurred in winter during periods of increased oxygenation. Egg carrying females were never found at depths where oxygen concentration was below 0.5 ml L-1, while over 50% of the autumn and spring cohorts of juveniles occurred at oxygen concentrations below that level. The depth range occupied by ovigerous females was more restricted than the rest of the population and their depth of occurrence followed the variability of the upper OMZ. The larval release period of OMZ resident species extends over late winter and spring, and its main peak precedes that of coastal species (spring) and the spring-summer chlorophyll-a maximum. We propose that for OMZ resident species, brood carrying during warmer and more oxygenated conditions in the adult benthic environment, might favor embryonic development, so OMZ seasonal variability could be acting as a selective pressure to synchronize reproductive periods.

Mortality and hospitalization at the end of life in newly admitted nursing home residents with and without dementia.

PubMed

Allers, Katharina; Hoffmann, Falk

2018-05-02

The proportion of deaths occurring in nursing homes is increasing and end of life hospitalizations in residents are common. This study aimed to obtain the time from nursing home admission to death and the frequency of hospitalizations prior to death among residents with and without dementia. This retrospective cohort study analyzed claims data of 127,227 nursing home residents aged 65 years and older newly admitted to a nursing home between 2010 and 2014. We analyzed hospitalizations during the last year of life and assessed mortality rates per 100 person-years. Factors potentially associated with time to death were analyzed in Cox proportional hazard models. The median time from nursing home admission to death was 777 and 635 days in residents with and without dementia, respectively. Being male, older age and a higher level of care decreased the survival time. Sex and age had a higher influence on survival time in residents with dementia, whereas level of care was found to have a higher influence in residents without dementia. Half of the residents of both groups were hospitalized during the last month and about 37% during the last week before death. Leading causes of hospitalizations were infections (with dementia: 20.6% vs. without dementia: 17.2%) and cardiovascular diseases (with dementia: 16.6% vs. without dementia: 19.0%). A high proportion of residents with and without dementia are hospitalized shortly before death. There should be an open debate about the appropriateness of hospitalizing nursing home residents especially those with dementia near death.

A break-even analysis of optimum faculty assignment for ambulatory primary care training.

PubMed

Xakellis, G C; Gjerde, C L; Xakellis, M G; Klitgaard, D

1996-12-01

The increased demand that faculty teach residents in ambulatory clinics necessitates the development of ambulatory care teaching models that are both educationally effective and financially viable. This study was designed to identify the resident-to-faculty ratios needed to provide financially viable faculty supervision of residents while maintaining acceptable resident waiting times for teaching. A computer simulation was developed to estimate the number of residents one or two faculty teachers could supervise in a university-based primary care teaching clinic. The number of residents was calculated for three waiting-time constraints and three scenarios of faculty tasks. A financial analysis of each model was performed. With no non-teaching tasks, two teachers were able to supervise 11 residents and keep waiting times under two minutes, while one teacher was able to supervise only three residents with this waiting-time constraint. The financial break-even point was achieved by all of the two-teacher models, but by none of the one-teacher models. In all three scenarios, using two teachers resulted in more than double the number of residents supervised and in higher utilization of faculty time (higher productivity) than did using one teacher. The two-teacher models of ambulatory supervision allowed for sufficient numbers of residents to be supervised so that teaching costs could be covered from patient care revenues; the one-teacher models did not break even financially. These simulations offer a viable option for academic institutions that are struggling to maintain teaching quality in the face of financial constraints.

Training for Efficiency: Work, Time and Systems-based Practice in Medical Residency*

PubMed Central

Szymczak, Julia E.; Bosk, Charles L.

2013-01-01

Medical residency is a period of intense socialization with a heavy workload. Previous sociological studies have identified efficiency as a practical skill necessary for success. However, many contextual features of the training environment have undergone dramatic change since these studies were conducted. What are the consequences of these changes for the socialization of residents to time management and the development of a professional identity? Based on observations of and interviews with internal medicine residents at 3 training programs, we find that efficiency is both a social norm and strategy that residents employ to manage a workload for which the demand for work exceeds the supply of time available to accomplish it. We found that residents struggle to be efficient in the face of seemingly intractable “systems” problems. Residents work around these problems, and in doing so develop a tolerance for organizational vulnerabilities. PMID:22863601

How Do Residents Spend Their Shift Time? A Time and Motion Study With a Particular Focus on the Use of Computers

PubMed Central

Mamykina, Lena; Vawdrey, David K.; Hripcsak, George

2016-01-01

Purpose To understand how much time residents spend using computers as compared with other activities, and what residents use computers for. Method This time and motion study was conducted in June and July 2010 at NewYork-Presbyterian/Columbia University Medical Center with seven residents (first-, second-, and third-year) on the general medicine service. An experienced observer shadowed residents during a single day shift, captured all their activities using an iPad application, and took field notes. The activities were captured using a validated taxonomy of clinical activities, expanded to describe computer-based activities with a greater level of detail. Results Residents spent 364.5 minutes (50.6%) of their shift time using computers, compared with 67.8 minutes (9.4%) interacting with patients. In addition, they spent 292.3 minutes (40.6%) talking with others in person, 186.0 minutes (25.8%) handling paper notes, 79.7 minutes (11.1%) in rounds, 80.0 minutes (11.1%) walking or waiting, and 54.0 minutes (7.5%) talking on the phone. Residents spent 685 minutes (59.6%) multitasking. Computer-based documentation activities amounted to 189.9 minutes (52.1%) of all computer-based activities time, with 128.7 minutes (35.3%) spent writing notes and 27.3 minutes (7.5%) reading notes composed by others. Conclusions The study showed residents spent considerably more time interacting with computers (over 50% of their shift time), than in direct contact with patients (less than 10% of their shift time). Some of this may be due to an increasing reliance on computing systems for access to patient data, further exacerbated by inefficiencies in the design of the electronic health record. PMID:27028026

How Do Residents Spend Their Shift Time? A Time and Motion Study With a Particular Focus on the Use of Computers.

PubMed

Mamykina, Lena; Vawdrey, David K; Hripcsak, George

2016-06-01

To understand how much time residents spend using computers compared with other activities, and what residents use computers for. This time and motion study was conducted in June and July 2010 at NewYork-Presbyterian/Columbia University Medical Center with seven residents (first-, second-, and third-year) on the general medicine service. An experienced observer shadowed residents during a single day shift, captured all their activities using an iPad application, and took field notes. The activities were captured using a validated taxonomy of clinical activities, expanded to describe computer-based activities with a greater level of detail. Residents spent 364.5 minutes (50.6%) of their shift time using computers, compared with 67.8 minutes (9.4%) interacting with patients. In addition, they spent 292.3 minutes (40.6%) talking with others in person, 186.0 minutes (25.8%) handling paper notes, 79.7 minutes (11.1%) in rounds, 80.0 minutes (11.1%) walking or waiting, and 54.0 minutes (7.5%) talking on the phone. Residents spent 685 minutes (59.6%) multitasking. Computer-based documentation activities amounted to 189.9 minutes (52.1%) of all computer-based activities time, with 128.7 minutes (35.3%) spent writing notes and 27.3 minutes (7.5%) reading notes composed by others. The study showed that residents spent considerably more time interacting with computers (over 50% of their shift time) than in direct contact with patients (less than 10% of their shift time). Some of this may be due to an increasing reliance on computing systems for access to patient data, further exacerbated by inefficiencies in the design of the electronic health record.

PDA usage and training: targeting curriculum for residents and faculty.

PubMed

Morris, Carl G; Church, Lili; Vincent, Chris; Rao, Ashwin

2007-06-01

Utilization of personal digital assistants (PDAs) in residency education is common, but information about their use and how residents are trained to use them is limited. Better understanding of resident and faculty PDA use and training is needed. We used a cross-sectional survey of 598 residents and faculty from the WWAMI (Washington, Wyoming, Alaska, Montana, and Idaho) Family Medicine Residency Network regarding PDA usage and training. Use of PDAs is common among residents (94%) and faculty (79%). Ninety-six percent of faculty and residents report stable or increasing frequency of use over time. The common barriers to PDA use relate to lack of time, knowledge, and formal education. Approximately half of PDA users (52%) have received some formal training; however, the majority of users report being self-taught. Faculty and residents prefer either small-group or one-on-one settings with hands-on, self-directed, interactive formats for PDA training. Large-group settings in lecture, written, or computer program formats were considered less helpful or desirable. PDAs have become a commonly used clinical tool. Lack of time and adequate training present a barrier to optimal application of PDAs in family medicine residency education.

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.

The effects of the addition of a pediatric surgery fellow on the operative experience of the general surgery resident.

PubMed

Raines, Alexander; Garwe, Tabitha; Adeseye, Ademola; Ruiz-Elizalde, Alejandro; Churchill, Warren; Tuggle, David; Mantor, Cameron; Lees, Jason

2015-06-01

Adding fellows to surgical departments with residency programs can affect resident education. Our specific aim was to evaluate the effect of adding a pediatric surgery (PS) fellow on the number of index PS cases logged by the general surgery (GS) residents. At a single institution with both PS and GS programs, we examined the number of logged cases for the fellows and residents over 10 years [5 years before (Time 1) and 5 years after (Time 2) the addition of a PS fellow]. Additionally, the procedure related relative value units (RVUs) recorded by the faculty were evaluated. The fellows averaged 752 and 703 cases during Times 1 and 2, respectively, decreasing by 49 (P = 0.2303). The residents averaged 172 and 161 cases annually during Time 1 and Time 2, respectively, decreasing by 11 (P = 0.7340). The total number of procedure related RVUs was 4627 and 6000 during Times 1 and 2, respectively. The number of cases logged by the PS fellows and GS residents decreased after the addition of a PS fellow; however, the decrease was not significant. Programs can reasonably add an additional PS fellow, but care should be taken especially in programs that are otherwise static in size.

Efficacy of pharmacokinetic interactions between piperonyl butoxide and albendazole against gastrointestinal nematodiasis in goats.

PubMed

Kumbhakar, N K; Sanyal, P K; Rawte, D; Kumar, D; Kerketta, A E; Pal, S

2016-09-01

To test the hypothesis that modulation of hepatic microsomal sulphoxidation and sulphonation by the cytochrome P450 inhibitor piperonyl butoxide could increase bioavailability of albendazole, the present study was undertaken to understand the pharmacokinetics of albendazole in goats at a dose of 7.5 mg kg- 1 body weight with and without co-administration with piperonyl butoxide at 63.0 mg kg- 1 body weight. Plasma albendazole sulphoxide metabolite, the anthelmintically active moiety, reached its maximum concentration of 0.322 ± 0.045 μg ml- 1 and 0.384 ± 0.013 μg ml- 1 at 18 h and 24 h after administration of albendazole alone and co-administration of albendazole with piperonyl butoxide, respectively. Analysis of the data revealed statistically increased albendazole sulphoxide levels at 24 (P 0.05) in values of maximum concentration (normal and calculated) could be observed between groups of goats. However, values of time to reach the concentration maximum (normal and calculated), area under the concentration-time curve (0-∞ and calculated), minimum residence time, distribution half-life, elimination half-life and total area under the first movement of plasma drug concentration-time curve were significantly higher (P <  0.05) in plasma levels of albendazole sulphoxide in goats following single oral co-administration of albendazole with piperonyl butoxide. The faecal egg count reduction and lower 95% confidence limit for the group treated with albendazole alone were 97 and 68%, while for co-administration of albendazole and piperonyl butoxide the values were 99 and 97%, respectively. The ED50 for egg hatch was 0.196, indicating suspected resistance to benzimidazole anthelmintics. The drug combination proved efficacious against an albendazole-resistant nematode parasite population in goats.

Control of topography gradients on residence time distributions, mixing dynamics and reactive hotspot development

NASA Astrophysics Data System (ADS)

Bandopadhyay, Aditya; Le Borgne, Tanguy; Davy, Philippe

2017-04-01

Topography-driven subsurface flows are thought to play a central role in determining solute turnover and biogeochemical processes at different scales in the critical zone, including river-hyporheic zone exchanges, hillslope solute transport and reactions, and catchment biogeochemical cycles. Hydraulic head gradients, induced by topography gradients at different scales, generate a distribution of streamlines at depth, dictating the spatial distribution of redox sensitive species, the magnitude of surface water - ground water exchanges and ultimately the source/sink function of the subsurface. Flow velocities generally decrease with depth, leading to broad residence time distributions, which have been shown to affect river chemistry and geochemical reactions in catchments. In this presentation, we discuss the impact of topography-driven flows on mixing processes and the formation of localized reactive hotspots. For this, we solve analytically the coupled flow, mixing and reaction equations in two-dimensional vertical cross-sections of subsurface domains with different topography gradients. For a given topography gradient, we derive the spatial distribution of subsurface velocities, the rates of solute mixing accross streamlines and the induced kinetics of redox, precipitation and dissolution reactions using a Lagrangian approach (Le Borgne et al. 2014). We demonstrate that vertical velocity profiles driven by topography variations, act effectively as shear flows, hence stretching continuously the mixing fronts between recently infiltrated and resident water (Bandopadhyay et al. 2017). We thus derive analytical expressions for residence time distributions, mixing rates and kinetics of chemical reactions as a function of the topography gradients. We show that the rates dissolution and precipitation reactions are significantly enhanced by the existence of vertical velocity gradients and that reaction rates reach a maximum in a localized subsurface reactive layer, whose location and intensity depends on topography gradients. As a consequence of these findings, we discuss the links between topography variations, subsurface velocity gradients and biogeochemical processes in the critical zone. References: Bandopadhyay A., T. Le Borgne, Y. Méheust and M. Dentz (2017) Enhanced reaction kinetics and reactive mixing scale dynamics in mixing fronts under shear flow for arbitrary Damkohler numbers, Adv. in Water Resour. Vol. 100, p. 78-95 Le Borgne T., T. Ginn and M. Dentz (2014) Impact of Fluid Deformation on Mixing-Induced Chemical Reactions in Heterogeneous Flows, Geophys. Res. Lett., Vol. 41, 22, p. 7898-790

Using Citizen Science Data to Model the Distributions of Common Songbirds of Turkey Under Different Global Climatic Change Scenarios

PubMed Central

Abolafya, Moris; Onmuş, Ortaç; Şekercioğlu, Çağan H.; Bilgin, Raşit

2013-01-01

In this study, we evaluated the potential impact of climate change on the distributions of Turkey’s songbirds in the 21st century by modelling future distributions of 20 resident and nine migratory species under two global climate change scenarios. We combined verified data from an ornithological citizen science initiative (www.kusbank.org) with maximum entropy modeling and eight bioclimatic variables to estimate species distributions and projections for future time periods. Model predictions for resident and migratory species showed high variability, with some species projected to lose and others projected to gain suitable habitat. Our study helps improve the understanding of the current and potential future distributions of Turkey’s songbirds and their responses to climate change, highlights effective strategies to maximize avian conservation efforts in the study region, and provides a model for using citizen science data for biodiversity research in a large developing country with few professional field biologists. Our results demonstrate that climate change will not affect every species equally in Turkey. Expected range reductions in some breeding species will increase the risk of local extinction, whereas others are likely to expand their ranges. PMID:23844151

Using citizen science data to model the distributions of common songbirds of Turkey under different global climatic change scenarios.

PubMed

Abolafya, Moris; Onmuş, Ortaç; Şekercioğlu, Çağan H; Bilgin, Raşit

2013-01-01

In this study, we evaluated the potential impact of climate change on the distributions of Turkey's songbirds in the 21st century by modelling future distributions of 20 resident and nine migratory species under two global climate change scenarios. We combined verified data from an ornithological citizen science initiative (www.kusbank.org) with maximum entropy modeling and eight bioclimatic variables to estimate species distributions and projections for future time periods. Model predictions for resident and migratory species showed high variability, with some species projected to lose and others projected to gain suitable habitat. Our study helps improve the understanding of the current and potential future distributions of Turkey's songbirds and their responses to climate change, highlights effective strategies to maximize avian conservation efforts in the study region, and provides a model for using citizen science data for biodiversity research in a large developing country with few professional field biologists. Our results demonstrate that climate change will not affect every species equally in Turkey. Expected range reductions in some breeding species will increase the risk of local extinction, whereas others are likely to expand their ranges.

Hot temperatures during the dry season reduce survival of a resident tropical bird.

PubMed

Woodworth, Bradley K; Norris, D Ryan; Graham, Brendan A; Kahn, Zachary A; Mennill, Daniel J

2018-05-16

Understanding how climate change will shape species distributions in the future requires a functional understanding of the demographic responses of animals to their environment. For birds, most of our knowledge of how climate influences population vital rates stems from research in temperate environments, even though most of Earth's avian diversity is concentrated in the tropics. We evaluated effects of Southern Oscillation Index (SOI) and local temperature and rainfall at multiple temporal scales on sex-specific survival of a resident tropical bird, the rufous-and-white wren Thryophilus rufalbus , studied over 15 years in the dry forests of northwestern Costa Rica. We found that annual apparent survival of males was 8% higher than females, more variable over time, and responded more strongly to environmental variation than female survival, which did not vary strongly with SOI or local weather. For males, mean and maximum local temperatures were better predictors of survival than either rainfall or SOI, with high temperatures during the dry season and early wet season negatively influencing survival. These results suggest that, even for species adapted to hot environments, further temperature increases may threaten the persistence of local populations in the absence of distributional shifts. © 2018 The Author(s).

Surgical Pathology Resident Rotation Restructuring at a Tertiary Care Academic Center.

PubMed

Mehr, Chelsea R; Obstfeld, Amrom E; Barrett, Amanda C; Montone, Kathleen T; Schwartz, Lauren E

2017-01-01

Changes in the field of pathology and resident education necessitate ongoing evaluation of residency training. Evolutionary change is particularly important for surgical pathology rotations, which form the core of anatomic pathology training programs. In the past, we organized this rotation based on subjective insight. When faced with the recent need to restructure the rotation, we strove for a more evidence-based process. Our approach involved 2 primary sources of data. We quantified the number of cases and blocks submitted per case type to estimate workload and surveyed residents about the time required to gross specimens in all organ systems. A multidisciplinary committee including faculty, residents, and staff evaluated the results and used the data to model how various changes to the rotation would affect resident workload, turnaround time, and other variables. Finally, we identified rotation structures that equally distributed work and created a point-based system that capped grossing time for residents of different experience. Following implementation, we retrospectively compared turnaround time and duty hour violations before and after these changes and surveyed residents about their experiences with both systems. We evaluated the accuracy of the point-based system by examining grossing times and comparing them to the assigned point values. We found overall improvement in the rotation following the implementation. As there is essentially no literature on the subject of surgical pathology rotation organization, we hope that our experience will provide a road map to improve pathology resident education at other institutions.

Fine Sediment Residency in Streambeds in Southeastern Australia.

NASA Astrophysics Data System (ADS)

Croke, J. C.; Thompson, C. J.; Rhodes, E.

2007-12-01

A detailed understanding of channel forming and maintenance processes in streams requires some measurement and/or prediction of bed load transport and sediment mobility. Traditional field based measurements of such processes are often problematic due to the high discharge characteristics of upland streams. In part to compensate for such difficulties, empirical flow competence equations have also been developed to predict armour or bedform stabilising grain mobility. These equations have been applied to individual reaches to predict the entrainment of a threshold grain size and the vertical extent of flushing. In cobble- and boulder-bed channels the threshold grain size relates to the size of the bedform stabilising grains (eg. D84, D90). This then allows some prediction of when transport of the matrix material occurs. The application of Optically Stimulated Luminescence (OSL) dating is considered here as an alternative and innovative way to determine fine sediment residency times in stream beds. Age estimates derived from the technique are used to assist in calibrating sediment entrainment models to specific channel types and hydrological regimes. The results from a one-dimensional HEC-RAS model indicate that recurrence interval floods exceeding bankfull up to 13 years are competent to mobilise the maximum overlying surface grain sizes at the sites. OSL minimum age model results of well bleached quartz in the fine matrix particles are in general agreement with selected competence equation predictions. The apparent long (100-1400y) burial age of most of the mineral quartz suggests that competent flows are not able to flush all subsurface fine-bed material. Maximum bed load exchange (flushing) depth was limited to twice the depth of the overlying D90 grain size. Application of OSL in this study provides important insight into the nature of matrix material storage and flushing in mountain streams.

26 CFR 301.7701(b)-4 - Residency time periods.

Code of Federal Regulations, 2010 CFR

2010-04-01

... for tax purposes on the alien's residency starting date. The residency starting date for an alien who... present in the United States. The residency starting date for an alien who meets the lawful permanent... permanent resident. The residency starting date for an alien who satisfies both the substantial presence...

New Media for Educating Urology Residents: An Interview Study in Canada and Germany.

PubMed

Salem, Johannes; Borgmann, Hendrik; MacNeily, Andrew; Boehm, Katharina; Schmid, Marianne; Groeben, Christer; Baunacke, Martin; Huber, Johannes

To investigate the usage and perceived usefulness of new media for educating urology residents in Canada and Germany. We designed an 11-item online survey to assess the use and perceived usefulness of new media for education. We performed a comparative analysis. The survey was distributed via e-mail to 143 Canadian and 721 German urology residents. The survey included 58 urology residents from Canada and 170 from Germany. A total of 58 residents from Canada (41% response rate) and 170 from Germany (24% response rate) responded to this survey. Residents spent 45% of their education time on new media. The Internet was used by 91% (n = 208) of the residents for professional education purposes, with a median time of 270 minutes (interquartile range [IQR]: 114-540) per month. Apps were used by 54% (n = 118) of the residents, with a median time of 101 minutes (IQR: 45-293) per month. A total of 23% (n = 47) of the residents used social media (SoMe) for education, with a median time of 90 minutes (IQR: 53-80) per month. In all, 100% (n = 228) rated the Internet, 76% (n = 173) apps, and 43% (n = 97) SoMe as being useful for professional education purposes. A total of 90% (n = 205) watched medical videos for education, and 89% (n = 203) of these videos were on surgical procedures. Canadian urology residents used more new media sources for professional education than did the Germans (58% vs. 41%, p < 0.001). The time spent for education on new media was higher among Canadian residents for the Internet (p < 0.001), apps (p < 0.001), and SoMe (p = 0.033). Canadian residents reported more privacy concerns (p < 0.001). New media play a dominant role in the education of urology residents. The primary source for personal education in urology is the Internet. Future studies and technological developments should investigate and improve new media tools to optimize education during residency. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

26 CFR 301.6362-6 - Requirements relating to residence.

Code of Federal Regulations, 2010 CFR

2010-04-01

... time of creation of the trust, less than 50 percent in value of the trust corpus consists of real.... C, a dependent of his parents who are residents of State X, is a full-time student in a 4-year... a brief period of time, with no definite present intention of later removing therefrom. Residence...

Variation of Care Time Between Nursing Units in Classification-Based Nurse-to-Resident Ratios: A Multilevel Analysis

PubMed Central

Planer, Katarina; Hagel, Anja

2018-01-01

A validity test was conducted to determine how care level–based nurse-to-resident ratios compare with actual daily care times per resident in Germany. Stability across different long-term care facilities was tested. Care level–based nurse-to-resident ratios were compared with the standard minimum nurse-to-resident ratios. Levels of care are determined by classification authorities in long-term care insurance programs and are used to distribute resources. Care levels are a powerful tool for classifying authorities in long-term care insurance. We used observer-based measurement of assignable direct and indirect care time in 68 nursing units for 2028 residents across 2 working days. Organizational data were collected at the end of the quarter in which the observation was made. Data were collected from January to March, 2012. We used a null multilevel model with random intercepts and multilevel models with fixed and random slopes to analyze data at both the organization and resident levels. A total of 14% of the variance in total care time per day was explained by membership in nursing units. The impact of care levels on care time differed significantly between nursing units. Forty percent of residents at the lowest care level received less than the standard minimum registered nursing time per day. For facilities that have been significantly disadvantaged in the current staffing system, a higher minimum standard will function more effectively than a complex classification system without scientific controls. PMID:29442533

Variation of Care Time Between Nursing Units in Classification-Based Nurse-to-Resident Ratios: A Multilevel Analysis.

PubMed

Brühl, Albert; Planer, Katarina; Hagel, Anja

2018-01-01

A validity test was conducted to determine how care level-based nurse-to-resident ratios compare with actual daily care times per resident in Germany. Stability across different long-term care facilities was tested. Care level-based nurse-to-resident ratios were compared with the standard minimum nurse-to-resident ratios. Levels of care are determined by classification authorities in long-term care insurance programs and are used to distribute resources. Care levels are a powerful tool for classifying authorities in long-term care insurance. We used observer-based measurement of assignable direct and indirect care time in 68 nursing units for 2028 residents across 2 working days. Organizational data were collected at the end of the quarter in which the observation was made. Data were collected from January to March, 2012. We used a null multilevel model with random intercepts and multilevel models with fixed and random slopes to analyze data at both the organization and resident levels. A total of 14% of the variance in total care time per day was explained by membership in nursing units. The impact of care levels on care time differed significantly between nursing units. Forty percent of residents at the lowest care level received less than the standard minimum registered nursing time per day. For facilities that have been significantly disadvantaged in the current staffing system, a higher minimum standard will function more effectively than a complex classification system without scientific controls.

Pediatric resident perceptions of family-friendly benefits.

PubMed

Berkowitz, Carol D; Frintner, Mary Pat; Cull, William L

2010-01-01

The aim of this study was to examine the importance of family-friendly features in residency program selection, benefits offered to and used by residents, and importance of benefits in future job selection. A survey of a random, national sample of 1000 graduating pediatric residents in 2008 was mailed and e-mailed. Survey response rate for graduating resident respondents was 59%. Among the respondents, 76% were women. Thirty-seven percent of men and 32% of women were parents. Residents with children were more likely than residents without children to rate family-friendly characteristics as very important in their residency selection (P < .05). Many residents reported that their programs offered maternity leave (88%), paternity leave (59%), individual flexibility with schedule (63%), and lactation rooms (55%), but fewer reported on-site child care (24%), care for ill children (19%), and part-time residency positions (12%). Among residents reporting availability, 77% of women with children used maternity leave and lactation rooms. Few held part-time residency positions (2%), but many expressed interest (23% of women with children). The majority of residents with and without children reported that flexibility with schedule was important in their future job selection. Most women with children (71%) and many women without children (52%) considered part-time work to be very important in their job selection. Family-friendly benefits are important to residents, particularly those with children. The data provides a benchmark for the availability and use of family-friendly features at pediatric training programs. The data also shows that many residents are unaware if benefits are offered, which suggests a need to make available benefits more transparent to residents. Copyright 2010 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Psychotherapy Training: Residents' Perceptions and Experiences.

PubMed

Kovach, Jessica G; Dubin, William R; Combs, Christopher J

2015-10-01

This survey examined actual training hours in psychotherapy modalities as reported by residents, residents' perceptions of training needs, and residents' perceptions of the importance of different aspects of psychotherapy training. A brief, voluntary, anonymous, Internet-based survey was developed. All 14 program directors for Accreditation Council for Graduate Medical Education accredited programs in Pennsylvania, New Jersey, and Delaware provided email addresses for current categorical residents. The survey inquired about hours of time spent in various aspects of training, value assigned to aspects of training, residents' involvement in their own psychotherapy, and overall resident wellness. The survey was e-mailed to 328 residents. Of the 328 residents contacted, 133 (40.5%) responded. Median reported number of PGY 3 and 4 performed versus perceived ideal hours of supportive therapy, cognitive behavioral therapy (CBT), and psychodynamic therapy did not differ. Answers for clinical time utilizing these modalities ranged from "none or less than 1 h" per month to 20+ h per month. PGY 3 and 4 residents reported a median of "none or less than 1 h" per month performed of interpersonal, dialectical behavior therapy, couples/family/group, and child therapies but preferred more time using these therapies. Residents in all years of training preferred more hours of didactic instruction for all psychotherapies and for medication management. Residents ranked teaching modalities in the following order of importance: supervision, hours of psychotherapy performed, personal psychotherapy, readings, and didactic instruction. Residents engaged in their own psychotherapy were significantly more likely to rank the experiential aspects of psychotherapy training (personal psychotherapy, supervision, and hours performed) higher than residents not in psychotherapy. Current psychotherapy training for psychiatry residents is highly variable, but overall, residents want more psychotherapy education than they are receiving. Further research and discussion about how much psychotherapy training is feasible in an evolving field is required.

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.

A method of estimating in-stream residence time of water in rivers

NASA Astrophysics Data System (ADS)

Worrall, F.; Howden, N. J. K.; Burt, T. P.

2014-05-01

This study develops a method for estimating the average in-stream residence time of water in a river channel and across large catchments, i.e. the time between water entering a river and reaching a downstream monitoring point. The methodology uses river flow gauging data to integrate Manning's equation along a length of channel for different percentile flows. The method was developed and tested for the River Tees in northern England and then applied across the United Kingdom (UK). The study developed methods to predict channel width and main channel length from catchment area. For an 818 km2 catchment with a channel length of 79 km, the in-stream residence time at the 50% exceedence flow was 13.8 h. The method was applied to nine UK river basins and the results showed that in-stream residence time was related to the average slope of a basin and its average annual rainfall. For the UK as a whole, the discharge-weighted in-stream residence time was 26.7 h for the median flow. At median flow, 50% of the discharge-weighted in-stream residence time was due to only 6 out of the 323 catchments considered. Since only a few large rivers dominate the in-stream residence time, these rivers will dominate key biogeochemical processes controlling export at the national scale. The implications of the results for biogeochemistry, especially the turnover of carbon in rivers, are discussed.

Air-Parcel Residence Times Within Forest Canopies

NASA Astrophysics Data System (ADS)

Gerken, Tobias; Chamecki, Marcelo; Fuentes, Jose D.

2017-10-01

We present a theoretical model, based on a simple model of turbulent diffusion and first-order chemical kinetics, to determine air-parcel residence times and the out-of-canopy export of reactive gases emitted within forest canopies under neutral conditions. Theoretical predictions of the air-parcel residence time are compared to values derived from large-eddy simulation for a range of canopy architectures and turbulence levels under neutral stratification. Median air-parcel residence times range from a few sec in the upper canopy to approximately 30 min near the ground and the distribution of residence times is skewed towards longer times in the lower canopy. While the predicted probability density functions from the theoretical model and large-eddy simulation are in good agreement with each other, the theoretical model requires only information on canopy height and eddy diffusivities inside the canopy. The eddy-diffusivity model developed additionally requires the friction velocity at canopy top and a parametrized profile of the standard deviation of vertical velocity. The theoretical model of air-parcel residence times is extended to include first-order chemical reactions over a range of of Damköhler numbers ( Da) characteristic of plant-emitted hydrocarbons. The resulting out-of-canopy export fractions range from near 1 for Da =10^{-3} to less than 0.3 at Da = 10. These results highlight the necessity for dense and tall forests to include the impacts of air-parcel residence times when calculating the out-of-canopy export fraction for reactive trace gases.

Evaluation of Oral and Maxillofacial Surgery Residents' Operative Skills: Feasibility and Engagement Study Using SIMPL Software for a Mobile Phone.

PubMed

Kaban, Leonard B; Cappetta, Alyssa; George, Brian C; Lahey, Edward T; Bohnen, Jordan D; Troulis, Maria J

2017-10-01

There are no universally accepted tools to evaluate operative skills of surgical residents in a timely fashion. The purpose of this study was to determine the feasibility of using a smartphone application, SIMPL (System for Improving and Measuring Procedural Learning), developed by a multi-institutional research collaborative, to achieve a high rate of timely operative evaluations and resident communication and to collect performance data. The authors hypothesized that these goals would be achieved because the process is convenient and efficient. This was a prospective feasibility and engagement study using SIMPL to evaluate residents' operative skills. SIMPL requires the attending surgeon to answer 3 multiple-choice questions: 1) What level of help (Zwisch Scale) was required by the trainee? 2) What was the level of performance? 3) How complex was the case? The evaluator also can dictate a narrative. The sample was composed of 3 faculty members and 3 volunteer senior residents. Predictor variables were the surgeons, trainees, and procedures performed. Outcome variables included number and percentage of procedures performed by faculty-and-resident pairs assessed, time required to complete assessments, time lapsed to submission, percentage of assessments with narratives, and residents' response rates. From March through June 2016, 151 procedures were performed in the operating room by the faculty-and-resident teams. There were 107 assessments submitted (71%). Resident response (self-assessment) to faculty evaluations was 81%. Recorded time to complete assessments (n = 75 of 107) was shorter than 2 minutes. The time lapsed to submission was shorter than 72 hours (100%). Dictations were submitted for 35 evaluations (33%). Data for the type of help, performance, and complexity of cases were collected for each resident. SIMPL facilitates timely intraoperative evaluations of surgical skills, engagement by faculty and residents, and collection of detailed procedural data. Additional prospective trials to assess this tool further are planned. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Increase in Cesarean Operative Time Following Institution of the 80-Hour Workweek

PubMed Central

Smrtka, Michael P.; Gunatilake, Ravindu P.; Harris, Benjamin; Yu, Miao; Lan, Lan; Brancazio, Leo R.; Valea, Fidel A.; Grotegut, Chad A.; Brown, Haywood L.

2015-01-01

Background  In 2003, the Accreditation Council for Graduate Medical Education limited resident duty hours to 80 hours per week. More than a decade later, the effect of the limits on resident clinical competence is not fully understood. Objective  We sought to assess the effect of duty hour restrictions on resident performance of an uncomplicated cesarean delivery. Methods  We reviewed unlabored primary cesarean deliveries at Duke University Hospital after 34 weeks gestation, between 2003 and 2011. Descriptive statistics and linear regression were used to compare total operative time with incision to delivery time as a function of years since institution of the 80-hour workweek. Resident training level, subject body mass index, estimated blood loss, and skin closure method were controlled for in the regression model. Results  We identified 444 deliveries that met study criteria. The mean (SD) total operative time in 2003–2004 was 43.3 (14.3) minutes and 59.6 (10.7) minutes in 2010–2011 (P < .001). Multivariable regression demonstrated an increase in total operative time of 1.9 min/y (P < .001) but no change in incision to delivery time (P = .05). The magnitude of increased operative time was seen among junior residents (2.0 min/y, P < .001) compared to that of senior residents (1.2 min/y, P = .06). Conclusions  Since introduction of the 2003 duty hour limits, there has been an increase of nearly 20 minutes in the time required for a routine cesarean delivery. It is unclear if the findings are due to a change in residency duty hours or to another aspect of residency training. PMID:26457141

Results of the 2005-2008 Association of Residents in Radiation Oncology Survey of Chief Residents in the United States: Clinical Training and Resident Working Conditions

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

Gondi, Vinai, E-mail: gondi@humonc.wisc.edu; Bernard, Johnny Ray; Jabbari, Siavash

2011-11-15

Purpose: To document clinical training and resident working conditions reported by chief residents during their residency. Methods and Materials: During the academic years 2005 to 2006, 2006 to 2007, and 2007 to 2008, the Association of Residents in Radiation Oncology conducted a nationwide survey of all radiation oncology chief residents in the United States. Chi-square statistics were used to assess changes in clinical training and resident working conditions over time. Results: Surveys were completed by representatives from 55 programs (response rate, 71.4%) in 2005 to 2006, 60 programs (75.9%) in 2006 to 2007, and 74 programs (93.7%) in 2007 tomore » 2008. Nearly all chief residents reported receiving adequate clinical experience in commonly treated disease sites, such as breast and genitourinary malignancies; and commonly performed procedures, such as three-dimensional conformal radiotherapy and intensity-modulated radiotherapy. Clinical experience in extracranial stereotactic radiotherapy increased over time (p < 0.001), whereas clinical experience in endovascular brachytherapy (p <0.001) decreased over time. The distribution of gynecologic and prostate brachytherapy cases remained stable, while clinical case load in breast brachytherapy increased (p = 0.006). A small but significant percentage of residents reported receiving inadequate clinical experience in pediatrics, seeing 10 or fewer pediatric cases during the course of residency. Procedures involving higher capital costs, such as particle beam therapy and intraoperative radiotherapy, and infrequent clinical use, such as head and neck brachytherapy, were limited to a minority of institutions. Most residency programs associated with at least one satellite facility have incorporated resident rotations into their clinical training, and the majority of residents at these programs find them valuable experiences. The majority of residents reported working 60 or fewer hours per week on required clinical duties. Conclusions: Trends in clinical training and resident working conditions over 3 years are documented to allow residents and program directors to assess their residency training.« less

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.

Well-Being among Emergency Medicine Resident Physicians: Results from the ABEM Longitudinal Study of Emergency Medicine Residents.

PubMed

Perina, Debra G; Marco, Catherine A; Smith-Coggins, Rebecca; Kowalenko, Terry; Johnston, Mary M; Harvey, Anne

2018-05-11

The Longitudinal Study of Emergency Medicine Residents (LSEMR) conducted by the American Board of Emergency Medicine queries a randomized cohort of emergency medicine (EM) residents. It is designed to identify residents' perceptions of their training, sources of stress, well-being level, and career choice satisfaction over time. This study utilizes LSEMR to identify resident well-being levels, career satisfaction, factors producing stress, and whether a specific cohort is more stressed than the overall respondent group. Data from five longitudinal cohorts were analyzed using descriptive statistics to assess stressors, career satisfaction, and self-reported resident well-being. Participants' answers were reported on a 5-point Likert scale. There were 766 residents who completed the survey in five cohorts. Respondents were 30 years old (median 29), male (66%), and predominantly White (79%). The most frequently encountered problems included "time devoted to documentation and bureaucratic issues," "knowing enough," and "crowding in the emergency department." In contrast, the least frequently reported problems included "gender discrimination," "EMS support," "minority discrimination," and "other residents." Respondents thought being an EM resident was fun and would select EM again. Less than 20% indicated they had seriously considered transferring to another EM program. Resident reports of health concerns changed over time, with fewer residents reporting they were exceptionally healthy in 2016. Residents are, overall, happy with their career choice. However, concern was expressed regarding continued well-being in training. Sources of stress in training are identified. Strategies should be developed to decrease identified stressors and increase well-being among EM residents. Copyright © 2018 Elsevier Inc. All rights reserved.

Simulation center training as a means to improve resident performance in percutaneous noncontinuous CT-guided fluoroscopic procedures with dose reduction.

PubMed

Mendiratta-Lala, Mishal; Williams, Todd R; Mendiratta, Vivek; Ahmed, Hafeez; Bonnett, John W

2015-04-01

The purpose of this study was to evaluate the effectiveness of a multifaceted simulation-based resident training for CT-guided fluoroscopic procedures by measuring procedural and technical skills, radiation dose, and procedure times before and after simulation training. A prospective analysis included 40 radiology residents and eight staff radiologists. Residents took an online pretest to assess baseline procedural knowledge. Second-through fourth-year residents' baseline technical skills with a procedural phantom were evaluated. First-through third-year residents then underwent formal didactic and simulation-based procedural and technical training with one of two interventional radiologists and followed the training with 1 month of supervised phantom-based practice. Thereafter, residents underwent final written and practical examinations. The practical examination included essential items from a 20-point checklist, including site and side marking, consent, time-out, and sterile technique along with a technical skills portion assessing pedal steps, radiation dose, needle redirects, and procedure time. The results indicated statistically significant improvement in procedural and technical skills after simulation training. For residents, the median number of pedal steps decreased by three (p=0.001), median dose decreased by 15.4 mGy (p<0.001), median procedure time decreased by 4.0 minutes (p<0.001), median number of needle redirects decreased by 1.0 (p=0.005), and median number of 20-point checklist items successfully completed increased by three (p<0.001). The results suggest that procedural skills can be acquired and improved by simulation-based training of residents, regardless of experience. CT simulation training decreases procedural time, decreases radiation dose, and improves resident efficiency and confidence, which may transfer to clinical practice with improved patient care and safety.

Assessment of procedural skills in residents working in a research and training institute: An effort to ensure patient safety and quality control.

PubMed

Kumari, Kamlesh; Samra, Tanvir; Naik, B Naveen; Saini, Vikas

2018-01-01

To ensure patient safety, it is important to regularly assess the knowledge and practical skills of anesthesia trainees. This study was conducted to evaluate the competency of the residents and the impact of various corrective measures in the form of didactic lectures and clinical skill demonstrations on the conduct of various procedural skills by the residents. Ninety-five junior residents were enrolled in this study. Assessment of competency of 1 st , 2 nd , and 3 rd year residents in performing various procedure skills of anesthesia was done in two stages using procedure specific checklist (PSC) and Global Rating Scales (GRSs). Preliminary results of the first assessment (Score 1) were discussed with the residents; deficiencies were identified and corrective measures suggested by didactic lectures and clinical skill demonstrations which were followed by a subsequent assessment after 3 months (Score 2). There was a statistically significant improvement in the PSC and GRS scores after corrective measures for all the procedural interventions studied. Percentage increase in scores was maximum in 1 st year (42.98 ± 6.62) followed by 2 nd year (34.62 ± 5.49) and minimum in 3 rd year residents (18.06 ± 3.69). The percentage increase of scores was almost similar for all subset of procedural skills; low, intermediate, and high skill anesthetic procedures. For assessment of procedural skills of residents, use of PSC and GRS scores should be incorporated and the same should be used to monitor the impact of various corrective measures (didactic lectures and clinical skill demonstrations) on the conduct of various procedural skills by the resident.

Release behavior of tanshinone IIA sustained-release pellets based on crack formation theory.

PubMed

Liu, Pan; Li, Jin; Liu, Jianping; Yang, Jikun; Fan, Yongqing

2012-08-01

The objective of this study was to investigate the drug release mechanism and in vivo performance of Tanshinone IIA sustained-release pellets, coated with blends of polyvinyl acetate (PVAc) and poly(vinyl alcohol)-poly(ethylene glycol) (PVA-PEG) graft copolymer. A formulation screening study showed that pellets coated with PVAc-PVA-PEG at a ratio of 70:30 (w/w) succeeded in achieving a 24 h sustained release, irrespective of the coating weight (from 2% to 10%). Both the microscopic observation and mathematical model gave further insight into the underlying release mechanism, indicating that diffusion through water-filled cracks was dominant for the control of drug release. In vivo test showed that the maximum plasma concentration of sustained-release pellets was decreased from 82.13 ± 17.05 to 40.50 ± 11.72 ng mL as that of quick-release pellets. The time of maximum concentration, half time, and mean residence time were all prolonged from 3.80 ± 0.40 to 8.02 ± 0.81 h, 4.28 ± 1.21 to 8.18 ± 2.06 h, and 8.60 ± 1.59 to 17.50 ± 2.78 h, compared with uncoated preparations. A good in vitro-in vivo correlation was characterized by a high coefficient of determination (r = 0.9772). In conclusion, pellets coated with PVAc-PVA-PEG could achieve a satisfactory sustained-release behavior based on crack formation theory. Copyright © 2012 Wiley Periodicals, Inc.

Defining and measuring the mean residence time of lateral surface transient storage zones in small streams

Treesearch

T.R. Jackson; R. Haggerty; S.V. Apte; A. Coleman; K.J. Drost

2012-01-01

Surface transient storage (STS) has functional significance in stream ecosystems because it increases solute interaction with sediments. After volume, mean residence time is the most important metric of STS, but it is unclear how this can be measured accurately or related to other timescales and field-measureable parameters. We studied mean residence time of lateral...

SUBSURFACE RESIDENCE TIMES AS AN ALGORITHM FOR AQUIFER SENSITIVITY MAPPING: TESTING THE CONCEPT WITH ANALYTIC ELEMENT GROUND WATER MODELS IN THE CONTENTNEA CREEK BASIN, NORTH CAROLINA, USA

EPA Science Inventory

The objective of this research is to test the utility of simple functions of spatially integrated and temporally averaged ground water residence times in shallow "groundwatersheds" with field observations and more detailed computer simulations. The residence time of water in the...

Examining Time Use of Dutch Nursing Staff in Long-Term Institutional Care: A Time-Motion Study.

PubMed

Tuinman, Astrid; de Greef, Mathieu H G; Krijnen, Wim P; Nieweg, Roos M B; Roodbol, Petrie F

2016-02-01

Increasing residents' acuity levels and available resources in long-term institutional care requires insight into the care provided by nursing staff so as to guide task allocation and optimal use of resources, and enhance quality of care. The purpose of this study was to examine the relationship between time use and type of nursing staff, residents' acuity levels, and unit type by using a standardized nursing intervention classification. A multicenter cross-sectional observational study was performed using time-motion technique. Five Dutch long-term institutional care facilities participated. In total, 4 residential care units, 3 somatic units, and 6 psycho-geriatric units were included. Data were collected from 136 nursing staff members: 19 registered nurses, 89 nursing assistants, 9 primary caregivers, and 19 health care assistants. A structured observation list was used based on the Nursing Interventions Classification (NIC). Residents' acuity levels, representing residents' needs, were based on the Dutch Care Severity Index. Medians and interquartile ranges were calculated for time spent on interventions per type of nursing staff and units. Linear mixed models were used to examine the relationship between time spent on nursing interventions and the type of nursing staff, residents' acuity levels, and unit type. Observations resulted in 52,628 registered minutes for 102 nursing interventions categorized into 6 NIC domains for 335 residents. Nursing staff spent the most time on direct care interventions, particularly in the domain of basic physiological care. Variances in time spent on interventions between types of nursing staff were minimal. Unit type was more significantly (P < .05) associated with time spent on interventions in domains than the type of nursing staff. Residents' acuity levels did not affect time spent by nursing staff (P > .05). The current study found limited evidence for task allocation between the types of nursing staff, which may suggest a blurring of role differentiation. Also, findings suggest that residents received similar care regardless of their needs, implying that care is predominantly task-oriented instead of person-centered. Managers may reconsider whether the needs of residents are adequately met by qualified nursing staff, considering the differences in education and taking into account increasing acuity levels of residents and available resources. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Automated external defibrillators and simulated in-hospital cardiac arrests.

PubMed

Rossano, Joseph W; Jefferson, Larry S; Smith, E O'Brian; Ward, Mark A; Mott, Antonio R

2009-05-01

To test the hypothesis that pediatric residents would have shorter time to attempted defibrillation using automated external defibrillators (AEDs) compared with manual defibrillators (MDs). A prospective, randomized, controlled trial of AEDs versus MDs was performed. Pediatric residents responded to a simulated in-hospital ventricular fibrillation cardiac arrest and were randomized to using either an AED or MD. The primary end point was time to attempted defibrillation. Sixty residents, 21 (35%) interns, were randomized to 2 groups (AED = 30, MD = 30). Residents randomized to the AED group had a significantly shorter time to attempted defibrillation [median, 60 seconds (interquartile range, 53 to 71 seconds)] compared with those randomized to the MD group [median, 103 seconds (interquartile range, 68 to 288 seconds)] (P < .001). All residents in the AED group attempted defibrillation at <5 minutes compared with 23 (77%) in the MD group (P = .01). AEDs improve the time to attempted defibrillation by pediatric residents in simulated cardiac arrests. Further studies are needed to help determine the role of AEDs in pediatric in-hospital cardiac arrests.

Tissue persistence of fumonisin B1 in ducks and after exposure to a diet containing the maximum European tolerance for fumonisins in avian feeds.

PubMed

Tardieu, Didier; Bailly, Jean-Denis; Benlashehr, Imad; Auby, Alienor; Jouglar, Jean-Yves; Guerre, Philippe

2009-12-10

Toxicity and persistence of fumonisin B1 (FB1) in liver, kidney and muscle were investigated in ducks fed 5, 10 and 20mg FB1+FB2/kg feed during force-feeding. Mortality and signs of toxicity were only obtained with 20mg/kg, whereas an increased Sa/So ratio was observed from 5mg/kg on. Persistence of FB1 was only found in liver (16 and 20 microg FB1/kg liver in ducks fed 10 and 20 mg FB1+FB2/kg feed, respectively). Toxicokinetic studies were conducted by the intravenous route (IV, single dose: 10mg FB1/kg body weight) and the oral route (single dose: 100mg FB1/kg body weight), in growing ducks and in ducks during force-feeding. After IV administration, serum concentration-time curves were described by a two-compartment open model. Elimination half-life and mean residence time of FB1 were 26 and 24 min, respectively, clearance was 19.3 ml/min/kg. After oral administration, bioavailability, elimination half-life, mean residence time and clearance varied during force-feeding and growth from 2-2.3%, 71-80 min, 200-188 min, 16.7-17 ml/min/kg, respectively. Taken together these results demonstrate that the risk of persistence of FB1 in ducks after force-feeding is very low, Sa/So being a good biomarker which increases before signs of toxicity and risk of persistence of FB1 in tissue (limit of detection 13 microg/kg).

Effects of residence time on summer nitrate uptake in Mississippi River flow-regulated backwaters

USGS Publications Warehouse

James, W.F.; Richardson, W.B.; Soballe, D.M.

2008-01-01

Nitrate uptake may be improved in regulated floodplain rivers by increasing hydrological connectivity to backwaters. We examined summer nitrate uptake in a series of morphologically similar backwaters on the Upper Mississippi River receiving flow-regulated nitrate loads via gated culverts. Flows into individual backwaters were held constant over a summer period but varied in the summers of 2003 and 2004 to provide a range of hydraulic loads and residence times (??). The objectives were to determine optimum loading and ?? for maximum summer uptake. Higher flow adjustment led to increased loading but lower ?? and contact time for uptake. For highest flows, ?? was less than 1 day resulting in lower uptake rates (Unet, 4000 m). For low flows, ?? was greater than 5 days and U% approached 100%, but Unet was 200 mg m-2 day-1. Snet was < half the length of the backwaters under these conditions indicating that most of the load was assimilated in the upper reaches, leading to limited delivery to lower portions. Unet was maximal (384-629 mg m-2 day-1) for intermediate flows and ?? ranging between 1 and 1.5 days. Longer Snet (2000-4000 m) and lower U% (20-40%) reflected limitation of uptake in upper reaches by contact time, leading to transport to lower reaches for additional uptake. Uptake by ???10 000 ha of reconnected backwaters along the Upper Mississippi River (13% of the total backwater surface area) at a Unet of ???630 mg m-2 day-1 would be the equivalent of ???40% of the summer nitrate load (155 mg day-1) discharged from Lock and Dam 4. These results indicate that backwater nitrate uptake can play an important role in reducing nitrate loading to the Gulf of Mexico. Copyright ?? 2008 John Wiley & Sons, Ltd.

Modeling residence-time distribution in horizontal screw hydrolysis reactors

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

Sievers, David A.; Stickel, Jonathan J.

The dilute-acid thermochemical hydrolysis step used in the production of liquid fuels from lignocellulosic biomass requires precise residence-time control to achieve high monomeric sugar yields. Difficulty has been encountered reproducing residence times and yields when small batch reaction conditions are scaled up to larger pilot-scale horizontal auger-tube type continuous reactors. A commonly used naive model estimated residence times of 6.2-16.7 min, but measured mean times were actually 1.4-2.2 the estimates. Here, this study investigated how reactor residence-time distribution (RTD) is affected by reactor characteristics and operational conditions, and developed a method to accurately predict the RTD based on key parameters.more » Screw speed, reactor physical dimensions, throughput rate, and process material density were identified as major factors affecting both the mean and standard deviation of RTDs. The general shape of RTDs was consistent with a constant value determined for skewness. The Peclet number quantified reactor plug-flow performance, which ranged between 20 and 357.« less

Modeling residence-time distribution in horizontal screw hydrolysis reactors

DOE PAGES

Sievers, David A.; Stickel, Jonathan J.

2017-10-12

The dilute-acid thermochemical hydrolysis step used in the production of liquid fuels from lignocellulosic biomass requires precise residence-time control to achieve high monomeric sugar yields. Difficulty has been encountered reproducing residence times and yields when small batch reaction conditions are scaled up to larger pilot-scale horizontal auger-tube type continuous reactors. A commonly used naive model estimated residence times of 6.2-16.7 min, but measured mean times were actually 1.4-2.2 the estimates. Here, this study investigated how reactor residence-time distribution (RTD) is affected by reactor characteristics and operational conditions, and developed a method to accurately predict the RTD based on key parameters.more » Screw speed, reactor physical dimensions, throughput rate, and process material density were identified as major factors affecting both the mean and standard deviation of RTDs. The general shape of RTDs was consistent with a constant value determined for skewness. The Peclet number quantified reactor plug-flow performance, which ranged between 20 and 357.« less

Practice quality improvement during residency: where do we stand and where can we improve?

PubMed

Choudhery, Sadia; Richter, Michael; Anene, Alvin; Xi, Yin; Browning, Travis; Chason, David; Morriss, Michael Craig

2014-07-01

Completing a systems-based practice project, equivalent to a practice quality improvement project (PQI), is a residency requirement by the Accreditation Council for Graduate Medical Education and an American Board of Radiology milestone. The aim of this study was to assess the residents' perspectives on quality improvement projects in radiology. Survey data were collected from 154 trainee members of the Association of University Radiologists to evaluate the residents' views on PQI. Most residents were aware of the requirement of completing a PQI project and had faculty mentors for their projects. Residents who thought it was difficult to find a mentor were more likely to start their project later in residency (P < .0001). Publication rates were low overall, and lack of time was considered the greatest obstacle. Having dedicated time for a PQI project was associated with increased likelihood of publishing or presenting the data (P = .0091). Residents who rated the five surveyed PQI steps (coming up with an idea, finding a mentor, designing a project, finding resources, and finding time) as difficult steps were more likely to not have initiated a PQI project (P < .0001 for the first four and P = .0046 for time). We present five practical areas of improvement to make PQI a valuable learning experience: 1) Increasing awareness of PQI and providing ideas for projects, 2) encouraging faculty mentorship and publication, 3) educating residents about project design and implementation, 4) providing resources such as books and funds, and 5) allowing dedicated time. Copyright © 2014 AUR. Published by Elsevier Inc. All rights reserved.

A Checklist Intervention to Assess Resident Diagnostic Knee and Shoulder Arthroscopic Efficiency.

PubMed

Nwachukwu, Benedict; Gaudiani, Michael; Hammann-Scala, Jennifer; Ranawat, Anil

The purpose of this investigation was to apply an arthroscopic shoulder and knee checklist in the evaluation of orthopedic resident arthroscopic skill efficiency and to demonstrate the use of a surgical checklist for assessing resident surgical efficiency over the course of a surgical rotation. Orthopedic surgery residents rotating on the sports medicine service at our institution between 2011 and 2015 were enrolled in this study. Residents were administered a shoulder and knee arthroscopy assessment tool at the beginning and end of their 6-week rotation. The assessment tools consisted of checklist items for knee and shoulder arthroscopy skills. Residents were timed while performing these checklist tasks. The primary outcome measure was resident improvement as a function of time to completion for the checklist items, and the intervention was participation in a 6-week resident rotation with weekly arthroscopy didactics, cadaver simulator work, and operating room experience. A paired t test was used to compare means. Mean time to checklist completion during week 1 among study participants for the knee checklist was 787.4 seconds for the knee checklist and 484.4 seconds at the end of the rotation. Mean time to checklist completion during week 1 among study participants for the shoulder checklist was 1655.3 seconds and 832.7 seconds for the shoulder checklist at the end of the rotation. Mean improvement in time to completion was 303 seconds (p = 0.0006, SD = 209s) and 822.6 seconds (p = 0.00008, SD = 525.2s) for the arthroscopic knee and shoulder assessments, respectively. An arthroscopic checklist is 1 method to evaluate and assess resident efficiency and improvement during surgical training. Among residents participating in this study, we found statistically significant improvements in time for arthroscopic task completion. II. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

A Novel Approach to Practice-Based Learning and Improvement Using a Web-Based Audit and Feedback Module.

PubMed

Boggan, Joel C; Cheely, George; Shah, Bimal R; Heffelfinger, Randy; Springall, Deanna; Thomas, Samantha M; Zaas, Aimee; Bae, Jonathan

2014-09-01

Systematically engaging residents in large programs in quality improvement (QI) is challenging. To coordinate a shared QI project in a large residency program using an online tool. A web-based QI tool guided residents through a 2-phase evaluation of performance of foot examinations in patients with diabetes. In phase 1, residents completed reviews of health records with online data entry. Residents were then presented with personal performance data relative to peers and were prompted to develop improvement plans. In phase 2, residents again reviewed personal performance. Rates of performance were compared at the program and clinic levels for each phase, with data presented for residents. Acceptability was measured by the number of residents completing each phase. Feasibility was measured by estimated faculty, programmer, and administrator time and costs. Seventy-nine of 86 eligible residents (92%) completed improvement plans and reviewed 1471 patients in phase 1, whereas 68 residents (79%) reviewed 1054 patient charts in phase 2. Rates of performance of examination increased significantly between phases (from 52% to 73% for complete examination, P < .001). Development of the tool required 130 hours of programmer time. Project analysis and management required 6 hours of administrator and faculty time monthly. An online tool developed and implemented for program-wide QI initiatives successfully engaged residents to participate in QI activities. Residents using this tool demonstrated improvement in a selected quality target. This tool could be adapted by other graduate medical education programs or for faculty development.

Redfield Ratios in Inland Waters: Higher Biological Control of C:N:P Ratios in Tropical Semi-arid High Water Residence Time Lakes

PubMed Central

They, Ng H.; Amado, André M.; Cotner, James B.

2017-01-01

The canonical Redfield C:N:P ratio for algal biomass is often not achieved in inland waters due to higher C and N content and more variability when compared to the oceans. This has been attributed to much lower residence times and higher contributions of the watershed to the total organic matter pool of continental ecosystems. In this study we examined the effect of water residence times in low latitude lakes (in a gradient from humid to a semi-arid region) on seston elemental ratios in different size fractions. We used lake water specific conductivity as a proxy for residence time in a region of Eastern Brazil where there is a strong precipitation gradient. The C:P ratios decreased in the seston and bacterial size-fractions and increased in the dissolved fraction with increasing water retention time, suggesting uptake of N and P from the dissolved pool. Bacterial abundance, production and respiration increased in response to increased residence time and intracellular nutrient availability in agreement with the growth rate hypothesis. Our results reinforce the role of microorganisms in shaping the chemical environment in aquatic systems particularly at long water residence times and highlights the importance of this factor in influencing ecological stoichiometry in all aquatic ecosystems. PMID:28848518

Assessing the Benefits Provided by SWOT Data Towards Estimating Reservoir Residence Time in the Mekong River Basin

NASA Astrophysics Data System (ADS)

Bonnema, M.; Hossain, F.

2016-12-01

The Mekong River Basin is undergoing rapid hydropower development. Nine dams are planned on the main stem of the Mekong and many more on its extensive tributaries. Understanding the effects that current and future dams have on the river system and water cycle as a whole is vital for the millions of people living in the basin. reservoir residence time, the amount of time water spends stored in a reservoir, is a key parameter in investigating these impacts. The forthcoming Surface Water and Ocean Topography (SWOT) mission is poised to provide an unprecedented amount of surface water observations. SWOT, when augmented by current satellite missions, will provide the necessary information to estimate the residence time of reservoirs across the entire basin in a more comprehensive way than ever before. In this study, we first combine observations from current satellite missions (altimetry, spectral imaging, precipitation) to estimate the residence times of existing reservoirs. We then use this information to project how future reservoirs will increase the residence time of the river system. Next, we explore how SWOT observations can be used to improve residence time estimation by examining the accuracy of reservoir surface area and elevation observations as well as the accuracy of river discharge observations.

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.

Field survey of earthquake effects from the magnitude 4.0 southern Maine earthquake of October 16, 2012

USGS Publications Warehouse

Amy L. Radakovich,; Alex J. Fergusen,; Boatwright, John

2016-06-02

The magnitude 4.0 earthquake that occurred on October 16, 2012, near Hollis Center and Waterboro in southwestern Maine surprised and startled local residents but caused only minor damage. A two-person U.S. Geological Survey (USGS) team was sent to Maine to conduct an intensity survey and document the damage. The only damage we observed was the failure of a chimney and plaster cracks in two buildings in East and North Waterboro, 6 kilometers (km) west of the epicenter. We photographed the damage and interviewed residents to determine the intensity distribution in the epicentral area. The damage and shaking reports are consistent with a maximum Modified Mercalli Intensity (MMI) of 5–6 for an area 1–8 km west of the epicenter, slightly higher than the maximum Community Decimal Intensity (CDI) of 5 determined by the USGS “Did You Feel It?” Web site. The area of strong shaking in East Waterboro corresponds to updip rupture on a fault plane that dips steeply east. 

Resident involvement in laparoscopic procedures does not worsen clinical outcomes but may increase operative times and length of hospital stay.

PubMed

Jolley, Jennifer; Lomelin, Daniel; Simorov, Anton; Tadaki, Carl; Oleynikov, Dmitry

2016-09-01

Surgical procedures have a learning curve regarding the number of cases required for proficiency. Consequently, involvement of less experienced resident surgeons may impact patients and the healthcare system. This study examines basic and advanced laparoscopic procedures performed between 2010 and 2011 and evaluates the resident surgeon participation effect. Basic laparoscopic procedures (BL), appendectomy (LA), cholecystectomy (LC), and advanced Nissen fundoplication (LN) were queried from the American College of Surgeons National Surgical Quality Improvement Program database. Cases were identified using Current Procedural Terminology codes. Analyses were performed using IBM SPSS Statistics v.22, α-level = 0.05. Multiple logistic regression was used, accounting for age, race, gender, admission status, wound classification, and ASA classification. In total, 71,819 surgeries were reviewed, 66,327 BL (37,636 LC and 28,691 LA) and 5492 LN. Median age was 48 years for LC and 37 years for LA. In sum, 72.2 % of LC and 49.5 % of LA patients were female. LN median age was 59 years, and 67.7 % of patients were female. For BL, resident involvement was not significantly associated with mortality, morbidity, and return to the OR. Readmission was not related to resident involvement in LC. In LA, resident-involved surgeries had increased readmission and longer OR time, but decreased LOS. In LC, resident involvement was associated with longer LOS and OR time. Resident involvement was not a significant factor in the odds of mortality, morbidity, return to OR, or readmission in LN. Surgeries involving residents had increased odds of having longer LOS, and of lengthier surgery time. We demonstrate resident involvement is safe and does not result in poorer patient outcomes. Readmissions and LOS were higher in BL, and operative times were longer in all surgeries. Resident operations do appear to have real consequences for patients and may impact the healthcare system financially.

Prevalence and Cost of Full-Time Research Fellowships During General Surgery Residency – A National Survey

PubMed Central

Robertson, Charles M.; Klingensmith, Mary E.; Coopersmith, Craig M.

2009-01-01

Structured Abstract Objective To quantify the prevalence, outcomes, and cost of surgical resident research. Summary Background Data General surgery is unique among graduate medical education programs because a large percentage of residents interrupt their clinical training to spend 1-3 years performing full-time research. No comprehensive data exists on the scope of this practice. Methods Survey sent to all 239 program directors of general surgery residencies participating in the National Resident Matching Program. Results Response rate was 200/239 (84%). A total of 381 out of 1052 trainees (36%) interrupt residency to pursue full-time research. The mean research fellowship length is 1.7 years, with 72% of trainees performing basic science research. A significant association was found between fellowship length and post-residency activity, with a 14.7% increase in clinical fellowship training and a 15.2% decrease in private practice positions for each year of full-time research (p<0.0001). Program directors at 31% of programs reported increased clinical duties for research fellows as a result of ACGME work hour regulations for clinical residents, while a further 10% of programs are currently considering such changes. It costs $41.5 million to pay the 634 trainees who perform research fellowships each year, the majority of which is paid for by departmental funds (40%) and institutional training grants (24%). Conclusions Interrupting residency to perform a research fellowship is a common and costly practice among general surgery residents. While performing a research fellowship is associated with clinical fellowship training after residency, it is unclear to what extent this practice leads to the development of surgical investigators after post-graduate training. PMID:19106692

24/7/365 in-house radiologist coverage: effect on resident education.

PubMed

Collins, Jannette; Gruppen, Larry D; Bailey, Janet E; Bokhari, Syed Ahmad Jamal; Paladin, Angelisa M; Robbins, Jessica; White, Richard D

2014-07-01

To compare programs with and without 24-hour/7 days a week/365 days a year (24/7/365) in-house radiologist coverage regarding resident perceptions of their on-call experience, volume of resident dictations on call, and report turnaround time. Residents from six academic radiology departments were invited to participate in an 11-item online survey. Survey items were related to workload, level of autonomy, faculty feedback, comfort level, faculty supervision, and overall educational experience while on call from 8 pm to 8 am. Each site provided data on imaging volume, radiologist coverage, volume of examinations dictated by residents, number of residents on call, and report turnaround time from 8 pm to 8 am. F-ratios and eta-squares were calculated to determine the relationships between dependent and independent variables. A P value < .05 was considered statistically significant. A total of 146 (67%) of 217 residents responded. Residents in programs with 24/7/365 in-house radiologist coverage dictated a lower percentage of examinations (46%) compared with other residents (81%) and rated faculty feedback more positively (mean 3.8 vs. 3.3) but rated their level of autonomy (mean 3.6 vs. 4.5) and educational experience (mean 3.6 vs. 4.2) more negatively (all P < .05). Report turnaround time was lower in programs with 24/7/365 coverage than those without (mean 1.7 hours vs. 9.1 hours). The majority of resident comments were negative and related to loss of autonomy with 24/7/365 coverage. More rapid report turnaround time related to 24/7/365 coverage may come at the expense of resident education. Copyright © 2014 AUR. Published by Elsevier Inc. All rights reserved.

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.

Computerized rounding in a community hospital surgery residency program.

PubMed

Park, John; Tymitz, Kevin; Engel, Amy M; Welling, Richard E

2007-01-01

With the institution of the 80-hour work week, residency programs have worked to institute programs that decrease the time that residents spend in the hospital while maintaining patient safety. This study was intended to assess the amount of time saved using computerized patient information in the form of a personal data assistant (PDA). A community hospital surgical residency program with 22 residents initially collected data daily for 4 weeks without PDA use. Data included preround time, check-out time, total number of patients, number of medical/surgical patients, and number of intensive care unit patients. The definition of prerounding time was started when residents first began collecting information on their patients in the morning until 6:00 am. Check-out time started at 5:00 pm and lasted until the discussion of patient care with the night team had finished. Residents were then given PDAs allowing immediate up-to-date access to patient information, which most importantly included current vital signs, laboratory data, radiological dictations, medication lists, and fluid intake and output. After a 4-week acquaintance period with the PDA had passed, data were again collected from the residents daily for 4 weeks. Daily averages for each week and an overall total average were calculated. Daily averages were also calculated for each PGY level. Paired t-tests compared the pre-PDA and post-PDA total averages. No significant difference was found between the total number of patients pre-PDA and post-PDA (7.6 and 7.6, respectively, p = 0.98), the average number of medical/surgical patients (4.7 and 7.1, respectively, p = 0.16), or the average number of intensive care unit patients (2.6 and 0.4, respectively, p = 0.06). Also, no significant difference was found between pre-PDA and post-PDA with average check-out time (24.5 minutes and 21.9 minutes, respectively, p = 0.06). However, a significant decrease in rounding time occurred with pre-PDA round time at 50.5 minutes and post-PDA round time at 40.7 minutes (p = 0.02). Results of this study support the hypothesis that the prerounding time dramatically decreases with the PDA compared to without. Not only does this decrease in time help to keep residents under the 80-hour work week rule, but also it helps to eliminate much of the confusion that can cause patient safety issues.

Sodium hydroxide pretreatment and enzymatic hydrolysis of coastal Bermuda grass.

PubMed

Wang, Ziyu; Keshwani, Deepak R; Redding, Arthur P; Cheng, Jay J

2010-05-01

Coastal Bermuda grass was pretreated with NaOH at concentrations from 0.5% to 3% (w/v) for a residence time from 15 to 90min at 121 degrees C. The pretreatments were evaluated based on total lignin removal and production of total reducing sugars, glucose and xylose from enzymatic hydrolysis of the pretreated biomass. Up to 86% lignin removal was observed. The optimal NaOH pretreatment conditions at 121 degrees C for total reducing sugars production as well as glucose and xylose yields are 15min and 0.75% NaOH. Under these optimal pretreatment conditions, total reducing sugars yield was about 71% of the theoretical maximum, and the overall conversion efficiencies for glucan and xylan were 90.43% and 65.11%, respectively. Copyright 2009 Elsevier Ltd. All rights reserved.

The costs and quality of operative training for residents in tympanoplasty type I.

PubMed

Wang, Mao-Che; Yu, Eric Chen-Hua; Shiao, An-Suey; Liao, Wen-Huei; Liu, Chia-Yu

2009-05-01

A teaching hospital would incur more operation room costs on training surgical residents. To evaluate the increased operation time and the increased operation room costs of operations performed by surgical residents. As a model we used a very common surgical otology procedure -- tympanoplasty type I. From January 1, 2004 to December 31, 2004, we included in this study 100 patients who received tympanoplasty type I in Taipei Veterans General Hospital. Fifty-six procedures were performed by a single board-certified surgeon and 44 procedures were performed by residents. We analyzed the operation time and surgical outcomes in these two groups of patients. The operation room cost per minute was obtained by dividing the total operation room expenses by total operation time in the year 2004. The average operation time of residents was 116.47 min, which was significantly longer (p<0.0001) than that of the board-certified surgeon (average 81.07 min). It cost USD $40.36 more for each operation performed by residents in terms of operation room costs. The surgical success rate of residents was 81.82%, which was significantly lower (p=0.016) than that of the board-certified surgeon (96.43%).

Recovery of Sleep or Recovery of Self? A Grounded Theory Study of Residents' Decision Making Regarding How to Spend Their Nonclinical Postcall Time.

PubMed

Taylor, Taryn S; Nisker, Jeff; Teunissen, Pim W; Dornan, Tim; Lingard, Lorelei

2016-03-01

As resident work hours policies evolve, residents' off-duty time remains poorly understood. Despite assumptions about how residents should be using their postcall, off-duty time, there is little research on how residents actually use this time and the reasoning underpinning their activities. This study sought to understand residents' nonclinical postcall activities when they leave the hospital, their decision-making processes, and their perspectives on the relationship between these activities and their well-being or recovery. The study took place at a Liaison Committee on Medical Education-accredited Canadian medical school from 2012 to 2014. The authors recruited a purposive and convenience sample of postgraduate year 1-5 residents from six surgical and nonsurgical specialties at three hospitals affiliated with the medical school. Using a constructivist grounded theory approach, semistructured interviews were conducted, audio-taped, transcribed, anonymized, and combined with field notes. The authors analyzed interview transcripts using constant comparative analysis and performed post hoc member checking. Twenty-four residents participated. Residents characterized their predominant approach to postcall decision making as one of making trade-offs between multiple, competing, seemingly incompatible, but equally valuable, activities. Participants exhibited two different trade-off orientations: being oriented toward maintaining a normal life or toward mitigating fatigue. The authors' findings on residents' trade-off orientations suggest a dual recovery model with postcall trade-offs motivated by the recovery of sleep or of self. This model challenges the dominant viewpoint in the current duty hours literature and suggests that the duty hours discussion must be broadened to include other recovery processes.

42 CFR 415.208 - Services of moonlighting residents.

Code of Federal Regulations, 2010 CFR

2010-10-01

... IN TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS Services of Residents § 415.208 Services of... payment is made for services of a “teaching physician” associated with moonlighting services, and the time spent furnishing these services is not included in the teaching hospital's full-time equivalency count...

Linear and Nonlinear Time-Frequency Analysis for Parameter Estimation of Resident Space Objects

DTIC Science & Technology

2017-02-22

AFRL-AFOSR-UK-TR-2017-0023 Linear and Nonlinear Time -Frequency Analysis for Parameter Estimation of Resident Space Objects Marco Martorella...estimated to average 1 hour per response, including the time for reviewing instructions, searching existing   data sources, gathering and maintaining the...Nonlinear Time -Frequency Analysis for Parameter Estimation of Resident Space Objects 5a.  CONTRACT NUMBER 5b.  GRANT NUMBER FA9550-14-1-0183 5c.  PROGRAM

Suicidal thoughts among medical residents with burnout.

PubMed

van der Heijden, Frank; Dillingh, Gea; Bakker, Arnold; Prins, Jelle

2008-01-01

Recent research showed that medical residents have a high risk for developing burnout. The present study investigates the prevalence of burnout and its relationship with suicidal thoughts among medical residents. All Dutch medical residents (n = 5126) received a self-report questionnaire. Burnout was measured with the Maslach Burnout Inventory. Residents were asked about the frequency of suicidal thoughts. Response rate was 41.3% (n = 2115). 432 Residents (20.6%) were classified as burnout. 12% reported having suicidal thoughts at least 1 time during their residency, and 1% many times. Suicidal thoughts were substantially more prevalent in the group with burnout in comparison to non-burnout (20.5% vs. 7.6%; chi(2) = 182.9, p < .001). Knowledge about the relationship between burnout and suicidal thoughts among these young medical professionals could be important for suicide prevention.

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.

APPENDIX C - ADDITIONAL INFORMATION ON FLUSHING IN ESTUARIES

EPA Science Inventory

Water residence time is an important determinant of the sensitivity of the response of estuaries and other water bodies to nutrient loading. A variety of terms such as residence time, flushing time, transit time, turnover time, and age are used to describe time scales for transpo...

Menopausal medicine clinic: an innovative approach to enhancing the effectiveness of medical education.

PubMed

Jiang, Xuezhi; Sab, Shiv; Diamen, Sharon; Schnatz, Peter F

2012-10-01

The purpose of this study was to assess the effectiveness of a menopause clinic to enhance trainees' medical knowledge. Between July 2004 and May 2007, 73 resident physicians completed a rotation that included a weekly menopause clinic and completion of a pretest and posttest examination. Each test contained questions on topics covering menopause, perimenopause, and general women's health. At the end of each testing session, a total score and a menopause score were given. The mean (SD) pretest menopause score and total score were 63.2% (13.3%) and 63.7% (11.3%), respectively. The mean posttest increase in the menopause score was 14%, with a median score increase of 10.2% (P < 0.0001). The posttest results ranged from a maximum decrease of 7.8% to a maximum increase of 47.1%. The mean increase in the total score was 13%, with a median increase of 10.7% (P < 0.0001). For the posttest total score, the range went from -7.2% to 39.3%. There was no correlation between the score changes and the number of clinic sessions attended, the resident specialties (obstetrics/gynecology vs non-obstetrics/gynecology), the level of training (postgraduate year 1 or 2), or the examination order (test A vs test B taken first). Menopause clinics can add to resident physician knowledge about menopause-related matters. Menopause clinics may help educate future physicians in their ability to care for postmenopausal women.

A comparative evaluation of dried activated sludge and mixed dried activated sludge with rice husk silica to remove hydrogen sulfide

PubMed Central

2013-01-01

The aim of this study was to investigate the effectiveness of dried activated sludge (DAS) and mixed dried activated sludge with rice husk silica (DAS & RHS) for removal of hydrogen sulfide (H2S). Two laboratory-scale filter columns (packed one litter) were operated. Both systems were operated under different conditions of two parameters, namely different inlet gas concentrations and different inlet flow rates. The DAS & RHS packed filter showed more than 99.96% removal efficiency (RE) with empty bed residence time (EBRT) of 45 to 90 s and 300 mg/L inlet concentration of H2S. However, the RE decreased to 96.87% with the EBRT of 30 s. In the same condition, the DAS packed filter showed 99.37% RE. Nonetheless, the RE was shown to have dropped to 82.09% with the EBRT of 30 s. The maximum elimination capacity (EC) was obtained in the DAS & RHS packed filter up to 52.32 g/m3h, with the RE of 96.87% and H2S mass loading rate of 54 g/m3h. The maximum EC in the DAS packed filter was obtained up to 44.33 g/m3h with the RE of 82.09% and the H2S mass loading rate of 54 g/m3h. After 53 days of operating time and 54 g/m3h of loading rates, the maximum pressure drop reached to 3.0 and 8.0 (mm H2O) for the DAS & RHS packed and DAS packed filters, respectively. Based on the findings of this study, the DAS & RHS could be considered as a more suitable packing material to remove H2S. PMID:23497048

Residential exposure to radiofrequency fields from mobile phone base stations, and broadcast transmitters: a population-based survey with personal meter.

PubMed

Viel, J F; Clerc, S; Barrera, C; Rymzhanova, R; Moissonnier, M; Hours, M; Cardis, E

2009-08-01

Both the public perceptions, and most published epidemiologic studies, rely on the assumption that the distance of a particular residence from a base station or a broadcast transmitter is an appropriate surrogate for exposure to radiofrequency fields, although complex propagation characteristics affect the beams from antennas. The main goal of this study was to characterise the distribution of residential exposure from antennas using personal exposure meters. A total of 200 randomly selected people were enrolled. Each participant was supplied with a personal exposure meter for 24 h measurements, and kept a time-location-activity diary. Two exposure metrics for each radiofrequency were then calculated: the proportion of measurements above the detection limit (0.05 V/m), and the maximum electric field strength. Residential address was geocoded, and distance from each antenna was calculated. Much of the time, the recorded field strength was below the detection level (0.05 V/m), the FM band standing apart with a proportion above the detection threshold of 12.3%. The maximum electric field strength was always lower than 1.5 V/m. Exposure to GSM and DCS waves peaked around 280 m and 1000 m from the antennas. A downward trend was found within a 10 km range for FM. Conversely, UMTS, TV 3, and TV 4&5 signals did not vary with distance. Despite numerous limiting factors entailing a high variability in radiofrequency exposure assessment, but owing to a sound statistical technique, we found that exposures from GSM and DCS base stations increase with distance in the near source zone, to a maximum where the main beam intersects the ground. We believe these results will contribute to the ongoing public debate over the location of base stations and their associated emissions.

Molecular Dynamics Simulations and Kinetic Measurements to Estimate and Predict Protein-Ligand Residence Times.

PubMed

Mollica, Luca; Theret, Isabelle; Antoine, Mathias; Perron-Sierra, Françoise; Charton, Yves; Fourquez, Jean-Marie; Wierzbicki, Michel; Boutin, Jean A; Ferry, Gilles; Decherchi, Sergio; Bottegoni, Giovanni; Ducrot, Pierre; Cavalli, Andrea

2016-08-11

Ligand-target residence time is emerging as a key drug discovery parameter because it can reliably predict drug efficacy in vivo. Experimental approaches to binding and unbinding kinetics are nowadays available, but we still lack reliable computational tools for predicting kinetics and residence time. Most attempts have been based on brute-force molecular dynamics (MD) simulations, which are CPU-demanding and not yet particularly accurate. We recently reported a new scaled-MD-based protocol, which showed potential for residence time prediction in drug discovery. Here, we further challenged our procedure's predictive ability by applying our methodology to a series of glucokinase activators that could be useful for treating type 2 diabetes mellitus. We combined scaled MD with experimental kinetics measurements and X-ray crystallography, promptly checking the protocol's reliability by directly comparing computational predictions and experimental measures. The good agreement highlights the potential of our scaled-MD-based approach as an innovative method for computationally estimating and predicting drug residence times.

The business case for nursing in long-term care.

PubMed

Horn, Susan D

2008-05-01

Lower nurse staffing in hospitals has been associated with adverse patient outcomes; results in nursing homes (NHs) are less clear. We examined the association between nurses' direct care time and outcomes in long-stay NH residents and potential cost savings from decreased adverse outcomes versus additional wages for adequate nurse staffing. Data were from the National Pressure Ulcer Long-Term Care Study of 1,376 at-risk residents from 82 NHs. Primary data came from medical records. Hospital, pressure ulcer (PrU) treatment, and urinary tract infection (UTI) costs were from national statistics or cost-identification studies. Time horizon was 1 year. More registered nurse (RN) direct care time/resident/day was associated with fewer PrUs, hospitalizations, and UTIs. Annual net societal benefit was $3,191/resident/year in high-risk NH units with 30-40 min of RN time/resident/day versus units with <10 min. Thus, after controlling for important variables, more RN time/day was strongly associated with better outcomes and lower societal cost.

Redefining the Surgical Council of Resident Education (SCORE) Curriculum: A Comparison with the Operative Experiences of Graduated General Surgical Residents.

PubMed

Strosberg, David S; Quinn, Kristen M; Abdel-Misih, Sherif R; Harzman, Alan E

2018-04-01

Our objective was to investigate the number and classify surgical operations performed by general surgery residents and compare these with the updated Surgical Council on Resident Education (SCORE) curriculum. We performed a retrospective review of logged surgical cases from general surgical residents who completed training at a single center from 2011 to 2015. The logged cases were correlated with the operations extracted from the SCORE curriculum. Hundred and fifty-one procedures were examined; there were 98 "core" and 53 "advanced" cases as determined by the SCORE. Twenty-eight residents graduated with an average of 1017 major cases. Each resident completed 66 (67%) core cases and 17 (32%) advanced cases an average of one or more times with 39 (40%) core cases and 6 (11%) advanced cases completed five or more times. Core procedures that are infrequently or not performed by residents should be identified in each program to focus on resident education.

Medication Refusal: Resident Rights, Administration Dilemma.

PubMed

Haskins, Danielle R; Wick, Jeannette Y

2017-12-01

Occasionally, residents actively or passively refuse to take medications. Residents may refuse medication for a number of reasons, including religious beliefs, dietary restrictions, misunderstandings, cognitive impairment, desire to self-harm, or simple inconvenience. This action creates a unique situation for pharmacists and long-term facility staff, especially if patients have dementia. Residents have the legal right to refuse medications, and long-term care facilities need to employ a process to resolve disagreement between the health care team that recommends the medication and the resident who refuses it. In some cases, simple interventions like selecting a different medication or scheduling medications in a different time can address and resolve the resident's objection. If the medical team and the resident cannot resolve their disagreement, often an ethics consultation is helpful. Documenting the resident's refusal to take any or all medications, the health care team's actions and any other outcomes are important. Residents' beliefs may change over time, and the health care team needs to be prepared to revisit the issue as necessary.

Medical Student Interest in Flexible Residency Training Options.

PubMed

Piotrowski, Madison; Stulberg, Debra; Egan, Mari

2018-05-01

Medical residents continue to experience high rates of burnout during residency training even after implementation of the 2003 Accreditation Council for Graduate Medical Education duty-hour restrictions. The purpose of this study is to determine medical student interest in flexible residency training options. Researchers developed an 11-question survey for second through fourth-year medical students. The populations surveyed included medical students who were: (1) attending the 2015 American Academy of Family Physicians National Conference, the 2015 Family Medicine Midwest Conference, and (2) enrolled at University of Chicago Pritzker School of Medicine, University of Illinois College of Medicine at Chicago, Drexel University College of Medicine, and Case Western Reserve University School of Medicine. The survey was completed by 789 medical students. Over half of medical students surveyed indicated that they would be interested in working part-time during some portion of their residency training (51%), and that access to part-time training options would increase their likelihood of applying to a particular residency program (52%). When given the option of three residency training schedules of varying lengths, 41% of male students and 60% of female students chose a 60-hour workweek, even when that meant extending the residency length by 33% and reducing their yearly salary to $39,000. There is considerable interest among medical students in access to part-time residency training options and reduced-hour residency programs. This level of interest indicates that offering flexible training options could be an effective recruitment tool for residency programs and could improve students' perception of their work-life balance during residency.

A Novel Approach to Practice-Based Learning and Improvement Using a Web-Based Audit and Feedback Module

PubMed Central

Boggan, Joel C.; Cheely, George; Shah, Bimal R.; Heffelfinger, Randy; Springall, Deanna; Thomas, Samantha M.; Zaas, Aimee; Bae, Jonathan

2014-01-01

Background Systematically engaging residents in large programs in quality improvement (QI) is challenging. Objective To coordinate a shared QI project in a large residency program using an online tool. Methods A web-based QI tool guided residents through a 2-phase evaluation of performance of foot examinations in patients with diabetes. In phase 1, residents completed reviews of health records with online data entry. Residents were then presented with personal performance data relative to peers and were prompted to develop improvement plans. In phase 2, residents again reviewed personal performance. Rates of performance were compared at the program and clinic levels for each phase, with data presented for residents. Acceptability was measured by the number of residents completing each phase. Feasibility was measured by estimated faculty, programmer, and administrator time and costs. Results Seventy-nine of 86 eligible residents (92%) completed improvement plans and reviewed 1471 patients in phase 1, whereas 68 residents (79%) reviewed 1054 patient charts in phase 2. Rates of performance of examination increased significantly between phases (from 52% to 73% for complete examination, P < .001). Development of the tool required 130 hours of programmer time. Project analysis and management required 6 hours of administrator and faculty time monthly. Conclusions An online tool developed and implemented for program-wide QI initiatives successfully engaged residents to participate in QI activities. Residents using this tool demonstrated improvement in a selected quality target. This tool could be adapted by other graduate medical education programs or for faculty development. PMID:26279782

Removal of p-xylene from an air stream in a hybrid biofilter.

PubMed

Wu, Dan; Quan, Xie; Zhao, Yazhi; Chen, Shuo

2006-08-21

Biofiltration of an air stream containing p-xylene has been studied in a laboratory hybrid biofilter packed with a mixture of mature pig compost, forest soil and the packing material which was made of polyethylene (PE) and used in the moving bed biological reactor (MBBR) in wastewater treatment. Three flow rates, 9.17, 19.87 and 40.66 m(3)m(-2)h(-1), were investigated for p-xylene inlet concentration ranging from 0.1 to 3.3 g m(-3). A high elimination capacity of 80 g m(-3)h(-1) corresponding to removal efficiency of 96% was obtained at a flow rate of 9.17 m(3)m(-2)h(-1) (empty bed residence time of 132 s). At a flow rate of 40.66 m(3)m(-2)h(-1) (empty bed residence time of 30s), the maximum elimination capacity for p-xylene was 40 g m(-3)h(-1) and removal efficiencies were in the range of 47-100%. The production of carbon dioxide (P(CO(2))) is proportional to elimination capacity (EC) and the linear relation was formulated as P(CO(2))=1.65EC+15.58. Stable pH values ranging from 6.3 to 7.6 and low pressure drop values less than 0.2 cm H(2)O (19.6 Pa) of packing media in compost-based biofilter of hybrid biofilter were observed, which avoided acidification and compaction of packing media and sustained the activity of microorganism populations.

Effect of oil concentration and residence time on the biodegradation of α-pinene vapours in two-liquid phase suspended-growth bioreactors.

PubMed

Montes, María; Veiga, María C; Kennes, Christian

2012-02-20

Recently, research on the use of binary aqueous-organic liquid phase systems for the treatment of polluted air has significantly increased. This paper reports the removal of α-pinene from a waste air stream in a continuous stirred tank bioreactor (CSTB), using either a single-liquid aqueous phase or a mixed aqueous-organic liquid phase. The influence of gas flow rate, load and pollutant concentration was evaluated as well as the effect of the organic to aqueous phase ratio. Continuous experiments were carried out at different inlet α-pinene concentrations, ranging between 0.03 and 25.1 g m⁻³ and at four different flow rates, corresponding to residence times (RTs) of 120 s, 60 s, 36 s and 26 s. The maximum elimination capacities (ECs) reached in the CSTB were 382 g m⁻³ h⁻¹ (without silicone oil) and 608 g m⁻³ h⁻¹ (with 5%v/v silicone oil), corresponding to a 1.6-fold improvement using an aqueous-organic liquid phase. During shock-loads experiments, the performance and stability of the CSTB were enhanced with 5% silicone oil, quickly recovering almost 100% removal efficiency (RE), when pre-shock conditions were restored. The addition of silicone oil acted as a buffer for high α-pinene loads, showing a more stable behaviour in the case of two-liquid-phase systems. Copyright © 2011 Elsevier B.V. All rights reserved.

Behavior of decomposition of rifampicin in the presence of isoniazid in the pH range 1-3.

PubMed

Sankar, R; Sharda, Nishi; Singh, Saranjit

2003-08-01

The extent of decomposition of rifampicin in the presence of isoniazid was determined in the pH range 1-3 at 37 degrees C in 50 min, the mean stomach residence time. With increase in pH, the degradation initially increased from pH 1 to 2 and then decreased, resulting in a bell-shaped pH-decomposition profile. This showed that rifampicin degraded in the presence of isoniazid to a higher extent at pH 2, the maximum pH in the fasting condition, under which antituberculosis fixed-dose combination (FDC) products are administered. At this pH and in 50 min, rifampicin decomposed by approximately 34%, while the fall of isoniazid was 10%. The extent of decomposition for the two drugs was also determined in marketed formulations, and the values ranged between 13-35% and 4-11%, respectively. The extents of decomposition at stomach residence times of 15 min and 3 h were 11.94% and 62.57%, respectively, for rifampicin and 4.78% and 11.12%, respectively, for isoniazid. The results show that quite an extensive loss of rifampicin and isoniazid can occur as a result of interaction between them in fasting pH conditions. This emphasizes that antituberculosis FDC formulations, which contain both drugs, should be designed in a manner that the interaction of the two drugs is prevented when the formulations are administered on an empty stomach.

Subsurface flow in lowland river gravel bars

NASA Astrophysics Data System (ADS)

Bray, E. N.; Dunne, T.

2017-09-01

Geomorphic and hydraulic processes, which form gravel bars in large lowland rivers, have distinctive characteristics that control the magnitude and spatial patterns of infiltration and exfiltration between rivers and their immediate subsurface environments. We present a bedform-infiltration relation together with a set of field measurements along two reaches of the San Joaquin River, CA to illustrate the conditions required for infiltration and exfiltration of flow between a stream and its undulating bed, and a numerical model to investigate the factors that affect paths and residence times of flow through barforms at different discharges. It is shown that asymmetry of bar morphology is a first-order control on the extent and location of infiltration, which would otherwise produce equal areas of infiltration and exfiltration under the assumption of sinusoidal bedforms. Hydraulic conductivity varies by orders of magnitude due to fine sediment accumulation and downstream coarsening related to the process of bar evolution. This systematic variability not only controls the magnitude of infiltration, but also the residence time of flow through the bed. The lowest hydraulic conductivity along the reach occurred where the difference between the topographic gradient and the water-surface gradient is at a maximum and thus where infiltration would be greatest into a homogeneous bar, indicating the importance of managing sand supply to maintain the ventilation and flow through salmon spawning riffles. Numerical simulations corroborate our interpretation that infiltration patterns and rates are controlled by distinctive features of bar morphology.

Effect of the 80-hour workweek on resident burnout.

PubMed

Gelfand, Dmitri V; Podnos, Yale D; Carmichael, Joseph C; Saltzman, Darin J; Wilson, Samuel E; Williams, Russell A

2004-09-01

With the introduction of the newly mandated restrictions on resident work hours, we expected improvement in subjective feelings of personal accomplishment and lessened emotional exhaustion and depersonalization. Residents and faculty members completed an anonymous online Maslach Burnout Inventory Human Services Survey (3rd ed; Consulting Psychologist Press Inc, Palo Alto, Calif) and work-hour registry before and after implementation of new restrictions. Urban, university-based department of surgery. All house staff (n = 37) and faculty (n = 27). Introduction of new Institutional Standards for Resident Duty Hours 2003. Main Outcome Measure Resident work hours and levels of emotional exhaustion, perceived degree of depersonalization, and personal accomplishment. Resident work hours per week decreased from 100.7 to 82.6 (P < .05) with introduction of the new schedule. Home call and formal educational activity time within working hours (eg, clinical conferences) significantly (P < .05) decreased from 11.5 and 4.8 hours to 4.6 and 2.5 hours per week, respectively. Operating room hours, clinic time, and duration of rounds did not show a significant change. Changes in parameters of resident and faculty emotional exhaustion, depersonalization, and personal accomplishment did not show statistical significance (P > .05). Despite successful reductions in resident work hours, measures of burnout were not significantly affected. However, important clinical activities such as time spent in the operating room, clinic, and making rounds were maintained. Formal in-hospital education time was reduced.

Rational optimization of drug-target residence time: Insights from inhibitor binding to the S. aureus FabI enzyme-product complex

PubMed Central

Chang, Andrew; Schiebel, Johannes; Yu, Weixuan; Bommineni, Gopal R.; Pan, Pan; Baxter, Michael V.; Khanna, Avinash; Sotriffer, Christoph A.; Kisker, Caroline; Tonge, Peter J.

2013-01-01

Drug-target kinetics has recently emerged as an especially important facet of the drug discovery process. In particular, prolonged drug-target residence times may confer enhanced efficacy and selectivity in the open in vivo system. However, the lack of accurate kinetic and structural data for series of congeneric compounds hinders the rational design of inhibitors with decreased off-rates. Therefore, we chose the Staphylococcus aureus enoyl-ACP reductase (saFabI) - an important target for the development of new anti-staphylococcal drugs - as a model system to rationalize and optimize the drug-target residence time on a structural basis. Using our new, efficient and widely applicable mechanistically informed kinetic approach, we obtained a full characterization of saFabI inhibition by a series of 20 diphenyl ethers complemented by a collection of 9 saFabI-inhibitor crystal structures. We identified a strong correlation between the affinities of the investigated saFabI diphenyl ether inhibitors and their corresponding residence times, which can be rationalized on a structural basis. Due to its favorable interactions with the enzyme, the residence time of our most potent compound exceeds 10 hours. In addition, we found that affinity and residence time in this system can be significantly enhanced by modifications predictable by a careful consideration of catalysis. Our study provides a blueprint for investigating and prolonging drug-target kinetics and may aid in the rational design of long-residence-time inhibitors targeting the essential saFabI enzyme. PMID:23697754

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.

Evaluation of AHRQ's on-time pressure ulcer prevention program: a facilitator-assisted clinical decision support intervention for nursing homes.

PubMed

Olsho, Lauren E W; Spector, William D; Williams, Christianna S; Rhodes, William; Fink, Rebecca V; Limcangco, Rhona; Hurd, Donna

2014-03-01

Pressure ulcers present serious health and economic consequences for nursing home residents. The Agency for Healthcare Research & Quality, in partnership with the New York State Department of Health, implemented the pressure ulcer module of On-Time Quality Improvement for Long Term Care (On-Time), a clinical decision support intervention to reduce pressure ulcer incidence rates. To evaluate the effectiveness of the On-Time program in reducing the rate of in-house-acquired pressure ulcers among nursing home residents. We employed an interrupted time-series design to identify impacts of 4 core On-Time program components on resident pressure ulcer incidence in 12 New York State nursing homes implementing the intervention (n=3463 residents). The sample was purposively selected to include nursing homes with high baseline prevalence and incidence of pressure ulcers and high motivation to reduce pressure ulcers. Differential timing and sequencing of 4 core On-Time components across intervention nursing homes and units enabled estimation of separate impacts for each component. Inclusion of a nonequivalent comparison group of 13 nursing homes not implementing On-Time (n=2698 residents) accounts for potential mean-reversion bias. Impacts were estimated via a random-effects Poisson model including resident-level and facility-level covariates. We find a large and statistically significant reduction in pressure ulcer incidence associated with the joint implementation of 4 core On-Time components (incidence rate ratio=0.409; P=0.035). Impacts vary with implementation of specific component combinations. On-Time implementation is associated with sizable reductions in pressure ulcer incidence.

Soil Carbon Residence Time in the Arctic - Potential Drivers of Past and Future Change

NASA Astrophysics Data System (ADS)

Huntzinger, D. N.; Fisher, J.; Schwalm, C. R.; Hayes, D. J.; Stofferahn, E.; Hantson, W.; Schaefer, K. M.; Fang, Y.; Michalak, A. M.; Wei, Y.

2017-12-01

Carbon residence time is one of the most important factors controlling carbon cycling in ecosystems. Residence time depends on carbon allocation and conversion among various carbon pools and the rate of organic matter decomposition; all of which rely on environmental conditions, primarily temperature and soil moisture. As a result, residence time is an emergent property of models and a strong determinant of terrestrial carbon storage capacity. However, residence time is poorly constrained in process-based models due, in part, to the lack of data with which to benchmark global-scale models in order to guide model improvements and, ultimately, reduce uncertainty in model projections. Here we focus on improving the understanding of the drivers to observed and simulated carbon residence time in the Arctic-Boreal region (ABR). Carbon-cycling in the ABR represents one of the largest sources of uncertainty in historical and future projections of land-atmosphere carbon dynamics. This uncertainty is depicted in the large spread of terrestrial biospheric model (TBM) estimates of carbon flux and ecosystem carbon pool size in this region. Recent efforts, such as the Arctic-Boreal Vulnerability Experiment (ABoVE), have increased the availability of spatially explicit in-situ and remotely sensed carbon and ecosystem focused data products in the ABR. Together with simulations from Multi-scale Synthesis and Terrestrial Model Intercomparison Project (MsTMIP), we use these observations to evaluate the ability of models to capture soil carbon stocks and changes in the ABR. Specifically, we compare simulated versus observed soil carbon residence times in order to evaluate the functional response and sensitivity of modeled soil carbon stocks to changes in key environmental drivers. Understanding how simulated carbon residence time compares with observations and what drives these differences is critical for improving projections of changing carbon dynamics in the ABR and globally.

EVATS: a proactive solution to improve surgical education and maintain flexibility in the new training era.

PubMed

Horvath, Karen D; Mann, Gary N; Pellegrini, Carlos

2006-01-01

To describe the development of the EVATS rotation. Descriptive document. University teaching hospital. Faculty and residents of the University of Washington. In July 2003 we identified the need for a new, independent, educational module within our residency training. Requirements for this rotation included dedicated time for technical skills training on simulators, independent competency learning modules, academic research project time, vacation time and coverage, and flexibility for unplanned leave (eg, interview travel, m/paternity leave). An EVATS rotation was created in July 2003 that is provided at each training level and lasts from 4 to 8 weeks depending on R-level. EVATS meets the following challenges: Emergency coverage (EVATS residents available for last-minute service coverage), vacation time/vacation coverage (2 weeks vacation + 1 week vacation coverage; this maintains vacations for all residents every 6 months), academic time (residents now must complete 1 academic project for graduation) and ACGME competency learning and assessment, and technical skills training (includes simulator work for open/lap skills). Initial implementation indices are high and include resident satisfaction, 80-hour work week compliance, academic productivity, and patient continuity of care. The 21st century brought new challenges for surgical training. Increased societal demands for skills training in a laboratory setting using simulators and the 6 ACGME competencies all require classroom-type training periods. Paradoxically, the 80-hour work week restricted the time available for these educational activities and made it more difficult for programs to accommodate resident vacations and emergencies. These challenges provided an opportunity to enhance the educational experience for our residency program. The product was the EVATS rotation. Early data after implementation are favorable.

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.

Does medical school research productivity predict a resident's research productivity during residency?

PubMed

Kohlert, Scott; Zuccaro, Laura; McLean, Laurie; Macdonald, Kristian

2017-04-27

Research productivity is an important component of the CanMEDS Scholar role and is an accreditation requirement of Canadian Otolaryngology training programs. Our objective was to determine if an association exists between publication rates before and during Otolaryngology residency. We obtained the names for all certified Canadian Otolaryngologists who graduated between 1998 and 2013 inclusive, and conducted a Medline search for all of their publications. Otolaryngologists were subgrouped based on year of residency graduation and the number of articles published pre-residency and during residency (0 or ≥1). Chi-squared analyses were used to evaluate whether publications pre-residency and year of graduation were associated with publications during residency. We obtained data for 312 Canadian Otolaryngologists. Of those 312 graduates, 46 (14.7%) had no identifiable publications on PubMed and were excluded from the final data analysis. Otolaryngology residents had a mean 0.65 (95% CI 0.50-0.80) publications before residency and 3.35 (95% CI 2.90-3.80) publications during residency. Between 1998 and 2013, mean publication rates before and during residency both increased significantly (R 2  = 0.594 and R 2  = 0.759, respectively), whereas publication rates after residency graduation has stagnated (R 2  = 0.023). The odds of publishing during residency was 5.85 times higher (95% CI 2.69-12.71) if a resident published prior to residency (p < 0.0001). The Spearman correlation coefficient between publications before and during residency is 0.472 (p < 0.0001). Residents who publish at least one paper before residency are nearly six times as likely to publish during residency than those who did not publish before residency. These findings may help guide Otolaryngology program selection committees in ranking the best CaRMS candidates.

Nursing Effort and Quality of Care for Nursing Home Residents

ERIC Educational Resources Information Center

Arling, Greg; Kane, Robert L.; Mueller, Christine; Bershadsky, Julie; Degenholtz, Howard B.

2007-01-01

Purpose: The purpose of this study was to determine the relationship between nursing home staffing level, care received by individual residents, and resident quality-related care processes and functional outcomes. Design and Methods: Nurses recorded resident care time for 5,314 residents on 156 units in 105 facilities in four states (Colorado,…

Assessing spatiotemporal changes in forest carbon turnover times in observational data and models

NASA Astrophysics Data System (ADS)

Yu, K.; Smith, W. K.; Trugman, A. T.; van Mantgem, P.; Peng, C.; Condit, R.; Anderegg, W.

2017-12-01

Forests influence global carbon and water cycles, biophysical land-atmosphere feedbacks, and atmospheric composition. The capacity of forests to sequester atmospheric CO2 in a changing climate depends not only on the response of carbon uptake (i.e., gross primary productivity) but also on the simultaneous change in carbon residence time. However, changes in carbon residence with climate change are uncertain, impacting the accuracy of predictions of future terrestrial carbon cycle dynamics. Here, we use long-term forest inventory data representative of tropical, temperate, and boreal forests; satellite-based estimates of net primary productivity and vegetation carbon stock; and six models from the Coupled Model Intercomparison Project Phase 5 (CMIP5) to investigate spatiotemporal trends in carbon residence time and its relation to climate. Forest inventory and satellite-based estimates of carbon residence time show a pervasive decreasing trend across global forests. In contrast, the CMIP5 models diverge in predicting historical and future trends in carbon residence time. Divergence across CMIP5 models indicate carbon turnover times are not well constrained by observations, which likely contributes to large variability in future carbon cycle projections.

Working time of neurosurgical residents in Europe--results of a multinational survey.

PubMed

Stienen, Martin N; Netuka, David; Demetriades, Andreas K; Ringel, Florian; Gautschi, Oliver P; Gempt, Jens; Kuhlen, Dominique; Schaller, Karl

2016-01-01

The introduction of the European Working Time directive 2003/88/EC has led to a reduction of the working hours with distinct impact on the clinical and surgical activity of neurosurgical residents in training. A survey was performed among European neurosurgical residents between 06/2014 and 03/2015. Multiple logistic regression was used to assess the relationship between responder-specific variables (e.g., age, gender, country, postgraduate year (PGY)) and outcome (e.g., working time). A total of 652 responses were collected, of which n = 532 responses were taken into consideration. In total, 17.5, 22.1, 29.5, 19.5, 5.9, and 5.5 % of European residents indicated to work <40, 40-50, 51-60, 61-70, 71-80, or >80 h/week, respectively. Residents from France and Turkey (OR 4.72, 95 % CI 1.29-17.17, p = 0.019) and Germany (OR 2.06, 95 % CI 1.15-3.67, p = 0.014) were more likely to work >60 h/week than residents from other European countries. In total, 29 % of European residents were satisfied with their current working time, 11.3 % indicated to prefer reduced working time. More than half (55 %) would prefer to work more hours/week if this would improve their clinical education. Residents that rated their operative exposure as insufficient were 2.3 times as likely as others to be willing to work more hours (OR 2.32, 95 % CI 1.47-3.70, p < 0.001). Less than every fifth European resident spends >50 % of his/her working time in the operating room. By contrast, 77.4 % indicate to devote >25 % of their daily working time to administrative work. For every advanced PGY, the likelihood to spend >50 % of the working time in the OR increases by 19 % (OR 1.19, 95 % CI 1.02-1.40, p = 0.024) and the likelihood to spend >50 % of the working time with administrative work decreases by 18 % (OR 0.84, 95 % CI 0.76-0.94, p = 0.002). The results of this survey on >500 European neurosurgical residents clearly prove that less than 40 % conform with the 48-h week as claimed by the WTD2003/88/EC. Still, more than half of them would chose to work even more hours/week if their clinical education were to improve; probably due to subjective impression of insufficient training.

An objective method to determine the probability distribution of the minimum apparent age of a sample of radio-isotopic dates

NASA Astrophysics Data System (ADS)

Ickert, R. B.; Mundil, R.

2012-12-01

Dateable minerals (especially zircon U-Pb) that crystallized at high temperatures but have been redeposited, pose both unique opportunities and challenges for geochronology. Although they have the potential to provide useful information on the depositional age of their host rocks, their relationship to the host is not always well constrained. For example, primary volcanic deposits will often have a lag time (time between eruption and deposition) that is smaller than can be resolved using radiometric techniques, and the age of eruption and of deposition will be coincident within uncertainty. Alternatively, ordinary clastic sedimentary rocks will usually have a long and variable lag time, even for the youngest minerals. Intermediate cases, for example moderately reworked volcanogenic material, will have a short, but unknown lag time. A compounding problem with U-Pb zircon is that the residence time of crystals in their host magma chamber (time between crystallization and eruption) can be high and is variable, even within the products of a single eruption. In cases where the lag and/or residence time suspected to be large relative to the precision of the date, a common objective is to determine the minimum age of a sample of dates, in order to constrain the maximum age of the deposition of the host rock. However, both the extraction of that age as well as assignment of a meaningful uncertainty is not straightforward. A number of ad hoc techniques have been employed in the literature, which may be appropriate for particular data sets or specific problems, but may yield biased or misleading results. Ludwig (2012) has developed an objective, statistically justified method for the determination of the distribution of the minimum age, but it has not been widely adopted. Here we extend this algorithm with a bootstrap (which can show the effect - if any - of the sampling distribution itself). This method has a number of desirable characteristics: It can incorporate all data points while being resistant to outliers, it utilizes the measurement uncertainties, and it does not require the assumption that any given cluster of data represents a single geological event. In brief, the technique generates a synthetic distribution from the input data by resampling with replacement (a bootstrap). Each resample is a random selection from a Gaussian distribution defined by the mean and uncertainty of the data point. For this distribution, the minimum value is calculated. This procedure is repeated many times (>1000) and a distribution of minimum values is generated, from which a confidence interval can be constructed. We demonstrate the application of this technique using natural and synthetic datasets, show the advantages and limitations, and relate it to other methods. We emphasize that this estimate remains strictly a minimum age - as with any other estimate that does not explicitly incorporate lag or residence time, it will not reflect a depositional age if the lag/residence time is larger than the uncertainty of the estimate. We recommend that this or similar techniques be considered by geochronologists. Ludwig, K.R., 2012. Isoplot 3.75, A geochronological toolkit for Microsoft Excel; Berkeley Geochronology Center Special Publication no. 5

A computer program for estimating instream travel times and concentrations of a potential contaminant in the Yellowstone River, Montana

USGS Publications Warehouse

McCarthy, Peter M.

2006-01-01

The Yellowstone River is very important in a variety of ways to the residents of southeastern Montana; however, it is especially vulnerable to spilled contaminants. In 2004, the U.S. Geological Survey, in cooperation with Montana Department of Environmental Quality, initiated a study to develop a computer program to rapidly estimate instream travel times and concentrations of a potential contaminant in the Yellowstone River using regression equations developed in 1999 by the U.S. Geological Survey. The purpose of this report is to describe these equations and their limitations, describe the development of a computer program to apply the equations to the Yellowstone River, and provide detailed instructions on how to use the program. This program is available online at [http://pubs.water.usgs.gov/sir2006-5057/includes/ytot.xls]. The regression equations provide estimates of instream travel times and concentrations in rivers where little or no contaminant-transport data are available. Equations were developed and presented for the most probable flow velocity and the maximum probable flow velocity. These velocity estimates can then be used to calculate instream travel times and concentrations of a potential contaminant. The computer program was developed so estimation equations for instream travel times and concentrations can be solved quickly for sites along the Yellowstone River between Corwin Springs and Sidney, Montana. The basic types of data needed to run the program are spill data, streamflow data, and data for locations of interest along the Yellowstone River. Data output from the program includes spill location, river mileage at specified locations, instantaneous discharge, mean-annual discharge, drainage area, and channel slope. Travel times and concentrations are provided for estimates of the most probable velocity of the peak concentration and the maximum probable velocity of the peak concentration. Verification of estimates of instream travel times and concentrations for the Yellowstone River requires information about the flow velocity throughout the 520 mi of river in the study area. Dye-tracer studies would provide the best data about flow velocities and would provide the best verification of instream travel times and concentrations estimated from this computer program; however, data from such studies does not currently (2006) exist and new studies would be expensive and time-consuming. An alternative approach used in this study for verification of instream travel times is based on the use of flood-wave velocities determined from recorded streamflow hydrographs at selected mainstem streamflow-gaging stations along the Yellowstone River. The ratios of flood-wave velocity to the most probable velocity for the base flow estimated from the computer program are within the accepted range of 2.5 to 4.0 and indicate that flow velocities estimated from the computer program are reasonable for the Yellowstone River. The ratios of flood-wave velocity to the maximum probable velocity are within a range of 1.9 to 2.8 and indicate that the maximum probable flow velocities estimated from the computer program, which corresponds to the shortest travel times and maximum probable concentrations, are conservative and reasonable for the Yellowstone River.

Lean principles optimize on-time vascular surgery operating room starts and decrease resident work hours.

PubMed

Warner, Courtney J; Walsh, Daniel B; Horvath, Alexander J; Walsh, Teri R; Herrick, Daniel P; Prentiss, Steven J; Powell, Richard J

2013-11-01

Lean process improvement techniques are used in industry to improve efficiency and quality while controlling costs. These techniques are less commonly applied in health care. This study assessed the effectiveness of Lean principles on first case on-time operating room starts and quantified effects on resident work hours. Standard process improvement techniques (DMAIC methodology: define, measure, analyze, improve, control) were used to identify causes of delayed vascular surgery first case starts. Value stream maps and process flow diagrams were created. Process data were analyzed with Pareto and control charts. High-yield changes were identified and simulated in computer and live settings prior to implementation. The primary outcome measure was the proportion of on-time first case starts; secondary outcomes included hospital costs, resident rounding time, and work hours. Data were compared with existing benchmarks. Prior to implementation, 39% of first cases started on time. Process mapping identified late resident arrival in preoperative holding as a cause of delayed first case starts. Resident rounding process inefficiencies were identified and changed through the use of checklists, standardization, and elimination of nonvalue-added activity. Following implementation of process improvements, first case on-time starts improved to 71% at 6 weeks (P = .002). Improvement was sustained with an 86% on-time rate at 1 year (P < .001). Resident rounding time was reduced by 33% (from 70 to 47 minutes). At 9 weeks following implementation, these changes generated an opportunity cost potential of $12,582. Use of Lean principles allowed rapid identification and implementation of perioperative process changes that improved efficiency and resulted in significant cost savings. This improvement was sustained at 1 year. Downstream effects included improved resident efficiency with decreased work hours. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

The characteristics of a good clinical teacher as perceived by resident physicians in Japan: a qualitative study.

PubMed

Kikukawa, Makoto; Nabeta, Hiromi; Ono, Maiko; Emura, Sei; Oda, Yasutomo; Koizumi, Shunzo; Sakemi, Takanobu

2013-07-25

It is not known whether the characteristics of a good clinical teacher as perceived by resident physicians are the same in Western countries as in non-Western countries including Japan. The objective of this study was to identify the characteristics of a good clinical teacher as perceived by resident physicians in Japan, a non-Western country, and to compare the results with those obtained in Western countries. Data for this qualitative research were collected using semi-structured focus group interviews. Focus group transcripts were independently analyzed and coded by three authors. Residents were recruited by maximum variation sampling until thematic saturation was achieved. Twenty-three residents participated in five focus group interviews regarding the perceived characteristics of a good clinical teacher in Japan. The 197 descriptions of characteristics that were identified were grouped into 30 themes. The most commonly identified theme was "provided sufficient support", followed by "presented residents with chances to think", "provided feedback", and "provided specific indications of areas needing improvement". Using Sutkin's main categories (teacher, physician, and human characteristics), 24 of the 30 themes were categorized as teacher characteristics, 6 as physician characteristics, and none as human characteristics. "Medical knowledge" of teachers was not identified as a concern of residents, and "clinical competence of teachers" was not emphasized, whereas these were the two most commonly recorded themes in Sutkin's study. Our results suggest that Japanese and Western resident physicians place emphasis on different characteristics of their teachers. We speculate that such perceptions are influenced by educational systems, educational settings, and culture. Globalization of medical education is important, but it is also important to consider differences in educational systems, local settings, and culture when evaluating clinical teachers.

How long do natural waters “remember” release incidents of Marcellus Shale waters: a first order approximation using reactive transport modeling

DOE PAGES

Cai, Zhang; Li, Li

2016-12-13

Natural gas production from the Marcellus Shale formation has significantly changed energy landscape in recent years. Accidental release, including spills, leakage, and seepage of the Marcellus Shale flow back and produced waters can impose risks on natural water resources. With many competing processes during the reactive transport of chemical species, it is not clear what processes are dominant and govern the impacts of accidental release of Marcellus Shale waters (MSW) into natural waters. Here we carry out numerical experiments to explore this largely unexploited aspect using cations from MSW as tracers with a focus on abiotic interactions between cations releasedmore » from MSW and natural water systems. Reactive transport models were set up using characteristics of natural water systems (aquifers and rivers) in Bradford County, Pennsylvania. Results show that in clay-rich sandstone aquifers, ion exchange plays a key role in determining the maximum concentration and the time scale of released cations in receiving natural waters. In contrast, mineral dissolution and precipitation play a relatively minor role. The relative time scales of recovery τ rr, a dimensionless number defined as the ratio of the time needed to return to background concentrations over the residence time of natural waters, vary between 5 and 10 for Na, Ca, and Mg, and between 10 and 20 for Sr and Ba. In rivers and sand and gravel aquifers with negligible clay, τrr values are close to 1 because cations are flushed out at approximately one residence time. These values can be used as first order estimates of time scales of released MSW in natural water systems. This work emphasizes the importance of clay content and suggests that it is more likely to detect contamination in clay-rich geological formations. As a result, this work highlights the use of reactive transport modeling in understanding natural attenuation, guiding monitoring, and predicting impacts of contamination for risk assessment.« less

How long do natural waters “remember” release incidents of Marcellus Shale waters: a first order approximation using reactive transport modeling

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

Cai, Zhang; Li, Li

Natural gas production from the Marcellus Shale formation has significantly changed energy landscape in recent years. Accidental release, including spills, leakage, and seepage of the Marcellus Shale flow back and produced waters can impose risks on natural water resources. With many competing processes during the reactive transport of chemical species, it is not clear what processes are dominant and govern the impacts of accidental release of Marcellus Shale waters (MSW) into natural waters. Here we carry out numerical experiments to explore this largely unexploited aspect using cations from MSW as tracers with a focus on abiotic interactions between cations releasedmore » from MSW and natural water systems. Reactive transport models were set up using characteristics of natural water systems (aquifers and rivers) in Bradford County, Pennsylvania. Results show that in clay-rich sandstone aquifers, ion exchange plays a key role in determining the maximum concentration and the time scale of released cations in receiving natural waters. In contrast, mineral dissolution and precipitation play a relatively minor role. The relative time scales of recovery τ rr, a dimensionless number defined as the ratio of the time needed to return to background concentrations over the residence time of natural waters, vary between 5 and 10 for Na, Ca, and Mg, and between 10 and 20 for Sr and Ba. In rivers and sand and gravel aquifers with negligible clay, τrr values are close to 1 because cations are flushed out at approximately one residence time. These values can be used as first order estimates of time scales of released MSW in natural water systems. This work emphasizes the importance of clay content and suggests that it is more likely to detect contamination in clay-rich geological formations. As a result, this work highlights the use of reactive transport modeling in understanding natural attenuation, guiding monitoring, and predicting impacts of contamination for risk assessment.« less

Prevalence and cost of full-time research fellowships during general surgery residency: a national survey.

PubMed

Robertson, Charles M; Klingensmith, Mary E; Coopersmith, Craig M

2009-01-01

To quantify the prevalence, outcomes, and cost of surgical resident research. General surgery is unique among graduate medical education programs because a large percentage of residents interrupt their clinical training to spend 1 to 3 years performing full-time research. No comprehensive data exists on the scope of this practice. Survey sent to all 239 program directors of general surgery residencies participating in the National Resident Matching Program. Response rate was 200 of 239 (84%). A total of 381 of 1052 trainees (36%) interrupt residency to pursue full-time research. The mean research fellowship length is 1.7 years, with 72% of trainees performing basic science research. A significant association was found between fellowship length and postresidency activity, with a 14.7% increase in clinical fellowship training and a 15.2% decrease in private practice positions for each year of full-time research (P < 0.0001). Program directors at 31% of programs reported increased clinical duties for research fellows as a result of Accreditation Council for Graduate Medical Education work hour regulations for clinical residents, whereas a further 10% of programs are currently considering such changes. It costs $41.5 million to pay the 634 trainees who perform research fellowships each year, the majority of which is paid for by departmental funds (40%) and institutional training grants (24%). Interrupting residency to perform a research fellowship is a common and costly practice among general surgery residents. Although performing a research fellowship is associated with clinical fellowship training after residency, it is unclear to what extent this practice leads to the development of surgical investigators after postgraduate training.

Overwintering strategies of migratory birds: a novel approach for estimating seasonal movement patterns of residents and transients

USGS Publications Warehouse

Ruiz-Gutierrez, Viviana; Kendall, William L.; Saracco, James F.; White, Gary C.

2016-01-01

Our understanding of movement patterns in wildlife populations has played an important role in current ecological knowledge and can inform landscape conservation decisions. Direct measures of movement can be obtained using marked individuals, but this requires tracking individuals across a landscape or multiple sites.We demonstrate how movements can be estimated indirectly using single-site, capture–mark–recapture (CMR) data with a multi-state open robust design with state uncertainty model (MSORD-SU). We treat residence and transience as two phenotypic states of overwintering migrants and use time- and state-dependent probabilities of site entry and persistence as indirect measures of movement. We applied the MSORD-SU to data on eight species of overwintering Neotropical birds collected in 14 countries between 2002 and 2011. In addition to entry and persistence probabilities, we estimated the proportions of residents at a study site and mean residence times.We identified overwintering movement patterns and residence times that contrasted with prior categorizations of territoriality. Most species showed an evidence of residents entering sites at multiple time intervals, with transients tending to enter between peak resident movement times. Persistence and the proportion of residents varied by latitude, but were not always positively correlated for a given species.Synthesis and applications. Our results suggest that migratory songbirds commonly move among habitats during the overwintering period. Substantial proportions of populations appear to be comprised of transient individuals, and residents tend to persist at specific sites for relatively short periods of time. This information on persistence and movement patterns should be explored for specific habitats to guide landscape management on the wintering grounds, such as determining which habitats are conserved or restored as part of certification programmes of tropical agroforestry crops. We suggest that research and conservation efforts on Neotropical migrant songbirds focus on identifying landscape configurations and regional habitat networks that support these diverse overwintering strategies to secure full life cycle conservation.

Advanced laparoscopic bariatric surgery Is safe in general surgery training.

PubMed

Kuckelman, John; Bingham, Jason; Barron, Morgan; Lallemand, Michael; Martin, Matthew; Sohn, Vance

2017-05-01

Bariatric surgery makes up an increasing percentage of general surgery training. The safety of resident involvement in these complex cases has been questioned. We evaluated patient outcomes in resident performed laparoscopic bariatric procedures. Retrospective review of patients undergoing a laparoscopic bariatric procedure over seven years at a tertiary care single center. Procedures were primarily performed by a general surgery resident and proctored by an attending surgeon. Primary outcomes included operative volume, operative time and leak rate with perioperative outcomes evaluated as secondary outcomes. A total of 1649 bariatric procedures were evaluated. Operations included laparoscopic bypass (690) and laparoscopic sleeve gastrectomy (959). Average operating time was 136 min. Eighteen leaks (0.67%) were identified. Graduating residents performed an average of 89 laparoscopic bariatric cases during their training. There were no significant differences between resident levels with concern to operative time or leak rate (p 0.97 and p = 0.54). General surgery residents can safely perform laparoscopic bariatric surgery. When proctored by a staff surgeon, a resident's level of training does not significantly impact leak rate. Published by Elsevier Inc.

Nonideality in diffusion of ionic and hydrophobic solutes and pair dynamics in water-acetone mixtures of varying composition.

PubMed

Gupta, Rini; Chandra, Amalendu

2007-07-14

We have performed a series of molecular dynamics simulations of water-acetone mixtures containing either an ionic solute or a neutral hydrophobic solute to study the extent of nonideality in the dynamics of these solutes with variation of composition of the mixtures. The diffusion coefficients of the charged solutes, both cationic and anionic, are found to change nonmonotonically with the composition of the mixtures showing strong nonideality of their dynamics. Also, the extent of nonideality in the diffusion of these charged solutes is found to be similar to the nonideality that is observed for the diffusion and orientational relaxation of water and acetone molecules in these mixtures which show a somewhat similar changes in the solvation characteristics of charged and dipolar solutes with changes of composition of water-acetone mixtures. The diffusion of the hydrophobic solute, however, shows a monotonic increase with increase of acetone concentration showing its different solvation characteristics as compared to the charged and dipolar solutes. The links between the nonideality in diffusion and solvation structures are further confirmed through calculations of the relevant solute-solvent and solvent-solvent radial distribution functions for both ionic and hydrophobic solutes. We have also calculated various pair dynamical properties such as the relaxation of water-water and acetone-water hydrogen bonds and residence dynamics of water molecules in water and acetone hydration shells. The lifetimes of both water-water and acetone-water hydrogen bonds and also the residence times of water molecules are found to increase steadily with increase in acetone concentration. No maximum or minimum was found in the composition dependence of these pair dynamical quantities. The lifetimes of water-water hydrogen bonds are always found to be longer than that of acetone-water hydrogen bonds in these mixtures. The residence times of water molecules are also found to follow a similar trend.

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.

County Library Service to Rural Schools. Bulletin, 1930, No. 20

ERIC Educational Resources Information Center

Lathrop, Edith A.

1930-01-01

An efficient county library contemplates maximum service for money expended. Situated at the county seat or at some other centrally located place within the county, its book stock is carried to every resident of the county through a system branches, stations, and school deposits, and the services of an automobile and the parcel post. A trained…

Influence of forest and rangeland management on anadromous fish habitat in Western North America: habitat requirements of anadromous salmonids.

Treesearch

D.W. Reiser; T.C. Bjornn

1979-01-01

Habitat requirements of anadromous and some resident salmonid fishes have been described for various life stages, including upstream migration of adults, spawning, incubation, and juvenile rearing. Factors important in the migration of adults are water temperature, minimum water depth, maximum water velocity, turbidity, dissolved oxygen, and...

Description and Preliminary Evaluation of a Diabetes Technology Simulation Course

PubMed Central

Wilson, Rebecca D.; Bailey, Marilyn; Boyle, Mary E.; Seifert, Karen M.; Cortez, Karla Y.; Baker, Leslie J.; Hovan, Michael J.; Stepanek, Jan; Cook, Curtiss B.

2013-01-01

Background We aim to provide data on a diabetes technology simulation course (DTSC) that instructs internal medicine residents in the use of continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring system (CGMS) devices. Methods The DTSC was implemented during calendar year 2012 and conducted in the institution’s simulation center. It consisted of a set of prerequisites, a practicum, and completion of a web-based inpatient CSII-ordering simulation. DTSC participants included only those residents in the outpatient endocrinology rotation. Questionnaires were used to determine whether course objectives were met and to assess the satisfaction of residents with the course. Questionnaires were also administered before and after the endocrine rotation to gauge improvement in familiarity with CSII and CGMS technologies. Results During the first year, 12 of 12 residents in the outpatient endocrinology rotation completed the DTSC. Residents reported that the course objectives were fully met. The mean satisfaction score with the course ranged from 4.0 to 4.9 (maximum, 5), with most variables rated above 4.5. Self-reported familiarity with the operation of CSII and CGMS devices increased significantly in the postrotation survey compared with that on the prerotation survey (both p < .01). Conclusions In this pilot program, simulation-based education increased the perceived familiarity of residents with CSII and CGMS technologies. In light of these preliminary findings, the course will continue to be offered, with further data accrual. Future work will involve piloting the DTSC approach among other types of providers, such as residents in other specialties or inpatient nursing staff. PMID:24351182

Biodegradation kinetics of 1,4-benzoquinone in batch and continuous systems.

PubMed

Kumar, Pardeep; Nemati, Mehdi; Hill, Gordon A

2011-11-01

Combining chemical and biological treatments is a potentially economic approach to remove high concentration of recalcitrant compounds from wastewaters. In the present study, the biodegradation of 1,4-benzoquinone, an intermediate compound formed during phenol oxidation by chlorine dioxide, was investigated using Pseudomonas putida (ATCC 17484) in batch and continuous bioreactors. Batch experiments were conducted to determine the effects of 1,4-benzoquinone concentration and temperature on the microbial activity and biodegradation kinetics. Using the generated data, the maximum specific growth rate and biodegradation rate were determined as 0.94 h(-1) and 6.71 mg of 1,4-benzoquinone l(-1) h(-1). Biodegradation in a continuous bioreactor indicated a linear relationship between substrate loading and biodegradation rates prior to wash out of the cells, with a maximum biodegradation rate of 246 mg l(-1) h(-1) observed at a loading rate of 275 mg l(-1) h(-1) (residence time: 1.82 h). Biokinetic parameters were also determined using the steady state substrate and biomass concentrations at various dilution rates and compared to those obtained in batch cultures.

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.

Old groundwater influence on stream hydrochemistry and catchment response times in a small Sierra Nevada catchment: Sagehen Creek, California

USGS Publications Warehouse

Rademacher, Laura K.; Clark, Jordan F.; Clow, David W.; Bryant, Hudson G.

2005-01-01

The relationship between the chemical and isotopic composition of groundwater and residence times was used to understand the temporal variability in stream hydrochemistry in Sagehen basin, California. On the basis of the relationship between groundwater age and [Ca2+], the mean residence time of groundwater feeding Sagehen Creek during base flow is approximately 28 years. [Cl−]:[Ca2+] ratios in Sagehen Creek can be used to distinguish between two important processes: changes in the apparent age of groundwater discharging into the creek and dilution with snowmelt. The mean residence time of groundwater discharging into the creek is approximately 15 years during snowmelt periods. The results from this study have implications for hydrograph separation studies as groundwater is not a single, well‐mixed chemical component but rather is a variable parameter that predictably depends on groundwater residence time. Most current models of catchment hydrochemistry do not account for chemical and isotopic variability found within the groundwater reservoir. In addition, this study provides valuable insight into the long‐term hydrochemical response of a catchment to perturbations as catchment‐flushing times are related to the mean residence time of water in a basin.

Single molecule diffusion and the solution of the spherically symmetric residence time equation.

PubMed

Agmon, Noam

2011-06-16

The residence time of a single dye molecule diffusing within a laser spot is propotional to the total number of photons emitted by it. With this application in mind, we solve the spherically symmetric "residence time equation" (RTE) to obtain the solution for the Laplace transform of the mean residence time (MRT) within a d-dimensional ball, as a function of the initial location of the particle and the observation time. The solutions for initial conditions of potential experimental interest, starting in the center, on the surface or uniformly within the ball, are explicitly presented. Special cases for dimensions 1, 2, and 3 are obtained, which can be Laplace inverted analytically for d = 1 and 3. In addition, the analytic short- and long-time asymptotic behaviors of the MRT are derived and compared with the exact solutions for d = 1, 2, and 3. As a demonstration of the simplification afforded by the RTE, the Appendix obtains the residence time distribution by solving the Feynman-Kac equation, from which the MRT is obtained by differentiation. Single-molecule diffusion experiments could be devised to test the results for the MRT presented in this work. © 2011 American Chemical Society

Mobile technology in radiology resident education.

PubMed

Korbage, Aiham C; Bedi, Harprit S

2012-06-01

The authors hypothesized that ownership of a mobile electronic device would result in more time spent learning radiology. Current trends in radiology residents' studying habits, their use of electronic and printed radiology learning resources, and how much of the funds allotted to them are being used toward printed vs electronic education tools were assessed in this study. A survey study was conducted among radiology residents across the United States from June 13 to July 5, 2011. Program directors listed in the Association of Program Directors in Radiology e-mail list server received an e-mail asking for residents to participate in an online survey. The questionnaire consisted of 12 questions and assessed the type of institution, the levels of training of the respondents, and book funds allocated to residents. It also assessed the residents' study habits, access to portable devices, and use of printed and electronic radiology resources. Radiology residents are adopters of new technologies, with 74% owning smart phones and 37% owning tablet devices. Respondents spend nearly an equal amount of time learning radiology from printed textbooks as they do from electronic resources. Eighty-one percent of respondents believe that they would spend more time learning radiology if provided with tablet devices. There is considerable use of online and electronic resources and mobile devices among the current generation of radiology residents. Benefits, such as more study time, may be obtained by radiology programs that incorporate tablet devices into the education of their residents. Copyright © 2012 American College of Radiology. Published by Elsevier Inc. All rights reserved.

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.

First-Passage Times in d -Dimensional Heterogeneous Media

NASA Astrophysics Data System (ADS)

Vaccario, G.; Antoine, C.; Talbot, J.

2015-12-01

Although there are many theoretical studies of the mean first-passage time (MFPT), most neglect the diffusive heterogeneity of real systems. We present exact analytical expressions for the MFPT and residence times of a pointlike particle diffusing in a spherically symmetric d -dimensional heterogeneous system composed of two concentric media with different diffusion coefficients with an absorbing inner boundary (target) and a reflecting outer boundary. By varying the convention, e.g., Itō, Stratonovich, or isothermal, chosen to interpret the overdamped Langevin equation with multiplicative noise describing the diffusion process, we find different predictions and counterintuitive results for the residence time in the outer region and hence for the MFPT, while the residence time in the inner region is independent of the convention. This convention dependence of residence times and the MFPT could provide insights about the heterogeneous diffusion in a cell or in a tumor, or for animal and insect searches inside their home range.

Ophthalmology resident surgical competency: a national survey.

PubMed

Binenbaum, Gil; Volpe, Nicholas J

2006-07-01

To describe the prevalence, management, and career outcomes of ophthalmology residents who struggle with surgical competency and to explore related educational issues. Fourteen-question written survey. Fifty-eight program directors at Accreditation Council on Graduate Medical Education-accredited, United States ophthalmology residency programs, representing a total of 2179 resident graduates, between 1991 and 2000. Study participants completed a mailed, anonymous survey whose format combined multiple choice and free comment questions. Number of surgically challenged residents, types of problems identified, types of remediation, final departmental decision at the end of residency, known career outcomes, and residency program use of microsurgical skills laboratories and applicant screening tests. One hundred ninety-nine residents (9% overall; 10% mean per program) were labeled as having trouble mastering surgical skills. All of the programs except 2 had encountered such residents. The most frequently cited problems were poor hand-eye coordination (24%) and poor intraoperative judgment (22%). Most programs were supportive and used educational rather than punitive measures, the most common being extra practice-laboratory time (32%), scheduling cases with the best teaching surgeon (23%), and counseling (21%). Nearly one third (31%) of residents were believed to have overcome their difficulties before graduation. Other residents were encouraged to pursue medical ophthalmology (22%) or to obtain further surgical training through a fellowship (21%) or a supervised practice setting (12%); these residents were granted a departmental statement of satisfactory completion of residency for Board eligibility. Twelve percent were asked to leave residency. Of reported career outcomes, 92% of residents were practicing ophthalmology, 65% as surgical and 27% as medical ophthalmologists. Ninety-eight percent of residency programs had microsurgical practice facilities, 64% had a formal teaching course, and 36% had mandatory practice time. Most programs (76%) did not perform applicant vision or dexterity screening tests; questions existed about the legality and validity of such tests. The issue of ophthalmology residents who struggle to develop surgical competency appears common. Although many problems appear to be remediable with time, practice, and dedicated, patient teachers, more specific guidelines for a statement of surgical competency are likely necessary to standardize the Board certification process.

Pharmacokinetics of pidotimod in broiler chickens by UHPLC-MS/MS after oral and intravenous administration.

PubMed

Zhang, Ruili; Qiu, Mei; Zhao, Li; Cui, Liangliang; Wang, Chunyuan; Zhu, Jiajia; Hao, Zhihui

2018-03-01

Pidotimod is widely used in children as an immune promoter but it has not been fully evaluated in animals. The pharmacokinetics of pidotimod and its oral bioavailability have not been described in broiler chickens. We developed a simple and sensitive UHPLC-MS/MS assay for rapid determination of pidotimod levels in chicken blood. Recoveries were nearly 100% and the coefficients of accuracy and precision were minimal. Healthy broiler chickens were given 10 mg/kg pidotimod either orally or intravenously. The oral pidotimod was rapidly absorbed (time to reach maximum concentration, 1.25 h) and rapidly eliminated (the mean residence time was 3.2 h). A noncompartmental analysis of the intravenous route indicated a mean plasma clearance of 2.2 L (h kg) -1 with an estimated mean volume of distribution at steady state of 12.69 L/kg. The bioavailability of pidotimod after oral dosing was 27%. Copyright © 2017 John Wiley & Sons, Ltd.

Children's Perspectives on Everyday Experiences of Shared Residence: Time, Emotions and Agency Dilemmas

ERIC Educational Resources Information Center

Haugen, Gry Mette D.

2010-01-01

Shared residence is often presented as an arrangement that is in the best interests of the child following the divorce of its parents. Based on in-depth interviews with Norwegian children who have experienced shared residence, this article seeks to explore some dilemmas concerning time, agency and the children's emotions. Three characteristics of…

Orthodontic Residents' Indications for Use of the Lateral TMJ Tomogram and the Posteroanterior Cephalogram.

ERIC Educational Resources Information Center

Luke, Larry S.; And Others

1997-01-01

A study of 144 patients assigned to eight orthodontic residents over two years found residents requested lateral tomograms of the temporomandibular joint (TMJ) 28% of the time, commonly citing TMJ clicking, pain, and medico-legal protection. Posteroanterior cephalograms were ordered 26% of the time, commonly for facial asymmetry and maxillary…

The need for improved dermoscopy training in residency: a survey of US dermatology residents and program directors

PubMed Central

Patel, Parth; Khanna, Sarika; McLellan, Beth; Krishnamurthy, Karthik

2017-01-01

Background Inadequate dermoscopy training represents a major barrier to proper dermoscopy use. Objective To better understand the status of dermoscopy training in US residency programs. Methods A survey was sent to 417 dermatology residents and 118 program directors of dermatology residency programs. Results Comparing different training times for the same training type, residents with 1–10 hours of dedicated training had similar confidence using dermoscopy in general (p = 1.000) and satisfaction with training (p = .3224) than residents with >10 hours of dedicated training. Comparing similar training times for different training types, residents with 1–10 hours of dedicated training had significantly increased confidence using dermoscopy in general (p = .0105) and satisfaction with training (p = .0066) than residents with 1–10 hours of only bedside training. Lastly, residents with 1–10 hours of dedicated training and >10 hours of dedicated training had significantly increased confidence using dermoscopy in general (p = .0002, p = .2471) and satisfaction with training (p <.0001, p < .0001) than residents with no dermoscopy training at all. Conclusions Dermoscopy training in residency should include formal dermoscopy training that is overseen by the program director and is possibly supplemented by outside dermoscopy training. PMID:28515987

2003 survey of Canadian radiation oncology residents

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

Yee, Don; Fairchild, Alysa; Keyes, Mira

2005-06-01

Purpose: Radiation oncology's popularity as a career in Canada has surged in the past 5 years. Consequently, resident numbers in Canadian radiation oncology residencies are at all-time highs. This study aimed to survey Canadian radiation oncology residents about their opinions of their specialty and training experiences. Methods and Materials: Residents of Canadian radiation oncology residencies that enroll trainees through the Canadian Resident Matching Service were identified from a national database. Residents were mailed an anonymous survey. Results: Eight of 101 (7.9%) potential respondents were foreign funded. Fifty-two of 101 (51.5%) residents responded. A strong record of graduating its residents wasmore » the most important factor residents considered when choosing programs. Satisfaction with their program was expressed by 92.3% of respondents, and 94.3% expressed satisfaction with their specialty. Respondents planning to practice in Canada totaled 80.8%, and 76.9% plan to have academic careers. Respondents identified job availability and receiving adequate teaching from preceptors during residency as their most important concerns. Conclusions: Though most respondents are satisfied with their programs and specialty, job availability and adequate teaching are concerns. In the future, limited time and resources and the continued popularity of radiation oncology as a career will magnify the challenge of training competent radiation oncologists in Canada.« less

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.

Effect of operating parameters on bio-fuel production from waste furniture sawdust.

PubMed

Uzun, Basak Burcu; Kanmaz, Gülin

2013-04-01

Fast pyrolysis is an effective technology for conversion of biomass into energy and value-added chemicals instead of burning them directly. In this study, fast pyrolysis of waste furniture sawdust (pine sawdust) was investigated under various reaction conditions (reaction time, pyrolysis temperature, heating rate, residence time and particle size) in a tubular reactor. The optimum reaction conditions for bio-oil production was found as reaction time of 5 min, pyrolysis temperature of 500 °C, heating rate of 300 °C min(-1) under nitrogen flow rate of 400 cm(3) min(-1). At these conditions, maximum bio-oil yield was obtained as 42.09%. Pyrolysis oils were characterized by using various elemental analyses, fourier - transformation infrared (FT-IR) spectrometry and gas chromatography-mass spectrometry (GC-MS). The results of the GC-MS showed that cracking of large molecular phenolics was followed by partial conversion into phenol and alkylated phenols (45%) during the pyrolysis. According to the experimental and characterization results; the liquid product could be used as feedstock for the chemical industry or petroleum crude for refinery.

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.

Keeping up with the times: revising the dermatology residency curriculum in the era of molecular diagnostics and personalized medicine.

PubMed

LaChance, Avery; Murphy, Michael J

2014-11-01

The clinical use of molecular diagnostics, genomics, and personalized medicine is increasing and improving rapidly over time. However, medical education incorporating the practical application of these techniques is lagging behind. Although instruction in these areas should be expanded upon and improved at all levels of training, residency provides a concentrated period of time in which to hone in on skills that are practically applicable to a trainee's specialty of choice. Although residencies in some fields, such as pathology, have begun to incorporate practical molecular diagnostics training, this area remains a relative gap in dermatology residency programs. Herein, we advocate for the incorporation of training in molecular diagnostics and personalized medicine into dermatology residency programs and propose a basic curriculum template for how to begin approaching these topics. By incorporating molecular diagnostics into dermatology residency training, dermatologists have the opportunity to lead the way and actively shape the specialty's transition into the era of personalized medicine. © 2014 The International Society of Dermatology.

Air Parcel Residence Times within Tropical Forest Canopies and Implications for Reactive Gases

NASA Astrophysics Data System (ADS)

Gerken, T.; Chamecki, M.; Fuentes, J. D.

2014-12-01

The Amazon rainforest is the world's largest natural emitter of reactive trace gases. Due to its dense vegetation (leaf area index > 4), turbulence fluctuations are highly attenuated deep inside the canopy. However, strong coherent eddies that penetrate the upper portion of the canopy can be very effective in transporting gases. Sweeps and ejections act in the order of seconds and transport air parcels into or out of the canopy. The effects of coherent structures on the air parcel residence times and associated chemical processing of reactive gases remain largely unquantified in tropical forests. We combine canopy resolving Large-Eddy Simulation (LES) and field observations in the Brazilian Amazon to study residence times of air parcels in the rainforest as a function of canopy structure and height (h). Good agreement is obtained between simulated and observed turbulence statistics within and above the forest. Coherent structure properties obtained from quadrant analysis are also well reproduced. A Lagrangian particle tracking algorithm is used to quantify the distribution of residence times of air parcels "released" at different heights. Canopy residence times were determined from the particle trajectories. The resulting probability density function (PDF) strongly depended on the particle release height (z). For particles released in the upper canopy (at z/h=0.75) the most frequent residence times were in the order of 30s, with 50% of all particles ejected from the canopy after ~2 minutes. The mean residence time was close to 5 minutes, indicating a very skewed PDF. At z/h=0.25 the PDF was more evenly distributed with its median and mean in the order of ~10 minutes. Due to sweeps, both simulations had a non- negligible fraction of particles transported deep into the canopy, thus increasing greatly their residence times. As the reaction timescales of many biogenic volatile organic compounds (BVOC) are in the order of seconds to minutes, significant chemical processing can take place before particles are transported out of the canopy. This result highlights the importance of coherent motions on the capability of BVOC to escape the canopy space. Hence, it is important to consider the real distribution of residence times, highlighting the need for accurate canopy representation in LES models.

Time series analysis of demographic and temporal trends of tuberculosis in Singapore.

PubMed

Wah, Win; Das, Sourav; Earnest, Arul; Lim, Leo Kang Yang; Chee, Cynthia Bin Eng; Cook, Alex Richard; Wang, Yee Tang; Win, Khin Mar Kyi; Ong, Marcus Eng Hock; Hsu, Li Yang

2014-10-31

Singapore is an intermediate tuberculosis (TB) incidence country, with a recent rise in TB incidence from 2008, after a fall in incidence since 1998. This study identified population characteristics that were associated with the recent increase in TB cases, and built a predictive model of TB risk in Singapore. Retrospective time series analysis was used to study TB notification data collected from 1995 to 2011 from the Singapore Tuberculosis Elimination Program (STEP) registry. A predictive model was developed based on the data collected from 1995 to 2010 and validated using the data collected in 2011. There was a significant difference in demographic characteristics between resident and non-resident TB cases. TB risk was higher in non-residents than in residents throughout the period. We found no significant association between demographic and macro-economic factors and annual incidence of TB with or without adjusting for the population-at-risk. Despite growing non-resident population, there was a significant decrease in the non-resident TB risk (p < 0.0001). However, there was no evidence of trend in the resident TB risk over this time period, though differences between different demographic groups were apparent with ethnic minorities experiencing higher incidence rates. The study found that despite an increasing size of non-resident population, TB risk among non-residents was decreasing at a rate of about 3% per year. There was an apparent seasonality in the TB reporting.

Does a new surgical residency program increase operating room times?

PubMed

Castillo, Alvaro; Zarak, Alberto; Kozol, Robert A

2013-01-01

Our country faces a shortage of surgeons; hence, we may anticipate the development of new surgery residencies. Therefore, the question of the effect of a new program on operating room times (ORT) is important. Our primary aim was to compare ORT of 3 common procedures done by attendings alone vs ORT of cases with residents. We queried records of 1458 patients from the JFK Medical Center database for laparoscopic cholecystectomy, open inguinal hernia repair, and laparoscopic appendectomy from July 2010 to July 2012. We divided the sample into 2 groups: "attending alone" (2010-2011) and "with residents" (2011-2012). The ORT was calculated by "Cut time" and "Close time," as recorded in the OR. ORT for both groups was calculated using the unpaired t test. Of the total number of patients, 778 underwent laparoscopic cholecystectomy, 407 underwent open inguinal hernia repair, and 273 underwent laparoscopic appendectomy; of these, 620, 315, and 211 procedures, respectively, were done by the attending alone and 158, 92, and 62, respectively, were done with residents. Differences in ORT for the 3 types of surgery were statistically significant (p < 0.001). There was no statistical significance when comparing the first half with the second half of the academic year for residents' ORT. Resident involvement increases ORT. Cost analysis considering OR time and anesthesia time vs federal funding for Graduate Medical Education is complicated. The benefit of new programs in diminishing the shortage of surgeons cannot be underestimated. © 2013 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

How can surgeons facilitate resident intraoperative decision-making?

PubMed

Hill, Katherine A; Dasari, Mohini; Littleton, Eliza B; Hamad, Giselle G

2017-10-01

Cognitive skills such as decision-making are critical to developing operative autonomy. We explored resident decision-making using a recollection of specific examples, from the attending surgeon and resident, after laparoscopic cholecystectomy. In a separate semi-structured interview, the attending and resident both answered five questions, regarding the resident's operative roles and decisions, ways the attending helped, times when the attending operated, and the effect of the relationship between attending and resident. Themes were extracted using inductive methods. Thirty interviews were completed after 15 cases. Facilitators of decision-making included dialogue, safe struggle, and appreciation for retraction. Aberrant case characteristics, anatomic uncertainties, and time pressures provided barriers. Attending-resident mismatches included descriptions of transitioning control to the attending. Reciprocal dialogue, including concept-driven feedback, is helpful during intraoperative teaching. Unanticipated findings impede resident decision-making, and we describe differences in understanding transfers of operative control. Given these factors, we suggest that pre-operative discussions may be beneficial. Copyright © 2017 Elsevier Inc. All rights reserved.

The American Society for Clinical Pathology resident in-service examination: does resident performance provide insight into the effectiveness of clinical pathology education?

PubMed

McKenna, Barbara J

2007-06-01

The resident in-service examination in pathology is an in-training exercise that is taken by virtually all pathology residents in the United States as well as by some participants in Canada, Ireland, and Lebanon. Although all of the anatomic pathology topics in the examination, with only one exception-forensic pathology, show significant improvement in scores over the 4 years of residency training, three areas of clinical pathology training (laboratory administration, clinical chemistry, and microbiology) show significantly lower improvement in performance over the years of residency training. By contrast, transfusion medicine, hematopathology and the special topics section of the examination all demonstrate improved performance by residents over time. While the reason behind these differences must remain speculative at this time, these findings suggest that measures to improve effectiveness in clinical pathology training might be suggested by examining the differences between residency training practices between higher and lower performing areas of clinical pathology.

Automated near-real-time clinical performance feedback for anesthesiology residents: one piece of the milestones puzzle.

PubMed

Ehrenfeld, Jesse M; McEvoy, Matthew D; Furman, William R; Snyder, Dylan; Sandberg, Warren S

2014-01-01

Anesthesiology residencies are developing trainee assessment tools to evaluate 25 milestones that map to the six core competencies. The effort will be facilitated by development of automated methods to capture, assess, and report trainee performance to program directors, the Accreditation Council for Graduate Medical Education and the trainees themselves. The authors leveraged a perioperative information management system to develop an automated, near-real-time performance capture and feedback tool that provides objective data on clinical performance and requires minimal administrative effort. Before development, the authors surveyed trainees about satisfaction with clinical performance feedback and about preferences for future feedback. Resident performance on 24,154 completed cases has been incorporated into the authors' automated dashboard, and trainees now have access to their own performance data. Eighty percent (48 of 60) of the residents responded to the feedback survey. Overall, residents "agreed/strongly agreed" that they desire frequent updates on their clinical performance on defined quality metrics and that they desired to see how they compared with the residency as a whole. Before deployment of the new tool, they "disagreed" that they were receiving feedback in a timely manner. Survey results were used to guide the format of the feedback tool that has been implemented. The authors demonstrate the implementation of a system that provides near-real-time feedback concerning resident performance on an extensible series of quality metrics, and which is responsive to requests arising from resident feedback about desired reporting mechanisms.

Automated Near Real-Time Clinical Performance Feedback for Anesthesiology Residents: One Piece of the Milestones Puzzle

PubMed Central

Ehrenfeld, Jesse M.; McEvoy, Matthew D.; Furman, William R.; Snyder, Dylan; Sandberg, Warren S.

2014-01-01

Background Anesthesiology residencies are developing trainee assessment tools to evaluate 25 milestones that map to the 6 core competencies. The effort will be facilitated by development of automated methods to capture, assess, and report trainee performance to program directors, the Accreditation Council for Graduate Medical Education and the trainees themselves. Methods We leveraged a perioperative information management system to develop an automated, near-real-time performance capture and feedback tool that provides objective data on clinical performance and requires minimal administrative effort. Prior to development, we surveyed trainees about satisfaction with clinical performance feedback and about preferences for future feedback. Results Resident performance on 24,154 completed cases has been incorporated into our automated dashboard, and trainees now have access to their own performance data. Eighty percent (48 of 60) of our residents responded to the feedback survey. Overall, residents ‘agreed/strongly agreed’ that they desire frequent updates on their clinical performance on defined quality metrics and that they desired to see how they compared to the residency as a whole. Prior to deployment of the new tool, they ‘disagreed’ that they were receiving feedback in a timely manner. Survey results were used to guide the format of the feedback tool that has been implemented. Conclusions We demonstrate the implementation of a system that provides near real-time feedback concerning resident performance on an extensible series of quality metrics, and which is responsive to requests arising from resident feedback about desired reporting mechanisms. PMID:24398735

Residential Exposure to Urban Traffic Is Associated with Increased Carotid Intima-Media Thickness in Children

PubMed Central

Armijos, Rodrigo X.; Weigel, M. Margaret; Myers, Orrin B.; Li, Wen-Whai; Racines, Marcia; Berwick, Marianne

2015-01-01

Chronic exposure to urban traffic pollution is documented to promote atherosclerosis in adults but little is known about its potential effects in children. Our study examined the association of long-term exposure to traffic with carotid intima-media thickness (cIMT) in 287 healthy children. Residential proximity and distance-weighted traffic density (DWTD) were used as proximity markers for traffic-related air pollution exposure. The multivariable analyses revealed that children residing <100 meters from the nearest heavily trafficked road had cIMT mean and maximum measurements that were increased by 15% and 11% compared to those living ≥ 200 meters away (P = 0.0001). Similar increases in cIMT were identified for children in the highest versus lowest DWTD tertile. Children who resided 100–199 meters from traffic or in the middle DWTD tertile also exhibited increased cIMT but these differences were not statistically significant. No statistically significant differences were identified between residential distance to traffic or DWTD and systemic inflammation indicators (CRP, IL-6). The study results suggest that exposure to urban traffic promotes arterial remodeling in children. This finding is important since even small increases in cIMT over time can potentially lead to earlier progression to atherosclerosis. It is also important because traffic-related pollution is potentially modifiable. PMID:25685160

Residential exposure to urban traffic is associated with increased carotid intima-media thickness in children.

PubMed

Armijos, Rodrigo X; Weigel, M Margaret; Myers, Orrin B; Li, Wen-Whai; Racines, Marcia; Berwick, Marianne

2015-01-01

Chronic exposure to urban traffic pollution is documented to promote atherosclerosis in adults but little is known about its potential effects in children. Our study examined the association of long-term exposure to traffic with carotid intima-media thickness (cIMT) in 287 healthy children. Residential proximity and distance-weighted traffic density (DWTD) were used as proximity markers for traffic-related air pollution exposure. The multivariable analyses revealed that children residing <100 meters from the nearest heavily trafficked road had cIMT mean and maximum measurements that were increased by 15% and 11% compared to those living ≥ 200 meters away (P = 0.0001). Similar increases in cIMT were identified for children in the highest versus lowest DWTD tertile. Children who resided 100-199 meters from traffic or in the middle DWTD tertile also exhibited increased cIMT but these differences were not statistically significant. No statistically significant differences were identified between residential distance to traffic or DWTD and systemic inflammation indicators (CRP, IL-6). The study results suggest that exposure to urban traffic promotes arterial remodeling in children. This finding is important since even small increases in cIMT over time can potentially lead to earlier progression to atherosclerosis. It is also important because traffic-related pollution is potentially modifiable.

Local temperatures predict breeding phenology but do not result in breeding synchrony among a community of resident cavity-nesting birds.

PubMed

Drake, Anna; Martin, Kathy

2018-02-09

Weather and ecological factors are known to influence breeding phenology and thus individual fitness. We predicted concordance between weather conditions and annual variation in phenology within a community of eight resident, cavity-nesting bird species over a 17-year period. We show that, although clutch initiation dates for six of our eight species are correlated with local daily maximum temperatures, this common driver does not produce a high degree of breeding synchrony due to species-specific responses to conditions during different periods of the preceding winter or spring. These "critical temperature periods" were positively associated with average lay date for each species, although the interval between critical periods and clutch initiation varied from 4-78 days. The ecological factors we examined (cavity availability and a food pulse) had an additional influence on timing in only one of our eight focal species. Our results have strong implications for understanding heterogeneous wildlife responses to climate change: divergent responses would be expected within communities where species respond to local conditions within different temporal windows, due to differing warming trends between winter and spring. Our system therefore indicates that climate change could alter relative breeding phenology among sympatric species in temperate ecosystems.

Alienation of Elderly Korean American Immigrants as Related to Place of Residence, Gender, Age, Years of Education, Time in the U.S., Living with or without Children, and Living with or without a Spouse.

ERIC Educational Resources Information Center

Moon, Jeong-hwa; Pearl, Joseph H.

1991-01-01

Older Korean immigrants (n=137) completed Dean's Alienation Scale (DAS) to examine relationship of alienation to place of residence, gender, age, years of education, time in United States, and living arrangements. Found significant relationships between DAS subscales and place of residence, age, time in United States, and whether living with or…

In vivo eye surface residence determination by high-resolution scintigraphy of a novel ion-sensitive hydrogel based on gellan gum and kappa-carrageenan.

PubMed

Fernández-Ferreiro, Anxo; Silva-Rodríguez, Jesús; Otero-Espinar, Francisco Javier; González-Barcia, Miguel; Lamas, María Jesús; Ruibal, Alvaro; Luaces-Rodríguez, Andrea; Vieites-Prado, Alba; Lema, Isabel; Herranz, Michel; Gómez-Lado, Noemí; Blanco-Mendez, José; Gil-Martínez, María; Pardo, María; Moscoso, Alexis; Cortes, Julia; Sánchez-Martínez, María; Pardo-Montero, Juan; Aguiar, Pablo

2017-05-01

In last years, sensitive hydrogels have become a breakthrough in ophthalmic pharmaceutical technology aimed at developing new strategies to increase the residence time of active substances. In a previous paper, we qualitatively demonstrated the capacity of a new ion sensitive hydrogel to increase the residence time. Nevertheless, the clearance of the gel from the ocular surface was not quantifiable with the used methodology. The aim of the present work was to use a well-established approach based on scintigraphy to quantitatively estimate the residence time of the previously proposed hydrogel. The rat corneal residence time of a topic ophthalmic formulation containing gellan gum and kappa carragenan (0.82% w/v) labeled with 99m Tc-DTPA radiotracer was evaluated and compared with the residence of an aqueous solution. Ophthalmic safety studies such as eye irritation or passage through the cornea were also carried out. After 1.5h of contact, 77% of the hydrogel remained in the ocular surface, presenting kinetics of disappearance one-phase decay and a half time of 262min. We conclude that the novel ophthalmic hydrogel developed with kappa carrageenan and gellan gum remains for long periods of time on the corneal surface, presenting a drop that fits an exponential decay. Copyright © 2017 Elsevier B.V. All rights reserved.

Cooperative learning as applied to resident instruction in radiology reporting.

PubMed

Mueller, Donald; Georges, Alexandra; Vaslow, Dale

2007-12-01

The study is designed to evaluate the effectiveness of an active form of resident instruction, cooperative learning, and the residents' response to that form of instruction. The residents dictated three sets of reports both before and after instruction in radiology reporting using the cooperative learning method. The reports were evaluated for word count, Flesch-Kincaid grade level, advancement on clinical spectrum, clarity, and comparison to prior reports. The reports were evaluated for changes in performance characteristics between the pre- and postinstruction dictations. The residents' response to this form of instruction was evaluated by means of a questionnaire. The instruction was effective in changing the resident dictations. The results became shorter (P<.035), more complex (P<.0126), and demonstrated increased advancement on clinical spectrum (P<.0204). The resident response to this form of instruction was positive. One hundred percent or respondents indicated enjoyment working with their groups. Seventy-five percent stated they would like to participate in more cooperative learning activities. The least positive responses related to the amount of time devoted to the project. Sixty-three percent of respondents stated that the time devoted to the project was appropriate. Cooperative learning can be an effective tool in the setting of the radiology residency. Instructional time requirements must be strongly considered in designing a cooperative learning program.

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.

Work Hours Assessment and Monitoring Initiative (WHAMI) under resident direction: a strategy for working within limitations.

PubMed

Goldstein, Michael J; Samstein, Benjamin; Ude, Akuo; Widmann, Warren D; Hardy, Mark A

2005-01-01

A review of surgical residents' duty-hours prompted a Work Hours Assessment and Monitoring Initiative (WHAMI) that preemptively limits residents from violating "duty-hours rules." Work hours data for the Department of Surgery were reviewed over 8-months at New York Presbyterian Hospital-Columbia Campus. This ongoing review is performed by a work-hours monitoring team, which supervises residents' hours for the initial 5-days of each week. As residents approach work-hours limits for the week, they are dismissed from duty for appropriate time periods in the remaining 2 days of the week. The work-hours data entry compliance for 52 residents was increased from 93% to 99% after creation of the WHAMI. Before the new system, a mean of 9.5 residents per month (19%) worked an average of 7.3 +/- 6.4 hours over the 80-hour limit. Averaged monthly compliance with the 80-hour work limit was increased to 98% with introduction of the WHAMI. A review of on-call duty hours revealed a mean of 7 (14%) residents per month who worked an average of 2.4 hours beyond 24-hour call limitations including "sign-out" time imposed by the ACGME. New monitoring procedures have improved compliance to 100% with 24-hour call limitations imposed by the ACGME. Compliance with the more stringent New York State (NYS) guidelines has approached 94% with noncompliant residents extending on-call hours by an average of 1.5 hours over the 24-hour limitations, most on "off General Surgery" rotations or out-of-state rotations. Review of mandatory rest periods contributed to an increase in mean "time off" between work periods, thereby increasing compliance with ACGME guidelines and NYS regulations from 75% to 88%, and 90% to 98%, respectively. Residents reporting less than 10 hours rest reported increased "time off" from 6.2 +/- 2.0 to 7.9 +/- 1.3 hours (p < 0.001). Internal review of surgical resident's duty-hours at a large university hospital revealed that despite strict scheduling and the requirement of mandatory duty-hours entry, achieving the goals of meeting the duty-hours requirements and of ongoing data entry required the creation of a resident enforced, real-time Work Hours Assessment and Monitoring Initiative.

So Tired: Predictive Utility of Baseline Sleep Screening in a Longitudinal Observational Survey Cohort of First-Year Residents.

PubMed

Zebrowski, Jonathan P; Pulliam, Samantha J; Denninger, John W; Berkowitz, Lori R

2018-06-01

Sleep impairment is highly prevalent among resident physicians and is associated with both adverse patient outcomes and poor resident mental and physical health. Risk factors for sleep problems during residency are less clear, and no screening model exists to identify residents at risk for sleep impairment. The objective of this study was to assess change in resident sleep during training and to evaluate utility of baseline sleep screening in predicting future sleep impairment. This is a prospective observational repeated-measures survey study. The participants comprised PGY-1 residents across multiple specialties at Partners HealthCare hospitals. Main measures used for this study were demographic queries and two validated scales: the Pittsburgh Sleep Quality Index (PSQI), measuring sleep quality, and the Epworth Sleepiness Scale (ESS), measuring excessive daytime sleepiness. Two hundred eighty-one PGY-1 residents completed surveys at residency orientation, and 153 (54%) completed matched surveys 9 months later. Mean nightly sleep time decreased from 7.6 to 6.5 hours (p < 0.001). Mean PSQI score increased from 3.6 to 5.2 (p < 0.001), and mean ESS score increased from 7.2 to 10.4 (p < 0.001). The proportion of residents exceeding the scales' clinical cutoffs increased over time from 15 to 40% on the PSQI (p < 0.001) and from 26 to 59% on the ESS (p < 0.001). Baseline normal sleep was not protective: 68% of residents with normal scores on both scales at baseline exceeded the clinical cutoff on at least one scale at follow-up. Greater age and fewer children increased follow-up PSQI score (p < 0.001) but not ESS score. During PGY-1 training, residents experience worsening sleep duration, quality of sleep, and daytime sleepiness. Residents with baseline impaired sleep tend to remain impaired. Moreover, many residents with baseline normal sleep experience sleep deterioration over time. Sleep screening at residency orientation may identify some, but not all, residents who will experience sleep impairment during training.

Advancing Physically-Based Flow Simulations of Alluvial Systems Through Atmospheric Noble Gases and the Novel 37Ar Tracer Method

NASA Astrophysics Data System (ADS)

Schilling, Oliver S.; Gerber, Christoph; Partington, Daniel J.; Purtschert, Roland; Brennwald, Matthias S.; Kipfer, Rolf; Hunkeler, Daniel; Brunner, Philip

2017-12-01

To provide a sound understanding of the sources, pathways, and residence times of groundwater water in alluvial river-aquifer systems, a combined multitracer and modeling experiment was carried out in an important alluvial drinking water wellfield in Switzerland. 222Rn, 3H/3He, atmospheric noble gases, and the novel 37Ar-method were used to quantify residence times and mixing ratios of water from different sources. With a half-life of 35.1 days, 37Ar allowed to successfully close a critical observational time gap between 222Rn and 3H/3He for residence times of weeks to months. Covering the entire range of residence times of groundwater in alluvial systems revealed that, to quantify the fractions of water from different sources in such systems, atmospheric noble gases and helium isotopes are tracers suited for end-member mixing analysis. A comparison between the tracer-based mixing ratios and mixing ratios simulated with a fully-integrated, physically-based flow model showed that models, which are only calibrated against hydraulic heads, cannot reliably reproduce mixing ratios or residence times of alluvial river-aquifer systems. However, the tracer-based mixing ratios allowed the identification of an appropriate flow model parametrization. Consequently, for alluvial systems, we recommend the combination of multitracer studies that cover all relevant residence times with fully-coupled, physically-based flow modeling to better characterize the complex interactions of river-aquifer systems.

Pharmacokinetics and tissue distribution study in mice of triptolide-loaded lipid emulsion and accumulation effect on pancreas.

PubMed

Li, Xue; Mao, Yuling; Li, Kai; Shi, Tianyu; Yao, Huimin; Yao, Jianhua; Wang, Shujun

2016-05-01

Triptolide (TP) shows strong anti-tumor activities on various cancer cells, especially on pancreatic cancer. TP inhibits HSP70 expression leading to cell death in pancreatic cancer cells and induces cell death by apoptotic and autophagic pathways. In order to increase the therapeutic index of TP, a novel intravenous TP-loaded delivery system, TP-loaded lipid emulsion (TP-LE), has been developed to treat solid tumor. In the present study, the preparation and characterization of TP-LE were described. The pharmacokinetics and tissue distribution study of TP-LE in mice were also evaluated. Results demonstrated that TP-LE had an average particle size of 154.6 nm, entrapment efficiency (EE%) of 87%, zeta potential of -0.903 mV and autoclaved stability. The pharmacokinetic study showed that blood concentrations of both TP-LE and TP reached a maximum at the end of intravenous administration (1.25 mg/kg) and declined rapidly within the first 10 min with a mean residence time (MRT) of about 10 min. In the tissue distribution study, a preferential accumulation and longer residence time of drug in pancreas were found in TP-LE. The AUC0-60min of TP-LE in pancreas was 2.19 times in comparison to free TP, suggesting that the use of TP-LE conferred improvements in biodistribution, accumulation and therapeutic efficacy in pancreas. Moreover, the concentrations of TP-LE in heart, lung and kidney were lower than that of the TP group, indicating the potential for reduced toxicity of TP-LE. Together, all the results show that TP-LE appears to be a promising formulation for using TP in treating cancer, and more specifically pancreatic cancer.

The effects of growth and collapse on the magmatic system below Mt Taranaki, New Zealand.

NASA Astrophysics Data System (ADS)

Procter, Jonathan; Marcroft, Grace; Zellmer, Georg; Zernack, Anke

2017-04-01

Mt. Taranaki exhibits one of the best long-term records of volcanic growth and destruction of any volcano worldwide, making it ideal for understanding the long-term effects of changing lithostatic pressure, or loading and unloading, on the magma chamber and magma supply. The ring-plain around Mt. Taranaki houses volcaniclastic deposits that provide a near continuous record of the evolution of the volcano, yet these records have remained relatively unexploited when investigating the interrelated cyclical phases of volcano collapse and growth, the geochemical evolution of the centre, and the consequent time-varying hazard potential. In this study, we systematically sampled pumice-rich tephra and pumice-rich mass flow deposits that were stratigraphically immediately before and after the 24,801 ± 268 years BP Pungarehu Formation debris avalanche ( 7.5 km3). Crystals (clinopyroxene and plagioclase) were characterised in detail. Mg and Fe zoning across selected crystals from samples pre-and post-debris avalanche were found to have completely equilibrated, yet zoning patterns in Al remained intact and showed major differences in their formation, allowing for the calculation of diffusion rates. These have enabled the determination of maximum residence times (depths and pressure regimes) of the magma system. It is intended that this technique will be applied across the stratigraphic record, which contains 14 collapse events. This will provide insights into crustal magma transport and residence times, and the propagation of fissures and the buoyancy of the magma pre- and post-collapse, in order to characterise the evolution of the centre and quantify the long-term relationship between magmatic rise and volcano growth and destruction.

Atlantic Flyway review: Piedmont-Coastal Plain, Region IV, Fall 2001: Robbins Nest, Laurel, MD (390-0765)

USGS Publications Warehouse

Robbins, Chandler S.

2002-01-01

I continue to band before and after work and all day on weekends on my two and a half acres along the Patuxent River gorge between highway 1-95 and the Laurel city limits. Our kids have long since flown the coop, so I have no one to run the station when I am out of town; thus, I miss some of the best flight days. The chief changes in habitat over the years have been replacement of pines by young deciduous growth, loss of dogwoods in the mature deciduous forest, and gradual replacement of lawn by shrubbery. To explore changes in fall migration patterns, I compared my banding totals for the first five years of systematic fall banding with those of the most recent five years. By coincidence the totals were nearly identical: 2175 birds in 1973-1977 and 2169 in 1997-2001. However, my net hour totals were vastly different: 9124 in the first five years compared with 26,284 for the current period. It took nearly 2.9 times the effort to catch the same number of birds I used to band. Next year, my 30th, I'll be checking to see which species I am losing and which are maintaining their numbers.I had 35 returns of a dozen species, but all were either summer, winter, or permanent residents. The oldest this time was only four years old, a Gray Catbird. Eleven transients repeated on a subsequent day. The one longest in residence was a Gray-cheeked Thrush that l captured 10 times in 17 days; it weighed 31.0 g when banded and reached a maximum of 51.7 g 13 days later.

40 CFR 141.602 - System specific studies.

Code of Federal Regulations, 2014 CFR

2014-07-01

... the storage facility with the highest residence time in each pressure zone, and a time series graph of... (a)(2)(ii) of this section, and a 24-hour time series graph of residence time for each subpart V...-compliance results generated during the time period beginning with the first reported result and ending with...

40 CFR 141.602 - System specific studies.

Code of Federal Regulations, 2010 CFR

2010-07-01

... the storage facility with the highest residence time in each pressure zone, and a time series graph of... (a)(2)(ii) of this section, and a 24-hour time series graph of residence time for each subpart V... compliance and non-compliance results generated during the time period beginning with the first reported...

40 CFR 141.602 - System specific studies.

Code of Federal Regulations, 2012 CFR

2012-07-01

... the storage facility with the highest residence time in each pressure zone, and a time series graph of... (a)(2)(ii) of this section, and a 24-hour time series graph of residence time for each subpart V... compliance and non-compliance results generated during the time period beginning with the first reported...

40 CFR 141.602 - System specific studies.

Code of Federal Regulations, 2013 CFR

2013-07-01

... the storage facility with the highest residence time in each pressure zone, and a time series graph of... (a)(2)(ii) of this section, and a 24-hour time series graph of residence time for each subpart V... compliance and non-compliance results generated during the time period beginning with the first reported...

40 CFR 141.602 - System specific studies.

Code of Federal Regulations, 2011 CFR

2011-07-01

... the storage facility with the highest residence time in each pressure zone, and a time series graph of... (a)(2)(ii) of this section, and a 24-hour time series graph of residence time for each subpart V... compliance and non-compliance results generated during the time period beginning with the first reported...

Where Do Ethno-Linguistic Groups Meet? How Copresence during Free-Time Is Related to Copresence at Home and at Work

PubMed Central

Toomet, Ott; Silm, Siiri; Saluveer, Erki; Ahas, Rein; Tammaru, Tiit

2015-01-01

This paper analyzes ethnic segregation across the whole activity space—at place of residence, place of work, and during free-time. We focus on interethnic meeting potential during free-time, measured as copresence, and its relationship to copresence at place of residence and work. The study is based on cellphone data for a medium-sized linguistically divided European city (Tallinn, Estonia), where the Estonian majority and mainly Russian-speaking minority populations are of roughly equal size. The results show that both places of residence and work are segregated, while other activities occur in a far more integrated environment. Copresence during free-time is positively associated with copresence at place of residence and work, however, the relationship is very weak. PMID:25996504

Where Do Ethno-Linguistic Groups Meet? How Copresence during Free-Time Is Related to Copresence at Home and at Work.

PubMed

Toomet, Ott; Silm, Siiri; Saluveer, Erki; Ahas, Rein; Tammaru, Tiit

2015-01-01

This paper analyzes ethnic segregation across the whole activity space-at place of residence, place of work, and during free-time. We focus on interethnic meeting potential during free-time, measured as copresence, and its relationship to copresence at place of residence and work. The study is based on cellphone data for a medium-sized linguistically divided European city (Tallinn, Estonia), where the Estonian majority and mainly Russian-speaking minority populations are of roughly equal size. The results show that both places of residence and work are segregated, while other activities occur in a far more integrated environment. Copresence during free-time is positively associated with copresence at place of residence and work, however, the relationship is very weak.

Burnout, Perceived Stress, and Depression among Cardiology Residents in Argentina

ERIC Educational Resources Information Center

Waldman, Silvina V.; Diez, Juan Cruz Lopez; Arazi, Hernan Cohen; Linetzky, Bruno; Guinjoan, Salvador; Grancelli, Hugo

2009-01-01

Objective: Because medical residency is a stressful time for training physicians, placing residents at increased risk for psychological distress, the authors studied the prevalence of burnout, perceived stress, and depression in cardiology residents in Argentina and examined the association between sociodemographic characteristics and these…

E-Learning and Medical Residents, a Qualitative Perspective

ERIC Educational Resources Information Center

Segerman, Jill; Crable, Elaine; Brodzinski, James

2016-01-01

Medical education helps ensure doctors acquire skills and knowledge needed to care for patients. However, resident duty hour restrictions have impacted the time residents have available for medical education, leaving resident educators searching for alternate options for effective medical education. Classroom situated e-learning, a blended…

Simulations of Ground-Water Flow and Residence Time near Woodbury, Connecticut

USGS Publications Warehouse

Starn, J. Jeffrey; Brown, Craig J.

2007-01-01

Water withdrawn for public use from glacial stratified deposits in Woodbury, Connecticut, is a mixture of water from different source areas, each having a characteristic water-quality signature. The physical processes leading to this mixture were explored using a numerical model to simulate steady-state ground-water source areas and residence times for a public water-supply well (PSW-1) in Woodbury. Upland areas contribute water to the well that is primarily from undeveloped and agricultural land. Valley bottoms contribute water to the well that is primarily from developed land. From 1985 to 2002, 6 percent of the contributing recharge area to the well changed from agricultural and undeveloped to developed land. The pattern of recharge areas and land use causes stratification of ground water by residence time and by characteristic water quality, which is related to land use. As land use changes with time, the water-quality signature of developed land moves deeper into the aquifer. Predicted nitrate concentrations decreased from 1985 to 1995 because of the conversion from agricultural land to developed land, but then began to increase after 1995 because of the conversion of undeveloped land to developed land. Total dissolved solids concentrations, on the other hand, increased from 1985 to 2002 because agriculture is associated with lower total dissolved solids concentrations than is developed land. About 40 percent of the water withdrawn from PSW-1 originated as upland recharge before flowing through glacial deposits in the valley. About 44 percent of the water originated as recharge in either fluvial deposits (mean residence time 7 years) or deltaic deposits (mean residence time 4 years). About 16 percent of the water originated as recharge through storm drains with ground-water discharge (often known as 'dry wells'). The residence time for water that originated as recharge in dry wells is 2 to 4 years, and the mean residence time is 3 years. Dry wells are a fast pathway for water to enter the aquifer and provide a significant amount of water to PSW-1; therefore, PSW-1 is more susceptible to contamination in runoff from the commercial area, which enters the dry wells, than to recharge elsewhere in the area. Water withdrawn from a well is a mixture of waters with different residence times, and a single residence time does not fully characterize the susceptibility of the well to recent contamination. The mean simulated flow-weighted residence time in PSW-1 is 6 years, which compares reasonably well with the apparent residence time measured using tritium/helium data of 6 and 7 years (samples for age dating were collected twice from this well). There are at least two modes to the distribution of ages, one mode with residence times less than 5 years and one mode with residence times greater than 5 years. About 34 percent of the ground-water in PSW-1 is younger than 5 years and 56 percent of the water is from 5 to 9 years. The estimated nitrate loading rate from a single-family septic system is 18 grams per day. If each household in the contributing recharge area contributes nitrate at that loading rate to the well PSW-1, each additional septic system in the contributing recharge area is responsible for a 0.045-milligram-per-liter increase in nitrate at PSW-1 at the current pumping rate. Uncertainty in the predicted contributing recharge area can be propagated through the analysis using a Monte Carlo technique. There is a greater degree of certainty in the delineation of the recharge area near the well, and as one moves from the well toward the recharge areas, the uncertainty in the model increases. The area that possibly contributes water to the well using the Monte Carlo model is much larger than the recharge area delineated using the optimal parameter estimates. Within the probabilistic recharge area, the number of septic systems could be twice the number initially estimated.

Single-site robotic cholecystectomy and robotics training: should we start in the junior years?

PubMed

Ayabe, Reed I; Parrish, Aaron B; Dauphine, Christine E; Hari, Danielle M; Ozao-Choy, Junko J

2018-04-01

It has become increasingly important to expose surgical residents to robotic surgery as its applications continue to expand. Single-site robotic cholecystectomy (SSRC) is an excellent introductory case to robotics. Resident involvement in SSRC is known to be feasible. Here, we sought to determine whether it is safe to introduce SSRC to junior residents. A total of 98 SSRC cases were performed by general surgery residents between August 2015 and August 2016. Cases were divided into groups based on resident level: second- and third-years (juniors) versus fourth- and fifth-years (seniors). Patient age, gender, race, body mass index, and comorbidities were recorded. The number of prior laparoscopic cholecystectomies completed by participating residents was noted. Outcomes including operative time, console time, rate of conversion to open cholecystectomy, and complication rate were compared between groups. Juniors performed 54 SSRC cases, whereas seniors performed 44. There were no significant differences in patient age, gender, race, body mass index, or comorbidities between the two groups. Juniors had less experience with laparoscopic cholecystectomy. There was no significant difference in mean operative time (92.7 min versus 98.0 min, P = 0.254), console time (48.7 min versus 50.8 min, P = 0.639), or complication rate (3.7% versus 2.3%, P = 0.68) between juniors and seniors. SSRC is an excellent way to introduce general surgery residents to robotics. This study shows that with attending supervision, SSRC is feasible and safe for both junior and senior residents with very low complication rates and no adverse effect on operative time. Copyright © 2017 Elsevier Inc. All rights reserved.

Impact of the European Working Time Directive (EWTD) on the operative experience of surgery residents.

PubMed

Hopmans, Cornelis J; den Hoed, Pieter T; van der Laan, Lijckle; van der Harst, Erwin; van der Elst, Maarten; Mannaerts, Guido H H; Dawson, Imro; Timman, Reinier; Wijnhoven, Bas P L; IJzermans, Jan N M

2015-04-01

In Europe and the United States, work hour restrictions are considered to be particularly burdensome for residents in surgery specialties. The aim of this study was to examine whether reduction of the work week to 48 hours resulting from the implementation of the European Working Time Directive has affected the operative experience of surgery residents. This study was conducted in a general surgery training region in the Netherlands, consisting of 1 university hospital and 6 district training hospitals. Operating records summarizing the surgical procedures performed as "primary surgeon" in the operating theater for different grades of surgeons were retrospectively analyzed for the period 2005-2012 by the use of linear regression models. Operative procedures performed by residents were considered the main outcome measure. In total, 235,357 operative procedures were performed, including 47,458 (20.2%) in the university hospital and 187,899 (79.8%) in the district training hospitals (n = 5). For residents in the university hospital, the mean number of operative procedures performed per 1.0 full-time equivalent increased from 128 operations in 2005 to 204 operations in 2012 (P = .001), whereas for residents in district training hospitals, no substantial differences were found over time. The mean (±SD) operative caseload of 64 residents who completed the 6-year training program between 2005 and 2012 was 1,391 ± 226 (range, 768-1856). A comparison of the operative caseload according to year of board-certification showed no difference. Implementation of the European Working Time Directive has not affected adversely the number of surgical procedures performed by residents within a general surgical training region in the Netherlands. Copyright © 2015 Elsevier Inc. All rights reserved.

Impact of Residency Training Level on the Surgical Quality Following General Surgery Procedures.

PubMed

Loiero, Dominik; Slankamenac, Maja; Clavien, Pierre-Alain; Slankamenac, Ksenija

2017-11-01

To investigate the safety of surgical performance by residents of different training level performing common general surgical procedures. Data were consecutively collected from all patients undergoing general surgical procedures such as laparoscopic cholecystectomy, laparoscopic appendectomy, inguinal, femoral and umbilical hernia repair from 2005 to 2011 at the Department of Surgery of the University Hospital of Zurich, Switzerland. The operating surgeons were grouped into junior residents, senior residents and consultants. The comprehensive complication index (CCI) representing the overall number and severity of all postoperative complications served as primary safety endpoint. A multivariable linear regression analysis was used to analyze differences between groups. Additionally, we focused on the impact of senior residents assisting junior residents on postoperative outcome comparing to consultants. During the observed time, 2715 patients underwent a general surgical procedure. In 1114 times, a senior resident operated and in 669 procedures junior residents performed the surgery. The overall postoperative morbidity quantified by the CCI was for consultants 5.0 (SD 10.7), for senior residents 3.5 (8.2) and for junior residents 3.6 (8.3). After adjusting for possible confounders, no difference between groups concerning the postoperative complications was detected. There is also no difference in postoperative complications detectable if junior residents were assisted by consultants then if assisted by senior residents. Patient safety is ensured in general surgery when performed by surgical junior residents. Senior residents are able to adopt the role of the teaching surgeon in charge without compromising patients' safety.

Can changes in psychosocial factors and residency explain the decrease in physical activity during the transition from high school to college or university?

PubMed

Van Dyck, Delfien; De Bourdeaudhuij, Ilse; Deliens, Tom; Deforche, Benedicte

2015-04-01

When students make the transition from high school to college or university, their physical activity (PA) levels decrease strongly. Consequently, it is of crucial importance to identify the determinants of this decline in PA. The study aims were to (1) examine changes in psychosocial factors in students during the transition from high school to college/university, (2) examine if changes in psychosocial factors and residency can predict changes in PA, and (3) investigate the moderating effects of residency on the relationship between changes in psychosocial factors and changes in PA. Between March 2008 and October 2010, 291 Flemish students participated in a longitudinal study, with baseline measurements during the final year of high school and follow-up measurements at the start of second year of college/university. At both time points, participants completed a questionnaire assessing demographics, active transportation, leisure-time sports, psychosocial variables, and residency. Repeated measures MANOVA analyses and multiple moderated hierarchic regression analyses were conducted. Modeling, self-efficacy, competition-related benefits, and health-related, external and social barriers decreased, while health-related benefits and time-related barriers increased from baseline to follow-up. Decreases in modeling and time-related barriers were associated with a decrease in active transportation (adjusted R(2) = 3.2%); residency, decreases in self-efficacy, competition-related benefits, and increases in health- and time-related barriers predicted a decrease in leisure-time sports (adjusted R(2) = 29.3%). Residency only moderated two associations between psychosocial factors and changes in PA. Residency and changes in psychosocial factors were mainly important to explain the decrease in leisure-time sports. Other factors such as distance to college/university are likely more important to explain the decrease in active transportation; these are worth exploring in future studies. Because few interactions were found, similar interventions, focusing on self-efficacy, time management, and increasing perceived benefits may be effective to increase leisure-time sports in all students.

A biofilter for treating toluene vapors: performance evaluation and microbial counts behavior

PubMed Central

Zhu, Yazhong; Luo, Yimeng; Ma, Hongye; Wang, Yan

2016-01-01

A lab-scale biofilter packed with mixed packing materials was used for degradation of toluene. Different empty bed residence times, 148.3, 74.2 and 49.4 s, were tested for inlet concentration ranging from 0.2 to 1.2 g/m3. The maximum elimination capacity of 36.0 g/(m3 h) occurred at an inlet loading rate of 45.9 g/(m3 h). The contribution of the lower layer was higher than other layers and always had the highest elimination capacity. The carbon dioxide production rate and distribution of micro-organisms followed toluene elimination capacities. The results of this study indicated that mixed packing materials could be considered as a potential biofilter carrier, with low pressure drop (less than 84.9 Pa/m), for treating air streams containing VOCs. PMID:27231662

Vertical mercury distributions in the oceans

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

Gill, G.A.; Fitzgerald, W.F.

1988-06-01

The vertical distribution of mercury (Hg) was determined at coastal and open ocean sites in the northwest Atlantic and Pacific Oceans. Reliable and diagnostic Hg distribution were obtained, permitting major processes governing the marine biogeochemistry of Hg to be identified. The northwest Atlantic near Bermuda showed surface water Hg concentrations near 4 pM, a maximum of 10 pM within the main thermocline, and concentrations less than or equal to surface water values below the depth of the maximum. The maximum appears to result from lateral transport of Hg enriched waters from higher latitudes. In the central North Pacific, surface watersmore » (to 940 m) were slightly elevated (1.9 {plus minus} 0.7 pM) compared to deeper waters (1.4 {plus minus} 0.4 pM), but on thermocline Hg maximum was observed. At similar depths, Hg concentrations near Bermuda were elevated compared to the central North Pacific Ocean. The authors hypothesize that the source of this Hg comes from diagenetic reactions in oxic margin sediments, releasing dissolved Hg to overlying water. Geochemical steady-state box modeling arguments predict a relatively short ({approximately}350 years) mean residence time for Hg in the oceans, demonstrating the reactive nature of Hg in seawater and precluding significant involvement in nutrient-type recycling. Mercury's distributional features and reactive nature suggest that interaction of Hg with settling particulate matter and margin sediments play important roles in regulating oceanic Hg concentrations. Oceanic Hg distributions are governed by an external cycling process, in which water column distributions reflect a rapid competition between the magnitude of the input source and the intensity of the (water column) removal process.« less

Analysis of dermoscopy teaching modalities in United States dermatology residency programs

PubMed Central

Chen, Yun An; Rill, Joanne; Seiverling, Elizabeth V.

2017-01-01

The use of dermoscopy in dermatology residency programs is on the rise (over 94% of chief residents reported using a dermatoscope in 2013) [1]. Despite increased use (100% of our surveyed residents reported using a dermatoscope), dermoscopy training is one of the aspects of United States dermatology residency training with the lowest resident satisfaction [2]. Diagnostic accuracy with dermoscopy is highly correlated with the amount of dermoscopy training the user has undertaken [3]. We sought to analyze dermoscopy use in US Dermatology residencies to better understand resident dermoscopy utilization and teaching modalities. We found residents learn dermoscopy via multiple teaching modalities. The most commonly reported dermoscopy teaching modality was didactic lectures, followed by time in clinic with a dermoscopy expert. Of the different teaching modalities, time in the clinic with a dermoscopy expert was reported to be the most effective. We also found that the majority of dermatology residents receive didactic dermoscopy lectures and clinical dermoscopy training on the differentiation of benign nevi from melanoma using dermoscopy, the detection of basal cell carcinoma, and the identification of seborrheic keratosis. However, few residents receive dedicated training on the use of dermoscopy in the evaluation of inflammatory dermatoses and skin infections despite dermoscopy’s demonstrated value in both areas [4–7]. PMID:29085718

The Accreditation Council for Graduate Medical Education resident duty hour new standards: history, changes, and impact on staffing of intensive care units.

PubMed

Pastores, Stephen M; O'Connor, Michael F; Kleinpell, Ruth M; Napolitano, Lena; Ward, Nicholas; Bailey, Heatherlee; Mollenkopf, Fred P; Coopersmith, Craig M

2011-11-01

The Accreditation Council for Graduate Medical Education recently released new standards for supervision and duty hours for residency programs. These new standards, which will affect over 100,000 residents, take effect in July 2011. In response to these new guidelines, the Society of Critical Care Medicine convened a task force to develop a white paper on the impact of changes in resident duty hours on the critical care workforce and staffing of intensive care units. A multidisciplinary group of professionals with expertise in critical care education and clinical practice. Relevant medical literature was accessed through a systematic MEDLINE search and by requesting references from all task force members. Material published by the Accreditation Council for Graduate Medical Education and other specialty organizations was also reviewed. Collaboratively and iteratively, the task force corresponded by electronic mail and held several conference calls to finalize this report. The new rules mandate that all first-year residents work no more than 16 hrs continuously, preserving the 80-hr limit on the resident workweek and 10-hr period between duty periods. More senior trainees may work a maximum of 24 hrs continuously, with an additional 4 hrs permitted for handoffs. Strategic napping is strongly suggested for trainees working longer shifts. Compliance with the new Accreditation Council for Graduate Medical Education duty-hour standards will compel workflow restructuring in intensive care units, which depend on residents to provide a substantial portion of care. Potential solutions include expanded utilization of nurse practitioners and physician assistants, telemedicine, offering critical care training positions to emergency medicine residents, and partnerships with hospitalists. Additional research will be necessary to evaluate the impact of the new standards on patient safety, continuity of care, resident learning, and staffing in the intensive care unit.

Geo-mapping of time trends in childhood caries risk--a method for assessment of preventive care.

PubMed

Strömberg, Ulf; Holmn, Anders; Magnusson, Kerstin; Twetman, Svante

2012-06-11

Dental caries is unevenly distributed within populations with a higher burden in low socio-economy groups. Several attempts have been made to allocate resources to those that need them the most; there is a need for convenient approaches to population-based monitoring of caries risk over time. The aim of this study was to develop the geo-map concept, addressing time trends in caries risk, and demonstrate the novel approach by analyzing epidemiological data from preschool residents in the region of Halland, Sweden. The study population consisted of 9,973 (2006) and 10,927 (2010) children between 3 to 6 years of age (~77% of the eligible population) from whom caries data were obtained. Reported dmfs>0 for a child was considered as the primary caries outcome. Each study individual was geo-coded with respect to his/her residence parish (66 parishes in the region). Smoothed caries risk geo-maps, along with corresponding statistical certainty geo-maps, were produced by using the free software Rapid Inquiry Facility and the ESRI® ArcGIS system. Parish-level socioeconomic data were available. The overall proportion of caries-free (dmfs=0) children improved from 84.0% in 2006 to 88.6% in 2010. The ratio of maximum and minimum (parish-level) smoothed relative risks (SmRRs) increased from 1.76/0.44=4.0 in 2006 to 2.37/0.33=7.2 in 2010, which indicated an increased geographical polarization of early childhood caries in the population. Eight parishes showed evidential, positional changes in caries risk between 2006 and 2010; their corresponding SmRRs and statistical certainty ranks changed markedly. No considerable parallel changes in parish-level socioeconomic characteristics were seen during the same time period. Geo-maps based on caries risk can be used to monitor changes in caries risk over time. Thus, geo-mapping offers a convenient tool for evaluating the effectiveness of tailored health promotion and preventive care in child populations.

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.

Resident Participation in Fixation of Intertrochanteric Hip Fractures: Analysis of the NSQIP Database.

PubMed

Neuwirth, Alexander L; Stitzlein, Russell N; Neuwirth, Madalyn G; Kelz, Rachel K; Mehta, Samir

2018-01-17

Future generations of orthopaedic surgeons must continue to be trained in the surgical management of hip fractures. This study assesses the effect of resident participation on outcomes for the treatment of intertrochanteric hip fractures. The National Surgical Quality Improvement Program (NSQIP) database (2010 to 2013) was queried for intertrochanteric hip fractures (International Classification of Diseases, 9th Revision, Clinical Modification [ICD-9-CM] code 820.21) treated with either extramedullary (Current Procedural Terminology [CPT] code 27244) or intramedullary (CPT code 27245) fixation. Demographic variables, including resident participation, as well as primary (death and serious morbidity) and secondary outcome variables were extracted for analysis. Univariate, propensity score-matched, and multivariate logistic regression analyses were performed to evaluate outcome variables. Data on resident participation were available for 1,764 cases (21.0%). Univariate analyses for all intertrochanteric hip fractures demonstrated no significant difference in 30-day mortality (6.3% versus 7.8%; p = 0.264) or serious morbidity (44.9% versus 43.2%; p = 0.506) between the groups with and without resident participation. Multivariate and propensity score-matched analyses gave similar results. Resident involvement was associated with prolonged operating-room time, length of stay, and time to discharge when a prolonged case was defined as one above the 90th percentile for time parameters. Resident participation was not associated with an increase in morbidity or mortality but was associated with an increase in time-related secondary outcome measures. While attending surgeon supervision is necessary, residents can and should be involved in the care of these patients without concern that resident involvement negatively impacts perioperative morbidity and mortality. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Career goals and expectations of men and women pharmacy residents.

PubMed

King, C M; Oliver, E J; Jeffrey, L P

1982-11-01

Personal and professional characteristics of men and women hospital pharmacy residents were studied to identify differences that could affect future hospital pharmacy practice. Residents in 111 ASHP-accredited pharmacy residency programs received a survey containing questions on demographic information, reasons for selecting a residency, areas of professional interest, postresidency career goals, responsibilities to home and family, and advantages and disadvantages associated with gender. Of 286 residents receiving questionnaires, 226 responded; the percentages of men and women responding corresponded to the ratio of men and women in hospital pharmacy residencies. While men and women expressed educational goals that were not significantly different, more men than women had earned or were in the process of earning advanced degrees. No significant differences were evident between men's and women's plans for marriage and children, but 73% of the women indicated that they would take time out from their practice to raise children, compared with only 9% of the men. The majority of residents did not think their gender affected them in their residency programs, but in professional interactions more men saw gender as an advantage and more women as a disadvantage. Significantly more than women aspired to be hospital pharmacy directors. The results suggest that men are obtaining advanced training closer to the time they graduate from pharmacy school and that in the future women competing for promotions may be older than men competing for comparable positions. Those planning pharmacy staffing should consider the needs of women, and men, who expect to take time out from their careers for family responsibilities and possibly seek part-time positions when they return to the work force.

The Milestones Passport: A Learner-Centered Application of the Milestone Framework to Prompt Real-Time Feedback in the Emergency Department.

PubMed

Yarris, Lalena M; Jones, David; Kornegay, Joshua G; Hansen, Matthew

2014-09-01

In July 2013, emergency medicine residency programs implemented the Milestone assessment as part of the Next Accreditation System. We hypothesized that applying the Milestone framework to real-time feedback in the emergency department (ED) could affect current feedback processes and culture. We describe the development and implementation of a Milestone-based, learner-centered intervention designed to prompt real-time feedback in the ED. We developed and implemented the Milestones Passport, a feedback intervention incorporating subcompetencies, in our residency program in July 2013. Our primary outcomes were feasibility, including faculty and staff time and costs, number of documented feedback encounters in the first 2 months of implementation, and user-reported time required to complete the intervention. We also assessed learner and faculty acceptability. Development and implementation of the Milestones Passport required 10 hours of program coordinator time, 120 hours of software developer time, and 20 hours of faculty time. Twenty-eight residents and 34 faculty members generated 257 Milestones Passport feedback encounters. Most residents and faculty reported that the encounters required fewer than 5 minutes to complete, and 48% (12 of 25) of the residents and 68% (19 of 28) of faculty reported satisfaction with the Milestones Passport intervention. Faculty satisfaction with overall feedback in the ED improved after the intervention (93% versus 54%, P  =  .003), whereas resident satisfaction with feedback did not change significantly. The Milestones Passport feedback intervention was feasible and acceptable to users; however, learner satisfaction with the Milestone assessment in the ED was modest.

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.

Factors that determine academic versus private practice career interest in radiation oncology residents in the United States: results of a nationwide survey.

PubMed

Chang, Daniel T; Shaffer, Jenny L; Haffty, Bruce G; Wilson, Lynn D

2013-11-01

To determine what factors US radiation oncology residents consider when choosing academic or nonacademic careers. A 20-question online survey was developed and sent to all US radiation oncology residents to assess factors that influence their career interest. Residents were asked to rate their interest in academics (A) versus private practice (PP) on a 0 (strong interest in A) to 100 (strong interest in PP) scale. Responses were classified as A (0-30), undecided (40-60), and PP (70-100). Residents were also asked to rank 10 factors that most strongly influenced their career interest. Three hundred thirty-one responses were collected, of which 264 were complete and form the basis for this analysis. Factors that correlated with interest in A included having a PhD (P=.018), postgraduate year level (P=.0006), research elective time (P=.0003), obtaining grant funding during residency (P=.012), and number of publications before residency (P=.0001), but not number of abstracts accepted in the past year (P=.65) or publications during residency (P=.67). The 3 most influential factors for residents interested in A were: (1) baseline interest before residency; (2) academic role models; and (3) research opportunities during residency. The 3 most influential factors for residents interested in PP were: (1) baseline interest before residency; (2) academic role models; and (3) academic pressure and obligations. Interest in A correlated with postgraduate year level, degree, and research time during residency. Publications before but not during residency correlated with academic interest, and baseline interest was the most influential factor. These data can be used by residency program directors to better understand what influences residents' career interest. Copyright © 2013 Elsevier Inc. All rights reserved.

Factors that Determine Academic Versus Private Practice Career Interest in Radiation Oncology Residents in the United States: Results of a Nationwide Survey

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

Chang, Daniel T., E-mail: dtchang@stanford.edu; Shaffer, Jenny L.; Haffty, Bruce G.

Purpose: To determine what factors US radiation oncology residents consider when choosing academic or nonacademic careers. Methods and Materials: A 20-question online survey was developed and sent to all US radiation oncology residents to assess factors that influence their career interest. Residents were asked to rate their interest in academics (A) versus private practice (PP) on a 0 (strong interest in A) to 100 (strong interest in PP) scale. Responses were classified as A (0-30), undecided (40-60), and PP (70-100). Residents were also asked to rank 10 factors that most strongly influenced their career interest. Results: Three hundred thirty-one responsesmore » were collected, of which 264 were complete and form the basis for this analysis. Factors that correlated with interest in A included having a PhD (P=.018), postgraduate year level (P=.0006), research elective time (P=.0003), obtaining grant funding during residency (P=.012), and number of publications before residency (P=.0001), but not number of abstracts accepted in the past year (P=.65) or publications during residency (P=.67). The 3 most influential factors for residents interested in A were: (1) baseline interest before residency; (2) academic role models; and (3) research opportunities during residency. The 3 most influential factors for residents interested in PP were: (1) baseline interest before residency; (2) academic role models; and (3) academic pressure and obligations. Conclusions: Interest in A correlated with postgraduate year level, degree, and research time during residency. Publications before but not during residency correlated with academic interest, and baseline interest was the most influential factor. These data can be used by residency program directors to better understand what influences residents' career interest.« less

Patient-Centered Handovers: Ethnographic Observations of Attending and Resident Physicians: Ethnographic Observations of Attending and Resident Physicians.

PubMed

Mount-Campbell, Austin F; Rayo, Michael F; OʼBrien, James J; Allen, Theodore T; Patterson, Emily S

Handover communication improvement initiatives typically employ a "one size fits all" approach. A human factors perspective has the potential to guide how to tailor interventions to roles, levels of experience, settings, and types of patients. We conducted ethnographic observations of sign-outs by attending and resident physicians in 2 medical intensive care units at one institution. Digitally audiotaped data were manually analyzed for content using codes and time spent using box plots for emergent categories. A total of 34 attending and 58 resident physician handovers were observed. Resident physicians spent more time for "soon to be discharged" and "higher concern" patients than attending physicians. Resident physicians spent less time discussing patients which they had provided care for within the last 3 days ("handbacks"). The study suggested differences for how handovers were conducted for attending and resident physicians for 3 categories of patients; handovers differ on the basis of role or level of expertise, patient type, and amount of prior knowledge of the patient. The findings have implications for new directions for subsequent research and for how to tailor quality improvement interventions based upon the role, level of experience, level of prior knowledge, and patient categories.

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

The role of riparian vegetation density, channel orientation and water velocity in determining river temperature dynamics

NASA Astrophysics Data System (ADS)

Garner, Grace; Malcolm, Iain A.; Sadler, Jonathan P.; Hannah, David M.

2017-10-01

A simulation experiment was used to understand the importance of riparian vegetation density, channel orientation and flow velocity for stream energy budgets and river temperature dynamics. Water temperature and meteorological observations were obtained in addition to hemispherical photographs along a ∼1 km reach of the Girnock Burn, a tributary of the Aberdeenshire Dee, Scotland. Data from nine hemispherical images (representing different uniform canopy density scenarios) were used to parameterise a deterministic net radiation model and simulate radiative fluxes. For each vegetation scenario, the effects of eight channel orientations were investigated by changing the position of north at 45° intervals in each hemispheric image. Simulated radiative fluxes and observed turbulent fluxes drove a high-resolution water temperature model of the reach. Simulations were performed under low and high water velocity scenarios. Both velocity scenarios yielded decreases in mean (≥1.6 °C) and maximum (≥3.0 °C) temperature as canopy density increased. Slow-flowing water resided longer within the reach, which enhanced heat accumulation and dissipation, and drove higher maximum and lower minimum temperatures. Intermediate levels of shade produced highly variable energy flux and water temperature dynamics depending on the channel orientation and thus the time of day when the channel was shaded. We demonstrate that in many reaches relatively sparse but strategically located vegetation could produce substantial reductions in maximum temperature and suggest that these criteria are used to inform future river management.

[Modern didactics in surgical education--between demand and reality].

PubMed

Pape-Köhler, C; Chmelik, C; Rose, M; Heiss, M M

2010-12-01

Surgical residency contains an inadequate amount of hands-on training in the operating room and time constraints further make this type of education on the floor unlikely. Due to these deficits in residency training, private surgical courses outside of the established residency programmes are in high demand. Therefore, surgical residents must spend their own resources and time in addition to their residency training in order to receive adequate clinical exposure. Didactic approaches like problem-based learning have begun to influence our modern education. These novel education approaches along with visualisation training, video-based presentations, and multimedia-based training can be useful adjuncts to traditional surgical training. © Georg Thieme Verlag Stuttgart ˙ New York.

Residents' Perceptions of Classroom Situated E-Learning for Medical Education

ERIC Educational Resources Information Center

Segerman, Jill

2013-01-01

Medical education helps ensure doctors acquire skills and knowledge needed to care for patients. However, resident duty hour restrictions have impacted time residents have for medical education, leaving resident educators searching for innovative options for effective medical education. Classroom situated e-learning, a blended learning delivery…

Trends in violence education in family medicine residency curricula.

PubMed

Cronholm, Peter F; Singh, Vijay; Fogarty, Colleen T; Ambuel, Bruce

2014-09-01

Violence is a significant public health issue with far-reaching implications for the health of individuals and their communities. Our objective was to describe trends in violence-related training in family medicine residency programs since the last national survey was conducted in 1997. Surveys were sent to 337 US family medicine residency programs with the program director having active Society of Teachers of Family Medicine (STFM) membership. Measures included residency setting and characteristics, violence-related curricular content, teaching techniques and personnel, timing of content, and impact of changes in Residency Review Committee (RRC) and Accreditation Council for Graduate Medical Education (ACGME) requirements. Descriptive statistics and bivariate analyses comparing measures across time were used. A total of 201 (60%) surveys were completed. The most common violence curricula was child (83%) and elder abuse (76%), and the most common teachers of violence-related content were family physicians, psychologists, and social workers. The most common teaching methods were clinical precepting (94%), lectures (90%), case vignettes (71%), and intimate partner violence (IPV) shelter experiences (67%). ACGME and RRC changes were not reflected in self-reported measures of curricular emphasis or time. Violence curricular content and number of hours has been constant in family medicine residencies over time. An increase in the reported use of active learning strategies was identified as a trend across surveys. Next steps for violence curricula involve assessment of residents' competency to identify and intervene in violence.

High School Students Residing in Educational Public Institutions: Health-Risk Behaviors

PubMed Central

Silveira, Nusa de Almeida; Noll, Matias; Barros, Patrícia de Sá

2016-01-01

Although several health-risk behaviors of adolescents have been described in the literature, data of high school students who reside at educational institutions in developing countries are scarce. This study aimed to describe behaviors associated with health risks among high school students who reside at an educational public institution and to associate these variables with the length of stay at the institution. This cross-sectional study was conducted during the year 2015 and included 122 students aged 14–19 years at a federal educational institution in the Midwest of Brazil; students were divided into residents of <8 months and those of >20 months. Information concerning the family socioeconomic status and anthropometric, dietary and behavioral profiles was investigated. Despite being physically active, students exhibited risk-associated behaviors such as cigarette and alcohol use and risky sexual behaviors that were exacerbated by fragile socioeconomic conditions and distance from family. A longer time in residence at the institution was associated with an older age (p ≤ 0.001), adequate body mass index (BMI; p = 0.02), nutritional knowledge (p = 0.01), and less doses of alcohol consumption (p ≤ 0.01) compared with those with shorter times in residence. In conclusion, the students exhibited different health-risk behaviors, and a longer institutional residence time, compared with a shorter time, was found to associate with the reduction of health-risk behaviors. PMID:27560808

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.

78 FR 59743 - Bureau of Consular Affairs; Registration for the Diversity Immigrant (DV-2015) Visa Program

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-27

... already a U.S. citizen or a Lawful Permanent Resident, but you will not be penalized if you do. Group... specifications: Image File Format: The miage must be in the Joint Photographic Experts Group (JPEG) format. Image... in the Joint Photographic Experts Group (JPEG) format. Image File Size: The maximum image file size...

The extended Price equation quantifies species selection on mammalian body size across the Palaeocene/Eocene Thermal Maximum.

PubMed

Rankin, Brian D; Fox, Jeremy W; Barrón-Ortiz, Christian R; Chew, Amy E; Holroyd, Patricia A; Ludtke, Joshua A; Yang, Xingkai; Theodor, Jessica M

2015-08-07

Species selection, covariation of species' traits with their net diversification rates, is an important component of macroevolution. Most studies have relied on indirect evidence for its operation and have not quantified its strength relative to other macroevolutionary forces. We use an extension of the Price equation to quantify the mechanisms of body size macroevolution in mammals from the latest Palaeocene and earliest Eocene of the Bighorn and Clarks Fork Basins of Wyoming. Dwarfing of mammalian taxa across the Palaeocene/Eocene Thermal Maximum (PETM), an intense, brief warming event that occurred at approximately 56 Ma, has been suggested to reflect anagenetic change and the immigration of small bodied-mammals, but might also be attributable to species selection. Using previously reconstructed ancestor-descendant relationships, we partitioned change in mean mammalian body size into three distinct mechanisms: species selection operating on resident mammals, anagenetic change within resident mammalian lineages and change due to immigrants. The remarkable decrease in mean body size across the warming event occurred through anagenetic change and immigration. Species selection also was strong across the PETM but, intriguingly, favoured larger-bodied species, implying some unknown mechanism(s) by which warming events affect macroevolution. © 2015 The Author(s).

Modelling of carrying capacity in National Park - Fru\\vska Gora (Serbia) case study

NASA Astrophysics Data System (ADS)

Vujko, Aleksandra; Plavša, Jovan; Petrović, Marko D.; Radovanović, Milan; Gajić, Tamara

2017-03-01

Negative effects of tourism development in a destination are usually the consequence of the high concentration of tourists, accommodation facilities and the activities that are practiced in a relatively restricted area. One of the most important measures to protect the areas is to calculate the maximum number of tourists that can simultaneously reside in a region, i.e. the determination of the carrying capacity. This paper outlines a method for determining carrying capacity based on zoning of environmental resources and zoning within a region. The paper argues for a return to the idea of identifying maximum appropriate number of users. The main hypothesis of the paper is based on the statement that the development of tourism in Fru\\vska Gora (Mountain) National Park in Northern Serbia must be in accordance with the basic principles of sustainability, including the determination of carrying capacity. The main research goal was to show the opinion of local residents about the uncontrolled development of tourism, and to determine the carrying capacity in four sports and recreational zones of the mountain. The carrying capacity of the area is calculated by Lavery and Stanev formulas.

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.

Effects of Fuel Preheat on Soot Formation in Microgravity Laminar Diffusion Flames

NASA Technical Reports Server (NTRS)

Konsur, Bogdan; Megaridis, Constantine M.; Griffin, DeVon W.

1997-01-01

Nonbuoyant flames offer themselves as an attractive and promising platform to gain a better understanding of soot mechanisms. The effects of buoyancy can be eliminated temporarily in drop towers which sustain brief intervals of reduced gravity-typically lower than 10(exp -3)g- extending up to several seconds at a time. Microgravity facilities have been employed to show that nonbuoyant flames are longer, wider and sootier than their normal-gravity counterparts. Sunderland et al. recently verified the existence of smoke point in laminar nonbuoyant flames. As reported, microgravity flames operating above their smoke point displayed a blunt tip and much broader soot-containing regimes in comparison to their buoyant counterparts. Mortazavi et al. established that residence times in microgravity laminar jet diffusion flames with Re=0(100) tend to be proportional to burner diameter and inversely proportional to burner exit velocity. This offers the capability to alter residence times in nonbuoyant laminar jet diffusion flames when varying the burner exit diameters and velocities. Megaridis et al. presented a quantitative definition of the soot-field structure within laminar microgravity jet diffusion flames which operated well above their smoke point. The experimental methodology involved a full-field laser-light extinction technique and jet diffusion flames of nitrogen-diluted (50% vol.) acetylene fuel burning in quiescent air at atmospheric pressure. The work was conducted at the 2.2s drop tower of the NASA Lewis Research Center (NASA-LeRC). Parallel work on 1-g flames was also presented in (6) to facilitate comparisons on the effect of gravity on the soot fields. As reported, the soot spatial distributions in 0-g flames did not change in a detectable manner after 1s within a typical 2.2s experiment. During that period, the soot field was shown to sustain a pronounced annular structure throughout the luminous nonbuoyant-flame zone. The maximum soot volume fraction measured at 0-g was nearly a factor of two higher than that at 1-g, thus confirming the enhanced sooting tendency of nonbuoyant flames. Greenberg and Ku presented a similar study and reported trends that matched those of for the 50% (vol.) nitrogen-diluted acetylene fuel. Furthermore, they examined pure acetylene flames and reported similar trends with respect to the influence of gravity on maximum soot volume fractions and flame cross-section-averaged soot loadings. Both studies clearly demonstrated the improved spatial resolution of microgravity flames compared to their normal-gravity counterparts. The current study evaluates the influence of moderate fuel preheat on soot formation within 0-g laminar gas jet diffusion flames. While fuel temperature variations have little influence on residence times in 1-g, they have a much more significant effect in 0-g. The primary objective of this program is to quantify this effect and its consequences on sooting by comparing soot volume fraction distributions under preheated and unpreheated-fuel conditions. Furthermore, the current work aims at expanding the limited soot database available for nonbuoyant flames. Soot fields in such flames can be used to perform additional tests of recently developed soot sub-models which have the potential to become powerful predicting tools in combustion design.

Expansion of a residency program through provision of second-shift decentralized services.

PubMed

Host, Brian D; Anderson, Michael J; Lucas, Paul D

2014-12-15

The rationale for and logistics of the expansion of a postgraduate year 1 (PGY1) residency program in a community hospital are described. Baptist Health Lexington, a nonprofit community hospital in Lexington, Kentucky, sought to expand the PGY1 program by having residents perform second-shift decentralized pharmacist functions. Program expansion was predicated on aligning resident staffing functions with current hospitalwide initiatives involving medication reconciliation and patient education. The focus was to integrate residents into the workflow while allowing them more time to practice as pharmacists and contribute to departmental objectives. The staffing function would increase residents' overall knowledge of departmental operations and foster their sense of independence and ownership. The decentralized functions would include initiation of clinical pharmacokinetic consultations, admission medication reconciliation, discharge teaching for patients with heart failure, and order-entry support from decentralized locations. The program grew from three to five residents and established a staffing rotation for second-shift decentralized coverage. The increased time spent staffing did not detract from the time allotted to previously established learning experiences and enhanced overall continuity of the staffing experience. The change also emphasized to the residents the importance of integration of distributive and clinical functions within the department. Pharmacist participation in admission and discharge medication reconciliation activities has also increased patient satisfaction, evidenced by follow-up surveys conducted by the hospital. A PGY1 residency program was expanded through the provision of second-shift decentralized clinical services, which helped provide residents with increased patient exposure and enhanced staffing experience. Copyright © 2014 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Effectiveness of Resident Physicians as Triage Liaison Providers in an Academic Emergency Department.

PubMed

Weston, Victoria; Jain, Sushil K; Gottlieb, Michael; Aldeen, Amer; Gravenor, Stephanie; Schmidt, Michael J; Malik, Sanjeev

2017-06-01

Emergency department (ED) crowding is associated with detrimental effects on ED quality of care. Triage liaison providers (TLP) have been used to mitigate the effects of crowding. Prior studies have evaluated attending physicians and advanced practice providers as TLPs, with limited data evaluating resident physicians as TLPs. This study compares operational performance outcomes between resident and attending physicians as TLPs. This retrospective cohort study compared aggregate operational performance at an urban, academic ED during pre- and post-TLP periods. The primary outcome was defined as cost-effectiveness based upon return on investment (ROI). Secondary outcomes were defined as differences in median ED length of stay (LOS), median door-to-provider (DTP) time, proportion of left without being seen (LWBS), and proportion of "very good" overall patient satisfaction scores. Annual profit generated for physician-based collections through LWBS capture (after deducting respective salary costs) equated to a gain (ROI: 54%) for resident TLPs and a loss (ROI: -31%) for attending TLPs. Accounting for hospital-based collections made both profitable, with gains for resident TLPs (ROI: 317%) and for attending TLPs (ROI: 86%). Median DTP time for resident TLPs was significantly lower (p<0.0001) than attending or historical control. Proportion of "very good" patient satisfaction scores and LWBS was improved for both resident and attending TLPs over historical control. Overall median LOS was not significantly different. Resident and attending TLPs improved DTP time, patient satisfaction, and LWBS rates. Both resident and attending TLPs are cost effective, with residents having a more favorable financial profile.

Assessing Technical Performance and Determining the Learning Curve in Cleft Palate Surgery Using a High-Fidelity Cleft Palate Simulator.

PubMed

Podolsky, Dale J; Fisher, David M; Wong Riff, Karen W; Szasz, Peter; Looi, Thomas; Drake, James M; Forrest, Christopher R

2018-06-01

This study assessed technical performance in cleft palate repair using a newly developed assessment tool and high-fidelity cleft palate simulator through a longitudinal simulation training exercise. Three residents performed five and one resident performed nine consecutive endoscopically recorded cleft palate repairs using a cleft palate simulator. Two fellows in pediatric plastic surgery and two expert cleft surgeons also performed recorded simulated repairs. The Cleft Palate Objective Structured Assessment of Technical Skill (CLOSATS) and end-product scales were developed to assess performance. Two blinded cleft surgeons assessed the recordings and the final repairs using the CLOSATS, end-product scale, and a previously developed global rating scale. The average procedure-specific (CLOSATS), global rating, and end-product scores increased logarithmically after each successive simulation session for the residents. Reliability of the CLOSATS (average item intraclass correlation coefficient (ICC), 0.85 ± 0.093) and global ratings (average item ICC, 0.91 ± 0.02) among the raters was high. Reliability of the end-product assessments was lower (average item ICC, 0.66 ± 0.15). Standard setting linear regression using an overall cutoff score of 7 of 10 corresponded to a pass score for the CLOSATS and the global score of 44 (maximum, 60) and 23 (maximum, 30), respectively. Using logarithmic best-fit curves, 6.3 simulation sessions are required to reach the minimum standard. A high-fidelity cleft palate simulator has been developed that improves technical performance in cleft palate repair. The simulator and technical assessment scores can be used to determine performance before operating on patients.

The RA Role Revisited: Differences in Perspectives of RA Responsibilities.

ERIC Educational Resources Information Center

Schuh, John H.; And Others

1982-01-01

Determined resident assistants' (RA) role perceptions of students, parents, faculty, and administrators, full-time professional residence life staff, and resident assistants. Compared various constituent groups' perceptions of the RA role. (RC)

Enhancing dermatology education: resident presentation opportunities.

PubMed

Park, Kelly K

2015-09-01

Dermatology residency is a time to maximize educational experiences, which include opportunities to attend academic meetings and present research and clinical cases. In this article, resident presentation opportunities at major academic dermatology meetings are reviewed.

Residence and Migration of First-Time Freshmen Enrolled in Higher Education Institutions: Fall 1992. E.D. TABS.

ERIC Educational Resources Information Center

Korb, Roslyn

This report presents 10 tables of data on the residence and migration of first-time college freshmen in the fall of 1992 using data from the residency portion of the "Fall Enrollment" survey of the Integrated Postsecondary Education Data System (IPEDS). The data are presented by state, by control and level of institution, for all…

Simulation in Canadian postgraduate emergency medicine training - a national survey.

PubMed

Russell, Evan; Hall, Andrew Koch; Hagel, Carly; Petrosoniak, Andrew; Dagnone, Jeffrey Damon; Howes, Daniel

2018-01-01

Simulation-based education (SBE) is an important training strategy in emergency medicine (EM) postgraduate programs. This study sought to characterize the use of simulation in FRCPC-EM residency programs across Canada. A national survey was administered to residents and knowledgeable program representatives (PRs) at all Canadian FRCPC-EM programs. Survey question themes included simulation program characteristics, the frequency of resident participation, the location and administration of SBE, institutional barriers, interprofessional involvement, content, assessment strategies, and attitudes about SBE. Resident and PR response rates were 63% (203/321) and 100% (16/16), respectively. Residents reported a median of 20 (range 0-150) hours of annual simulation training, with 52% of residents indicating that the time dedicated to simulation training met their needs. PRs reported the frequency of SBE sessions ranging from weekly to every 6 months, with 15 (94%) programs having an established simulation curriculum. Two (13%) of the programs used simulation for resident assessment, although 15 (94%) of PRs indicated that they would be comfortable with simulation-based assessment. The most common PR-identified barriers to administering simulation were a lack of protected faculty time (75%) and a lack of faculty experience with simulation (56%). Interprofessional involvement in simulation was strongly valued by both residents and PRs. SBE is frequently used by Canadian FRCPC-EM residency programs. However, there exists considerable variability in the structure, frequency, and timing of simulation-based activities. As programs transition to competency-based medical education, national organizations and collaborations should consider the variability in how SBE is administered.

Learnings From the Pilot Implementation of Mobile Medical Milestones Application.

PubMed

Page, Cristen P; Reid, Alfred; Coe, Catherine L; Carlough, Martha; Rosenbaum, Daryl; Beste, Janalynn; Fagan, Blake; Steinbacher, Erika; Jones, Geoffrey; Newton, Warren P

2016-10-01

Implementation of the educational milestones benefits from mobile technology that facilitates ready assessments in the clinical environment. We developed a point-of-care resident evaluation tool, the Mobile Medical Milestones Application (M3App), and piloted it in 8 North Carolina family medicine residency programs. We sought to examine variations we found in the use of the tool across programs and explored the experiences of program directors, faculty, and residents to better understand the perceived benefits and challenges of implementing the new tool. Residents and faculty completed presurveys and postsurveys about the tool and the evaluation process in their program. Program directors were interviewed individually. Interviews and open-ended survey responses were analyzed and coded using the constant comparative method, and responses were tabulated under themes. Common perceptions included increased data collection, enhanced efficiency, and increased perceived quality of the information gathered with the M3App. Residents appreciated the timely, high-quality feedback they received. Faculty reported becoming more comfortable with the tool over time, and a more favorable evaluation of the tool was associated with higher utilization. Program directors reported improvements in faculty knowledge of the milestones and resident satisfaction with feedback. Faculty and residents credited the M3App with improving the quality and efficiency of resident feedback. Residents appreciated the frequency, proximity, and specificity of feedback, and faculty reported the app improved their familiarity with the milestones. Implementation challenges included lack of a physician champion and competing demands on faculty time.

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.

Resident Autonomy in the Operating Room: How Faculty Assess Real-time Entrustability.

PubMed

Chen, Xiaodong Phoenix; Sullivan, Amy M; Smink, Douglas S; Alseidi, Adnan; Bengtson, Joan M; Kwakye, Gifty; Dalrymple, John L

2018-02-20

This study aimed to identify the empirical processes and evidence that expert surgical teachers use to determine whether to take over certain steps or entrust the resident with autonomy to proceed during an operation. Assessing real-time entrustability is inherent in attending surgeons' determinations of residents' intraoperative autonomy in the operating room. To promote residents' autonomy, it is necessary to understand how attending surgeons evaluate residents' performance and support opportunities for independent practice based on the assessment of their entrustability. We conducted qualitative semi-structured interviews with 43 expert surgical teachers from 21 institutions across 4 regions of the United States, using purposeful and snowball sampling. Participants represented a range of program types, program size, and clinical expertise. We applied the Framework Method of content analysis to iteratively analyze interview transcripts and identify emergent themes. We identified a 3-phase process used by most expert surgical teachers in determining whether to take over intraoperatively or entrust the resident to proceed, including 1) monitoring performance and "red flags," 2) assessing entrustability, and 3) granting autonomy. Factors associated with individual surgeons (eg, level of comfort, experience, leadership role) and the context (eg, patient safety, case, and time) influenced expert surgical teachers' determinations of entrustability and residents' final autonomy. Expert surgical teachers' 3-phase process of decisions on take-over provides a potential framework that may help surgeons identify appropriate opportunities to develop residents' progressive autonomy by engaging the resident in the determination of entrustability before deciding to take over.

Needs assessment of Wisconsin primary care residents and faculty regarding interest in global health training

PubMed Central

Bauer, Terese A; Sanders, James

2009-01-01

Background The primary objectives of this study were to assess Wisconsin's primary care residents' attitudes toward international health training, the interest among faculty to provide IH training, and the preferred modality of IH training. Methods Surveys were administered using 505 residents and 413 medical faculty in primary care residencies in Wisconsin. Results from 128 residents and 118 medical school faculty members were collected during the spring of 2007 and analyzed. Results In total, 25% of residents (128/505) and 28% of faculty (118/413) responded to the survey. A majority of residents (58%) and faculty (63%) were interested in global health issues. Among residents, 63% planned on spending professional time working abroad. Few residents (9%) and faculty (11%) assess their residencies as preparing residents well to address topics relating to international health. The survey indicates that adequate faculty in Wisconsin could provide mentorship in international health as 47% (55) of faculty had experience working as a physician internationally, 49% (58) of faculty spend more than 25% clinical time caring for patient from underserved communities and 39% (46) would be willing to be involved with developing curriculum, lecturing and/or mentoring residents in international health. Conclusion Overall, the majority of the respondents expressed high interest in IH and few felt prepared to address IH issues indicating a need for increased training in this area. The findings of this survey are likely relevant as a prototype for other primary care residencies. PMID:19552817

Air exchange rates and migration of VOCs in basements and residences

PubMed Central

Du, Liuliu; Batterman, Stuart; Godwin, Christopher; Rowe, Zachary; Chin, Jo-Yu

2015-01-01

Basements can influence indoor air quality by affecting air exchange rates (AERs) and by the presence of emission sources of volatile organic compounds (VOCs) and other pollutants. We characterized VOC levels, AERs and interzonal flows between basements and occupied spaces in 74 residences in Detroit, Michigan. Flows were measured using a steady-state multi-tracer system, and 7-day VOC measurements were collected using passive samplers in both living areas and basements. A walkthrough survey/inspection was conducted in each residence. AERs in residences and basements averaged 0.51 and 1.52 h−1, respectively, and had strong and opposite seasonal trends, e.g., AERs were highest in residences during the summer, and highest in basements during the winter. Air flows from basements to occupied spaces also varied seasonally. VOC concentration distributions were right-skewed, e.g., 90th percentile benzene, toluene, naphthalene and limonene concentrations were 4.0, 19.1, 20.3 and 51.0 μg m−3, respectively; maximum concentrations were 54, 888, 1117 and 134 μg m−3. Identified VOC sources in basements included solvents, household cleaners, air fresheners, smoking, and gasoline-powered equipment. The number and type of potential VOC sources found in basements are significant and problematic, and may warrant advisories regarding the storage and use of potentially strong VOCs sources in basements. PMID:25601281

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.

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.

[Part-time medical specialist training; experiences with job-sharing for trainee internists].

PubMed

Bevers, K; Nauta, S; Stuyt, P M

2004-02-14

Due to various factors such as social changes, an increasing number of couples with two incomes, and a growing proportion of female doctors, there has been a growing demand for part-time work in recent years. This is also true for resident physicians. Objections such as a discontinuity in care and the decline in the quality of education frequently prevent resident physicians from working part-time. Over the past two years, the University Medical Centre Nijmegen, the Netherlands, has experimented with job-sharing on clinical wards for resident physicians in internal medicine. This approach works well in practice, as long as a number of conditions, including the proper transfer of medical information and good communication, are satisfied. Job-sharing is one means of satisfying the growing demand for part-time work among resident physicians and specialists.

[Fire behavior of Mongolian oak leaves fuel bed under no-wind and zero-slope conditions. II. Analysis of the factors affecting flame length and residence time and related prediction models].

PubMed

Zhang, Ji-Li; Liu, Bo-Fei; Di, Xue-Ying; Chu, Teng-Fei; Jin, Sen

2012-11-01

Taking fuel moisture content, fuel loading, and fuel bed depth as controlling factors, the fuel beds of Mongolian oak leaves in Maoershan region of Northeast China in field were simulated, and a total of one hundred experimental burnings under no-wind and zero-slope conditions were conducted in laboratory, with the effects of the fuel moisture content, fuel loading, and fuel bed depth on the flame length and its residence time analyzed and the multivariate linear prediction models constructed. The results indicated that fuel moisture content had a significant negative liner correlation with flame length, but less correlation with flame residence time. Both the fuel loading and the fuel bed depth were significantly positively correlated with flame length and its residence time. The interactions of fuel bed depth with fuel moisture content and fuel loading had significant effects on the flame length, while the interactions of fuel moisture content with fuel loading and fuel bed depth affected the flame residence time significantly. The prediction model of flame length had better prediction effect, which could explain 83.3% of variance, with a mean absolute error of 7.8 cm and a mean relative error of 16.2%, while the prediction model of flame residence time was not good enough, which could only explain 54% of variance, with a mean absolute error of 9.2 s and a mean relative error of 18.6%.

Use of a Novel Airway Kit and Simulation in Resident Training on Emergent Pediatric Airways.

PubMed

Melzer, Jonathan M; Hamersley, Erin R S; Gallagher, Thomas Q

2017-06-01

Objective Development of a novel pediatric airway kit and implementation with simulation to improve resident response to emergencies with the goal of improving patient safety. Methods Prospective study with 9 otolaryngology residents (postgraduate years 1-5) from our tertiary care institution. Nine simulated pediatric emergency airway drills were carried out with the existing system and a novel portable airway kit. Response times and time to successful airway control were noted with both the extant airway system and the new handheld kit. Results were analyzed to ensure parametric data and compared with t tests. A Bonferroni adjustment indicated that an alpha of 0.025 was needed for significance. Results Use of the airway kit significantly reduced the mean time of resident arrival by 47% ( P = .013) and mean time of successful intubation by 50% ( P = .007). Survey data indicated 100% improved resident comfort with emergent airway scenarios with use of the kit. Discussion Times to response and meaningful intervention were significantly reduced with implementation of the handheld airway kit. Use of simulation training to implement the new kit improved residents' comfort and airway skills. This study describes an affordable novel mobile airway kit and demonstrates its ability to improve response times. Implications for Practice The low cost of this airway kit makes it a tenable option even for smaller hospitals. Simulation provides a safe and effective way to familiarize oneself with novel equipment, and, when possible, realistic emergent airway simulations should be used to improve provider performance.

Quantifying the residence time and flushing characteristics of a shallow, back-barrier estuary: Application of hydrodynamic and particle tracking models

USGS Publications Warehouse

Defne, Zafer; Ganju, Neil K.

2015-01-01

Estuarine residence time is a major driver of eutrophication and water quality. Barnegat Bay-Little Egg Harbor (BB-LEH), New Jersey, is a lagoonal back-barrier estuary that is subject to anthropogenic pressures including nutrient loading, eutrophication, and subsequent declines in water quality. A combination of hydrodynamic and particle tracking modeling was used to identify the mechanisms controlling flushing, residence time, and spatial variability of particle retention. The models demonstrated a pronounced northward subtidal flow from Little Egg Inlet in the south to Pt. Pleasant Canal in the north due to frictional effects in the inlets, leading to better flushing of the southern half of the estuary and particle retention in the northern estuary. Mean residence time for BB-LEH was 13 days but spatial variability was between ∼0 and 30 days depending on the initial particle location. Mean residence time with tidal forcing alone was 24 days (spatial variability between ∼0 and 50 days); the tides were relatively inefficient in flushing the northern end of the Bay. Scenarios with successive exclusion of physical processes from the models revealed that meteorological and remote offshore forcing were stronger drivers of exchange than riverine inflow. Investigations of water quality and eutrophication should take into account spatial variability in hydrodynamics and residence time in order to better quantify the roles of nutrient loading, production, and flushing.

The effects of water absorption and roasting conditions on fracture properties and internal structure of sesame seeds.

PubMed

Katsuno, Nakako; Fujimura, Makoto; Hanya, Akira; Nishizu, Takahisa

2017-04-01

We investigated the effects of soaking, residence time before roasting and roasting conditions on the fracture properties and structure of the cross-section of sesame seeds. Soaking time affected only the size of the side voids of the seed cross-section. The fracture force and strain of the roasted seeds decreased as residence time increased. The center void of the roasted seeds, important for seed crispness increased as residence time increased. In contrast, the side void of the roasted seeds only increased with residence time during the first 10 min. Seeds roasted at higher temperatures had smaller fracture forces and larger central voids than those roasted at lower temperatures. During roasting at 300 °C, the fracture force and strain decreased as the center void ratio increased. Overall, both a sufficient time for moisture diffusion in the seeds and a high roasting temperature were necessary to produce crisp roasted seeds.

Simulation-Based Testing of Pager Interruptions During Laparoscopic Cholecystectomy.

PubMed

Sujka, Joseph A; Safcsak, Karen; Bhullar, Indermeet S; Havron, William S

2018-01-30

To determine if pager interruptions affect operative time, safety, or complications and management of pager issues during a simulated laparoscopic cholecystectomy. Twelve surgery resident volunteers were tested on a Simbionix Lap Mentor II simulator. Each resident performed 6 randomized simulated laparoscopic cholecystectomies; 3 with pager interruptions (INT) and 3 without pager interruptions (NO-INT). The pager interruptions were sent in the form of standardized patient vignettes and timed to distract the resident during dissection of the critical view of safety and clipping of the cystic duct. The residents were graded on a pass/fail scale for eliciting appropriate patient history and management of the pager issue. Data was extracted from the simulator for the following endpoints: operative time, safety metrics, and incidence of operative complications. The Mann-Whitney U test and contingency table analysis were used to compare the 2 groups (INT vs. NO-INT). Level I trauma center; Simulation laboratory. Twelve general surgery residents. There was no significant difference between the 2 groups in any of the operative endpoints as measured by the simulator. However, in the INT group, only 25% of the time did the surgery residents both adequately address the issue and provide effective patient management in response to the pager interruption. Pager interruptions did not affect operative time, safety, or complications during the simulated procedure. However, there were significant failures in the appropriate evaluations and management of pager issues. Consideration for diversion of patient care issues to fellow residents not operating to improve quality and safety of patient care outside the operating room requires further study. Copyright © 2018. Published by Elsevier Inc.

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.

Medical students' perceptions of their housestaffs' ability to teach physical examination skills.

PubMed

Smith, Miriam A; Gertler, Tracy; Freeman, Katherine

2003-01-01

To evaluate the amount of time housestaff spent at the bedside on physical examination skills with third-year medical students and whether housestaff enhanced physical examination skills. All Albert Einstein College of Medicine students who completed the third-year medicine inpatient clerkship at one of five participating sites evaluated housestaff (interns and residents) with whom they spent at least ten days. The students quantified the amount of time housestaff spent with them at the bedside and used a modified five-point Likert scale to evaluate housestaff's enhancement of students' physical examination skills. Data were analyzed separately for interns, but pooled for residents (years two and three). Differences between groups were tested using Wilcoxon rank-sum and by Mantel-Haenszel chi-square tests. Totals of 191 responses for interns and 166 responses for residents were collected from October 1999 to October 2000. Fifteen (8%) of the intern group and 59 (36%) of the resident group spent no time at the bedside (p <.0001). Students were most satisfied with enhancement of pulmonary, cardiovascular, and gastrointestinal skills and least satisfied with enhancement of ENT, eye, and genitourinary skills (p <.0001). Interns spent more time with students than did residents. Almost one third of the residents spent no time on physical examination skills with students. Training programs should re-emphasize the importance of housestaff's teaching at the bedside and address areas of deficiency.

Cost and logistics for implementing the American College of Surgeons objective structured clinical examination.

PubMed

Sudan, Ranjan; Clark, Philip; Henry, Brandon

2015-01-01

The American College of Surgeons has developed a reliable and valid OSCE (objective structured clinical examination) to assess the clinical skills of incoming postgraduate year 1 surgery residents, but the cost and logistics of implementation have not been described. Fixed costs included staff time, medical supplies, facility fee, standardized patient (SP) training time, and one OSCE session. Variable costs were incurred for additional OSCE sessions. Costs per resident were calculated and modeled for increasing the number of test takers. American College of Surgeons OSCE materials and examination facilities were free. Fixed costs included training 11 SPs for 4 hours ($1,540), moulage and simulation material ($469), and administrative effort for 44 hours ($2,200). Variable cost for each session was $1,540 (SP time). Total cost for the first session was $6,649 ($664/resident), decreased to $324/resident for 3 sessions, and projected to further decline to $239/resident for 6 sessions. The cost decreased as the number of residents tested increased. To manage costs, testing more trainees by regional collaboration is recommended. Copyright © 2015 Elsevier Inc. All rights reserved.

How Entrustment Is Informed by Holistic Judgments Across Time in a Family Medicine Residency Program: An Ethnographic Nonparticipant Observational Study.

PubMed

Sagasser, Margaretha H; Fluit, Cornelia R M G; van Weel, Chris; van der Vleuten, Cees P M; Kramer, Anneke W M

2017-06-01

Entrustment has mainly been conceptualized as delegating discrete professional tasks. Because residents provide most of their patient care independently, not all resident performance is visible to supervisors; the entrustment process involves more than granting discrete tasks. This study explored how supervisors made entrustment decisions based on residents' performance in a long-term family medicine training program. A qualitative nonparticipant observational study was conducted in 2014-2015 at competency-based family medicine residency programs in the Netherlands. Seven supervisor-resident pairs participated. During two days, one researcher observed first-year residents' patient encounters, debriefing sessions, and supervisor-resident educational meetings and interviewed them separately afterwards. Data were collected and analyzed using iterative, phenomenological inductive research methodology. The entrustment process developed over three phases. Supervisors based their initial entrustment on prior knowledge about the resident. In the ensuing two weeks, entrustment decisions regarding independent patient care were derived from residents' observed general competencies necessary for a range of health problems (clinical reasoning, decision making, relating to patients); medical knowledge and skills; and supervisors' intuition. Supervisors provided supervision during and after encounters. Once residents performed independently, supervisors kept reevaluating their decisions, informed by residents' overall growth in competencies rather than by adhering to a predefined set of tasks. Supervisors in family medicine residency training took a holistic approach to trust, based on general competencies, knowledge, skills, and intuition. Entrustment started before training and developed over time. Building trust is a mutual process between supervisor and resident, requiring a good working relationship.

Curricula and Organization of Primary Care Residencies in Internal Medicine.

ERIC Educational Resources Information Center

Eisenberg, John M.

1980-01-01

The organization and curricula of internal medicine residencies programs that emphasize primary care are described and compared with traditional residencies in internal medicine. It is noted that primary care residents spend more time in ambulatory care and are allowed more electives in specialties outside of internal medicine. Out-of-hospital…

Deep water circulation, residence time, and chemistry in a karst complex.

PubMed

Aquilina, L; Ladouche, B; Doerfliger, N; Bakalowicz, M

2003-01-01

We investigated the hydrochemistry of a complex karst hydrosystem made of two carbonate units along a coastal lagoon. Ground water emerges on the lagoon floor from a submarine spring. In addition, thermal waters circulate through the limestone and mix with karst water near the lagoon shore. A distinction between the water from the two carbonate units is related to marine influences and human activities. In one of the massifs, the data show an incongruent dissolution of dolomite with time. In the other system, a slight contamination by saline fluids from the thermal reservoir has led to high calcium and magnesium concentrations. 36Cl, 14C, and 3H data constrain the residence time of the water, and allow for the distinguishing of four circulation types: (1) shallow surface circulation (primarily above sea level) in the karstic units with short residence times (<20 years); (2) shallow subsurface circulation (approximately 0 to -50 m) below the karstic units with residence time in the order of 50 years; (3) deep circulation at depth of 700 to 1500 m in the Jurassic limestones below thick sedimentary cover, with residence time of several thousand years for a part of the water; and (4) deep circulation at a depth of approximately 2500 m, which represents the thermal reservoir in the Jurassic units with residence time of approximately 100,000 years. An interpretative hydrogeological framework is based on the constraints of the geochemical analyses of the deep thermal system, and by water flow from the surface to the deep parts of the carbonate formations.

Problems, perceptions and actions: An interdependent process for generating informal social control.

PubMed

Hipp, John R; Wickes, Rebecca

2018-07-01

Using two waves of survey data for residents in neighborhoods in Brisbane, this study explores the interdependent relationship between residents' perceptions of neighboring, cohesion, collective efficacy, neighborhood disorder, and the actions they take to address these problems. Our longitudinal results show that residents' perceived severity of a problem helps explain engaging in activity to address the problem. People loitering appeared to be the most galvanizing problem for residents, but had particularly deleterious effects on perceptions of cohesion and collective efficacy. We also find that residents who perceive more neighboring in their local area engage in more public and parochial social control activity and residents who live in collectively efficacious neighborhoods are more likely to engage in parochial social control action. Furthermore, residents who themselves perceive more collective efficacy in the neighborhood engage in more parochial or public social control during the subsequent time period. Importantly, we find strong evidence that residents update their sense of collective efficacy. Perceiving more problems in the neighborhood, and perceiving that these problems are increasing, reduced perceptions of neighboring and collective efficacy over time. Copyright © 2018 Elsevier Inc. All rights reserved.

Groundwater residence time : tell me who you are and I will tell which information you may provide

NASA Astrophysics Data System (ADS)

Aquilina, Luc; Labasque, Thierry; Kolbe, Tamara; Marçais, Jean; Leray, Sarah; Abbott, Ben; de Dreuzy, Jean-Raynald

2016-04-01

Groundwater residence-time or ages have been widely used in hydrogeology during the last decades. Following tritium measurements, anthropogenic gases (CFC, SF6, 35Kr) have been developed. They provide information at the aquifer scale on long residence times. They complement the more localized data obtained from sparse boreholes with hydraulic and geophysical methods. Anthropogenic tracer concentrations are most generally considered as "Groundwater ages" using a piston flow model providing an order of magnitude for the residence time. More advanced information can however be derived from the combined analysis of the tracer concentrations. For example, the residence time distribution over the last 50 years can be well approached by the concentration of two sufficient different anthropogenic tracers in the group (CFC, SF6, 35Kr), i.e. tracers whose anthropogenic chronicles are sufficiently different. And, with additional constrains on geological and hydraulic properties, groundwater ages contribute to characterize the aquifer structures and the groundwater resources. Complex geological environments also include old groundwater bodies in extremely confined aquifer sections. In such cases, various tracers are related to highly different processes. CFCs can be taken as a marker of modern contamination to track exchanges between shallower and deeper aquifers, leakage processes, and modification of circulations linked to recent anthropogenic changes. 14C or 36Cl can be used to evidence much older processes but have to be related to the history of the chemical element itself. Numerous field studies in fact demonstrate the broad-range extent of the residence time distribution spanning in some cases several orders of magnitude. Flow and transport models in heterogeneous structures confirm such wide residence times and help to characterize their distribution. Residence times also serve as a privileged interface to the fate of some contaminants in aquifers or to trace geochemical processes. Among others, it is the case of (i) slow geochemical processes effective at large residence times such as silicate dissolution, (ii) biogeochemical reactivity activated by some modification of the flow structure, (iii) interactions between microbial diversity and biogeochemical reactivity. While first-order kinetics is commonly assumed, more advanced relations are developed between the nutrient and energy supply. O2 and NO3 nutrient relate to recharge processes on the one hand and Fe and S relate to dissolution in reducing environments on the other hand. Detailed studies of fractured aquifers in Brittany (France) are discussed.

Too little time to teach? Medical student education and the resident work-hour restriction.

PubMed

Zahn, Christopher M; Dunlow, Susan G; Alvero, Ruben; Parker, Jason D; Nace, Catherine; Armstrong, Alicia Y

2007-10-01

The purpose of this study was to examine the impact of the resident duty-hour restriction on medical student education through a survey of faculty, residents, and interns, with interns providing experience as students relative to implementation of work-hour restrictions. A survey was performed at two (one military and one civilian) obstetrics and gynecology residency programs. Additional surveys were obtained from an Association of Professors of Gynecology and Obstetrics workshop, which included military and nonmilitary attendees. The majority of faculty reported spending 5 to 10 hours per week in medical education before and after implementation of the work-hour restriction. Residents reported less time teaching students after work-hour restrictions were instituted. Nearly all interns, responding about their clinical clerkship experience as students, believed their educational experience would have been improved if residents were more involved in teaching. This pilot study suggests residents are less involved in medical student education following implementation of the duty-hour restrictions.

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.

Effect of residence time on two-step liquefaction of rice straw in a CO2 atmosphere: Differences between subcritical water and supercritical ethanol.

PubMed

Yang, Tianhua; Wang, Jian; Li, Bingshuo; Kai, Xingping; Li, Rundong

2017-04-01

This study investigated the influence of temperature and residence time on liquefaction of rice straw in subcritical CO 2 -subcritical water (subCO 2 -subH 2 O) and in subcritical CO 2 -supercritical ethanol (subCO 2 -scEtOH), considering the final reaction temperatures (270-345°C) and residence times (15 and 30min). Residence time was identified as a crucial parameter in the subCO 2 -subH 2 O liquefaction, whereas residence time had a marginal influence on subCO 2 -scEtOH liquefaction. When reaction conditions were 320°C and 15min, solvents have weak impact on the quality of bio-oil, HHV 28.57MJ/kg and 28.62MJ/kg, respectively. There was an obvious difference between the subCO 2 -subH 2 O and subCO 2 -scEtOH liquefaction mechanisms. In subCO 2 -subH 2 O, CO 2 promoted the carbonyl reaction. In subCO 2 -scEtOH, supercritical ethanol have the function of donating hydrogen and promoting the reaction of hydroxyl-alkylation. Copyright © 2017 Elsevier Ltd. All rights reserved.

Thiolated silicone oil: Synthesis, gelling and mucoadhesive properties

PubMed Central

Partenhauser, Alexandra; Laffleur, Flavia; Rohrer, Julia; Bernkop-Schnürch, Andreas

2015-01-01

The aim of this study was the development of novel thiolated silicone oils and their evaluation with regard to gelling and mucoadhesive properties. A thiol coupling of 220 ± 14 and 127 ± 33 μmol/g polymer for 3-mercaptopropionic acid (MPA)- and cysteine-coupled silicone oil was determined, respectively. The dynamic viscosity of MPA–silicone raised significantly (p < 0.000001) after oxidation with iodine to a maximum of 523-fold within 1 h. During tensile studies, MPA–silicone showed both the highest results for total work of adhesion (TWA) and maximum detachment force (MDF) with a 3.8- and 3.4-fold increase, respectively, compared to the control. As far as the residence time on small intestinal mucosa is concerned, both silicone conjugates were detectable in almost the same quantities for up to 8 h with 56.9 ± 3.3 and 47.8 ± 8.9% of the initially applied conjugated silicone oil. Thiolated silicone oils can be regarded superior in comparison to commonly used silicone oils due to a prolonged retention time in the small intestine as site of action. Gelling and mucoadhesive features are advantageous for antiflatulent as well as mucoprotective biomaterials. Thus, these novel thiomers seem promising for an upgrade of currently available products for the treatment of dyspepsia, reflux oesophagitis and even inflammatory bowel diseases such as ulcerative colitis or Crohn’s disease. PMID:25660565

The Residency Application Abyss: Insights and Advice

PubMed Central

Olson, Douglas P.; Oatts, Julius T.; Fields, Barry G.; Huot, Stephen J.

2011-01-01

Most medical students apply for residency training upon completion of medical school. The choice of specialty is one of a student’s first major career decisions, and the application process often results in considerable anxiety, as it is competitive, unpredictable, and requires a significant investment of time and money. This article, which addresses several important facets of the residency application using both experiential and evidence-based data, is organized chronologically into sections that describe a logical approach to applying for residency: choice of a specialty, the personal statement, the interview day, and developing a rank list. A list of relevant websites is also included. This paper is a resource that provides timely and tangible guidance to medical students applying for residency training. PMID:21966036

Competency-based education: a new model for teaching orthopaedics.

PubMed

Alman, Benjamin A; Ferguson, Peter; Kraemer, William; Nousiainen, Markku T; Reznick, Richard K

2013-01-01

The current methods used to train residents to become orthopaedic surgeons are based on tradition, not evidence-based models. Educators have only a limited ability to assess trainees for competency using validated tests in various domains. The reduction in resident work hours limits the time available for clinical training, which has resulted in some calls for lengthening the training process. Another approach to address limited training hours is to focus training in a program that allows residents to graduate from a rotation based on demonstrated competency rather than on time on a service. A pilot orthopaedic residency curriculum, which uses a competency-based framework of resident training and maximizes the use of available training hours, has been designed and is being implemented.